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Young KJ, Leboeuf-Yde C, Gorrell L, Bergström C, Evans DW, Axén I, Chance-Larsen K, Gagey O, Georgopoulos V, Goncalves G, Harris C, Harsted S, Kerry R, Lee E, McCarthy C, Nim C, Nyirö L, Schweinhardt P, Vogel S. Mechanisms of manipulation: a systematic review of the literature on immediate anatomical structural or positional changes in response to manually delivered high-velocity, low-amplitude spinal manipulation. Chiropr Man Therap 2024; 32:28. [PMID: 39261958 PMCID: PMC11389336 DOI: 10.1186/s12998-024-00549-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 08/27/2024] [Indexed: 09/13/2024] Open
Abstract
BACKGROUND Spinal manipulation (SM) has been claimed to change anatomy, either in structure or position, and that these changes may be the cause of clinical improvements. The aim of this systematic review was to evaluate and synthesise the peer-reviewed literature on the current evidence of anatomical changes in response to SM. METHODS The review was registered with PROSPERO (CRD42022304971) and reporting was guided by the standards of the PRISMA Statement. We searched Medline, Embase, CINAHL, AMED, Cochrane Library all databases, PEDro, and the Index to Chiropractic Literature from inception to 11 March 2022 and updated on 06 June 2023. Search terms included manipulation, adjustment, chiropractic, osteopathy, spine and spine-related structures. We included primary research studies that compared outcomes with and without SM regardless of study design. Manipulation was defined as high-velocity, low-amplitude thrust delivered by hand to the spine or directly related joints. Included studies objectively measured a potential change in an anatomical structure or in position. We developed a novel list of methodological quality items in addition to a short, customized list of risk of bias (RoB) items. We used quality and RoB items together to determine whether an article was credible or not credible. We sought differences in outcomes between SM and control groups for randomised controlled trials and crossover studies, and between pre- and post-SM outcomes for other study designs. We reported, in narrative form, whether there was a change or not. RESULTS The search retrieved 19,572 articles and 20 of those were included for review. Study topics included vertebral position (n = 3) facet joint space (n = 5), spinal stiffness (n = 3), resting muscle thickness (n = 6), intervertebral disc pressure (n = 1), myofascial hysteresis (n = 1), and further damage to already damaged arteries (n = 1). Eight articles were considered credible. The credible articles indicated that lumbar facet joint space increased and spinal stiffness decreased but that the resting muscle thickness did not change. CONCLUSION We found few studies on this topic. However, there are two promising areas for future study: facet joint space and spinal stiffness. A research strategy should be developed with funding for high quality research centres.
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Affiliation(s)
- Kenneth J Young
- Allied Health Research Unit, University of Central Lancashire, Preston, UK.
- Health Sciences, Doornfontein Campus, University of Johannesburg, Johannesburg, South Africa.
| | - Charlotte Leboeuf-Yde
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- University of Central Lancashire, Preston, UK
| | - Lindsay Gorrell
- Department of Chiropractic Medicine, Integrative Spinal Research Group, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Cecilia Bergström
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Umeå, Sweden
| | - David W Evans
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Iben Axén
- Karolinska Institutet, Institute of Environmental Medicine, Nobels V. 13, 177 77, Stockholm, Sweden
- The Norwegian Chiropractors' Research Foundation «Et Liv I Bevegelse», Lilleakerveien 31, 0283, Oslo, Norway
| | - Kenneth Chance-Larsen
- Department of Health and Functioning, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | | | - Vasileios Georgopoulos
- Advanced Physiotherapist Practitioner, University of Nottingham, A25 Academic Rheumatology, Clinical Sciences Building, City Hospital, Nottingham, UK
| | | | - Catherine Harris
- Synthesis, Economic Evaluation and Decision Science (SEEDS) Group, Health Technology Assessment Unit | Applied Health Research Hub, University of Central Lancashire, Preston, UK
- Methodological Innovation, Development, Adaptation and Support (MIDAS) Group, NIHR Applied Research Collaboration North West Coast (ARC NWC), Liverpool, UK
| | - Steen Harsted
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Medical Research Unit, Spine Centre of Southern Denmark, Lillebaelt Hospital, University Hospital of Southern Denmark, Middelfart, Denmark
| | - Roger Kerry
- School of Health Sciences, Medical School, Queen's Medical Centre, University of Nottingham, Room B228a, Nottingham, UK
| | - Edward Lee
- Division of Physiotherapy and Rehabilitation Sciences, University of Nottingham, Nottingham, England
| | - Christopher McCarthy
- Department of Health Professions, Faculty of Health and Education, Brooks Building, Manchester Metropolitan University, Manchester, UK
| | - Casper Nim
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Medical Research Unit, Spine Centre of Southern Denmark, Lillebaelt Hospital, University Hospital of Southern Denmark, Middelfart, Denmark
| | - Luana Nyirö
- Department of Chiropractic Medicine, Integrative Spinal Research Group, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Petra Schweinhardt
- Department of Chiropractic Medicine, Integrative Spinal Research Group, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Steven Vogel
- University College of Osteopathy, 275 Borough High Street, London, UK
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Evans DW, Lucas N. What is manipulation? A new definition. BMC Musculoskelet Disord 2023; 24:194. [PMID: 36918833 PMCID: PMC10015914 DOI: 10.1186/s12891-023-06298-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 03/07/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Definitions are important in healthcare. Unfortunately, problems can be found withall existing definitions of manipulation. METHODS This paper derives a set of eligibility criteria from prior definitions of manipulation to inform what should (and should not) be incorporated within a valid definition. These criteria were then used to select components from currently available empirical data to create a new definition. RESULTS The resulting definition of manipulation is: "Separation (gapping) of opposing articular surfaces of a synovial joint, caused by a force applied perpendicularly to those articular surfaces, that results in cavitation within the synovial fluid of that joint." The corresponding definition for the mechanical response of a manipulation is: "Separation (gapping) of opposing articular surfaces of a synovial joint that results in cavitation within the synovial fluid of that joint." In turn, the action of a manipulation can be defined as: "A force applied perpendicularly to the articular surfaces." CONCLUSIONS We believe these definitions to be valid (derived from and consistent with all available empirical data), complete (containing all necessary components), minimally sufficient (minimal redundancy, and sufficient to distinguish manipulation from other physical interventions), and robust (able to withstand important limitations embodied within sensible eligibility criteria). It is hoped that the simplicity and clarity of these definitions, and the transparency of their formation, will encourage their wide adoption in clinical, research, educational and professional settings.
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Affiliation(s)
- David W Evans
- Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, B15 2TT, UK. .,Research Centre, University College of Osteopathy, London, UK.
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LoGiudice RJ, Rivera PL. Veterinary Spinal Manipulative Therapy or Animal Chiropractic in Veterinary Rehabilitation. Vet Clin North Am Small Anim Pract 2023; 53:757-774. [PMID: 36997408 DOI: 10.1016/j.cvsm.2023.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
Veterinary rehabilitation is a multimodal diagnostic and treatment approach that is recommended and provided to patients daily. One therapeutic modality that may be beneficial (diagnostically and therapeutically) is veterinary spinal manipulative therapy or animal chiropractic (AC). AC is a receptor-based health-care modality being provided more frequently in veterinary practices. All clinicians should strive to understand the mode of action, indications, contraindications, how it affects the patient from the neuro-anatomical and biomechanical point of view, and most importantly, when not to provide the requested modality, as further diagnostics may be indicated.
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Investigation of reaction force magnitude and orientation during supine thoracic thrust manipulation applied to intervertebral and costovertebral regions. Musculoskelet Sci Pract 2020; 49:102217. [PMID: 32861370 DOI: 10.1016/j.msksp.2020.102217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 06/09/2020] [Accepted: 06/30/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Spinal manipulative techniques are commonly used in manual therapies but quantified descriptive and reliability data are lacking considering supine thoracic thrust manipulation. OBJECTIVES The purpose of this study is to explore and compare kinetic parameters during supine thoracic thrust manipulation performed at two different thoracic regions. Intra-rater task repeatability and influence of practitioners were estimated. DESIGN Exploratory and agreement study. METHODS Kinetic parameters were assessed by examining reaction force magnitude and orientation (on the basis of the zenithal angle) using force platforms. Manipulative procedure (consisting in the application of 3 preloads followed by one thrust adjustment) at both intervertebral and costovertebral region was performed by different practitioners at three sessions. Application of thrust was allowed for experienced practitioners only. Preload force, peak force magnitude and vector force orientation were compared between anatomical sites, sessions and practitioners, and bias with limit of agreement were estimated. RESULTS Repeatability analysis showed that practitioners achieved similar preload and peak force independent of the session, with comparable force orientation. Differences between practitioners were observed for preload and peak force but not regarding the zenithal angle during the thrust phase. CONCLUSIONS The present study is the first that explores kinetic parameters for supine thoracic thrust manipulation applied on two different regions of the thorax. Results confirm consistency of performance among practitioners for supine manipulative techniques at intervertebral and costovertebral region. While task repeatability was confirmed, several differences were observed between practitioners. Further investigations would examine velocity, acceleration and potential neurophysiological effect of such manipulative technique.
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Dugailly PM, Michaud A, Feipel V, Beyer B. Reaction Force Magnitude and Orientation During Supine Thoracic Spine Thrust Manipulation: An Exploratory Analysis and Reliability of Preload and Impulse Phase. J Manipulative Physiol Ther 2020; 43:597-605. [PMID: 32593464 DOI: 10.1016/j.jmpt.2019.10.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 08/30/2019] [Accepted: 10/10/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The main purpose of this study was to explore specific kinetic parameters during supine thoracic thrust manipulation and to analyze task reliability and differences between various practitioners METHODS: Kinetic parameters were assessed by examining ground reaction force magnitude and orientation (on the basis of the zenithal angle) using force platforms. The manipulative procedure (consisting of the application of 3 preloads followed by 1 single thrust adjustment) was performed by different practitioners at 3 sessions. Application of thrust was allowed for trained practitioners only. Preload force, peak force, and vector force orientation were compared between sessions and practitioners. RESULTS Reliability analysis showed that practitioners achieved similar preload and peak force independent of the session, with comparable force orientation data. Differences between practitioners were observed for preload and peak force but not regarding the zenithal angle during the thrust phase. CONCLUSION This study is the first that explores kinetic parameters for supine thoracic thrust manipulation. Task repeatability was confirmed and several differences were observed between practitioners. Certainly, there is a need for further investigation examining both dynamic parameters (ie, velocity and accelerations) and the potential neurologic effect of such manipulative technique.
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Affiliation(s)
- Pierre-Michel Dugailly
- Laboratory for Functional Anatomy, Faculty for Motor Sciences, Université Libre de Bruxelles, Brussels, Belgium; Department of Osteopathy, CESPU-Escola Superior de Saúde do Vale do Ave, Vila Nova de Famalicão, Portugal.
| | - Antoine Michaud
- Laboratory for Functional Anatomy, Faculty for Motor Sciences, Université Libre de Bruxelles, Brussels, Belgium
| | - Véronique Feipel
- Laboratory for Functional Anatomy, Faculty for Motor Sciences, Université Libre de Bruxelles, Brussels, Belgium
| | - Benoît Beyer
- Laboratory for Functional Anatomy, Faculty for Motor Sciences, Université Libre de Bruxelles, Brussels, Belgium; Unité de Recherche en Lymphologie et en Réadaptation, Faculty for Motor Sciences, Université Libre de Bruxelles, Brussels, Belgium
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Bond BM, Kinslow CD, Yoder AW, Liu W. Effect of spinal manipulative therapy on mechanical pain sensitivity in patients with chronic nonspecific low back pain: a pilot randomized, controlled trial. J Man Manip Ther 2019; 28:15-27. [PMID: 30935324 DOI: 10.1080/10669817.2019.1572986] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Objectives: The long-term goal of our study is to improve the understanding of the biological mechanisms associated with spinal manipulative therapy (SMT) in low back pain.Methods: This project involved a pilot randomized, blinded clinical trial (ClinicalTrials.gov registration number NCT03078114) of 3-week SMT in chronic nonspecific low back pain (CNSLBP) patients. We recruited 29 participants and randomly assigned them into either a SMT (n = 14) or sham SMT (n = 15) group. Pre- and postintervention, we quantified the effect of SMT on clinical outcomes (Numeric Pain Rating Scale and Oswestry Disability Index) and pressure pain threshold (PPT) at local (lumbar spine), regional (lower extremity), and remote (upper extremity) anatomical sites.Results: We observed a significant main effect for time signifying reduced hypersensitivity (increased PPT) at local (p = .015) and regional (p = .014) locations at 3 weeks. Furthermore, we found significant main effects of time indicating improvements in pain (p < .001) and disability (p = .02) from baseline among all participants regardless of intervention. However, no between-group differences were observed in PPT, clinical pain, or disability between the SMT and sham SMT groups over 3 weeks.Conclusions: After 3 weeks of SMT or sham SMT in CNSLBP patients, we found hypoalgesia at local and remote sites along with improved pain and low back-related disability.Level of Evidence: 1b.
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Affiliation(s)
- Bryan M Bond
- Department of Physical Therapy, University of Saint Mary, Leavenworth, KS, USA
| | - Chris D Kinslow
- Department of Physical Therapy, University of Saint Mary, Leavenworth, KS, USA
| | - Adam W Yoder
- Department of Physical Therapy, University of Saint Mary, Leavenworth, KS, USA
| | - Wen Liu
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, KS, USA
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Anderst WJ, Gale T, LeVasseur C, Raj S, Gongaware K, Schneider M. Intervertebral kinematics of the cervical spine before, during, and after high-velocity low-amplitude manipulation. Spine J 2018; 18:2333-2342. [PMID: 30142458 DOI: 10.1016/j.spinee.2018.07.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 07/30/2018] [Accepted: 07/31/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Neck pain is one of the most commonly reported symptoms in primary care settings, and a major contributor to health-care costs. Cervical manipulation is a common and clinically effective intervention for neck pain. However, the in vivo biomechanics of manipulation are unknown due to previous challenges with accurately measuring intervertebral kinematics in vivo during the manipulation. PURPOSE The objectives were to characterize manual forces and facet joint gapping during cervical spine manipulation and to assess changes in clinical and functional outcomes after manipulation. It was hypothesized that patient-reported pain would decrease and intervertebral range of motion (ROM) would increase after manipulation. STUDY DESIGN/SETTING Laboratory-based prospective observational study. PATIENT SAMPLE 12 patients with acute mechanical neck pain (4 men and 8 women; average age 40 ± 15 years). OUTCOME MEASURES Amount and rate of cervical facet joint gapping during manipulation, amount and rate of force applied during manipulation, change in active intervertebral ROM from before to after manipulation, and numeric pain rating scale (NPRS) to measure change in pain after manipulation. METHODS Initially, all participants completed a NPRS (0-10). Participants then performed full ROM flexion-extension, rotation, and lateral bending while seated within a custom biplane radiography system. Synchronized biplane radiographs were collected at 30 images/s for 3 seconds during each movement trial. Next, synchronized, 2.0-milliseconds duration pulsed biplane radiographs were collected at 160 images/s for 0.8 seconds during the manipulation. The manipulation was performed by a licensed chiropractor using an articular pillar push technique. For the final five participants, two pressure sensors placed on the thumb of the chiropractor (Novel pliance system) recorded pressure at 160 Hz. After manipulation, all participants repeated the full ROM movement testing and once again completed the NPRS. A validated volumetric model-based tracking process that matched subject-specific bone models (from computed tomography) to the biplane radiographs was used to track bone motion with submillimeter accuracy. Facet joint gapping was calculated as the average distance between adjacent articular facet surfaces. Pre- to postmanipulation changes were assessed using the Wilcoxon signed-rank test. RESULTS The facet gap increased 0.9 ± 0.40 mm during manipulation. The average rate of facet gapping was 6.2 ± 3.9 mm/s. The peak force and rate of force application during manipulation were 65 ± 4 N and 440 ± 58 N/s. Pain score improved from 3.7 ± 1.2 before manipulation to 2.0 ± 1.4 after manipulation (p <. 001). Intervertebral ROM increased after manipulation by 1.2° (p = .006), 2.1° (p = .01), and 3.9° (p = .003) at the C4/C5, C5/C6, and C6/C7 motion segments, respectively, during flexion-extension; by 1.5° (p = .028), 1.9° (p = .005), and 1.3° (p = .050) at the C3/C4, C4/C5, and C5/C6 motion segments, respectively, during rotation; and by 1.3° (p = .034) and 1.1° (p = .050) at the C4/C5 and C5/C6 motion segments, respectively, during lateral bending. Global head ROM relative to the torso increased after manipulation by 8º (p = .023), 10º (p = .002), and 13º (p = .019) during lateral bending, axial rotation and flexion-extension, respectively, after manipulation. CONCLUSIONS This study is the first to measure facet gapping during cervical manipulation on live humans. The results demonstrate that target and adjacent motion segments undergo facet joint gapping during manipulation and that intervertebral ROM is increased in all three planes of motion after manipulation. The results suggest that clinical and functional improvement after manipulation may occur as a result of small increases in intervertebral ROM across multiple motion segments. This study demonstrates the feasibility of characterizing in real time the manual inputs and biological responses that comprise cervical manipulation, including clinician-applied force, facet gapping, and increased intervertebral ROM. This provides a basis for future clinical trials to identify the mechanisms behind manipulation and to optimize the mechanical factors that reliably and sufficiently impact the key mechanisms behind manipulation.
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Affiliation(s)
- William J Anderst
- Department of Orthopedic Surgery, University of Pittsburgh, 3820 South Water St, Pittsburgh, PA 15203, USA.
| | - Tom Gale
- Department of Orthopedic Surgery, University of Pittsburgh, 3820 South Water St, Pittsburgh, PA 15203, USA
| | - Clarissa LeVasseur
- Department of Orthopedic Surgery, University of Pittsburgh, 3820 South Water St, Pittsburgh, PA 15203, USA
| | - Sandesh Raj
- Department of Orthopedic Surgery, University of Pittsburgh, 3820 South Water St, Pittsburgh, PA 15203, USA
| | - Kris Gongaware
- Department of Physical Therapy, University of Pittsburgh, 3820 South Water St, Pittsburgh, PA 15203, USA
| | - Michael Schneider
- Department of Physical Therapy, University of Pittsburgh, 3820 South Water St, Pittsburgh, PA 15203, USA
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Tieppo Francio V, Towery C, Davani S, Brown T. Spinal manipulation and therapeutic exercises in treating post-surgical resurgent lumbar radiculopathy. Oxf Med Case Reports 2017; 2017:omx062. [PMID: 29744116 PMCID: PMC5934664 DOI: 10.1093/omcr/omx062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 06/29/2017] [Indexed: 01/09/2023] Open
Abstract
Lumbar radiculopathy due to disc herniation is one of the most common conditions seen in orthopedic practices worldwide. Surgical intervention is often necessary, and most patients improve without reoccurrences. The purpose of this case is to describe the successful outcome of post-surgical resurgent lumbar radiculopathy treated with spinal manipulation and therapeutic exercises. Here, we discuss the case of a 42-year-old male who received twelve treatments of spinal manipulation, in addition to therapeutic McKenzie methods exercises. By the end of the treatment plan, the patient was asymptomatic and his outcome assessment score (Oswestry questionnaire) showed an 89% improvement. In a three-month follow-up, he remained stable, and therefore, this case reports a successful outcome and the worthiness of considering spinal manipulation and therapeutic exercises in patients suffering from resurgent lumbar radiculopathy, even when post-surgical changes are present, if there are no absolute contraindications.
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Affiliation(s)
- Vinicius Tieppo Francio
- USAT College of Medicine, University of Science, Arts and Technology, PO Box 506, S. Mayfield Estate Dr., Olveston, Montserrat MSR1350, British West Indies.,Essential Integrative Health, Spine and Pain Management, 3110 SW 89th, suite 200e, Oklahoma City, OK 73159, USA.,Variety Care, Community Health Center, 1025 Straka Terrace, Oklahoma City, OK 73139, USA
| | - Chris Towery
- USAT College of Medicine, University of Science, Arts and Technology, PO Box 506, S. Mayfield Estate Dr., Olveston, Montserrat MSR1350, British West Indies.,Faces Dermatology, 23206 Lyons Ave Suite 104, Santa Clarita, CA 91321, USA
| | - Saeid Davani
- USAT College of Medicine, University of Science, Arts and Technology, PO Box 506, S. Mayfield Estate Dr., Olveston, Montserrat MSR1350, British West Indies
| | - Tony Brown
- Harvard University, Harvard Summer School, 51 Brattle St, Cambridge, MA 02138-3722, USA
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Mansholt BA, Salsbury SA, Corber LG, Stites JS. Essential literature for the chiropractic profession: Results and implementation challenges from a survey of international chiropractic faculty. THE JOURNAL OF CHIROPRACTIC EDUCATION 2017; 31:140-163. [PMID: 28768114 PMCID: PMC5656150 DOI: 10.7899/jce-17-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Scientific literature applicable to chiropractic practice proliferates in quantity, quality, and source. Chiropractic is a worldwide profession and varies in scope between states or provinces and from country to country. It is logical to consider that the focus and emphasis of chiropractic education varies between programs as well. This original research study endeavored to determine "essential literature" recommended by chiropractic faculty. The purpose of this article is (1) to share our results and (2) to promote discussion and explore means for future collaboration of chiropractic faculty through a worldwide platform. METHODS A 2-phase recruitment occurred initially at the institutional level and subsequently at the faculty level. A Web-based survey used qualitative data collection methods to gather bibliographic citations. Descriptive statistics were calculated for demographics, and citation responses were ranked per number of recommendations, grouped into categories, and tabulated per journal source and publication date. RESULTS Forty-one chiropractic programs were contacted, resulting in 30 participating chiropractic programs (16 US and 14 international). Forty-five faculty members completed the entire survey, submitting 126 peer-reviewed publications and 25 additional citations. Readings emphasized clinical management of spine pain, the science of spinal manipulation, effectiveness of manual therapies, teaching of chiropractic techniques, outcomes assessments, and professional issues. CONCLUSION A systematic approach to surveying educators in international chiropractic institutions was accomplished. The results of the survey provide a list of essential literature for the chiropractic profession. We recommend establishing a chiropractic faculty registry for improved communication and collaboration.
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Cramer GD, Budavich M, Bora P, Ross K. A Feasibility Study to Assess Vibration and Sound From Zygapophyseal Joints During Motion Before and After Spinal Manipulation. J Manipulative Physiol Ther 2017; 40:187-200. [PMID: 28268027 DOI: 10.1016/j.jmpt.2017.01.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 11/01/2016] [Accepted: 01/10/2017] [Indexed: 12/01/2022]
Abstract
OBJECTIVE This feasibility study used novel accelerometry (vibration) and microphone (sound) methods to assess crepitus originating from the lumbar spine before and after side-posture spinal manipulative therapy (SMT). METHODS This study included 5 healthy and 5 low back pain (LBP) participants. Nine accelerometers and 1 specialized directional microphone were applied to the lumbar region, allowing assessment of crepitus. Each participant underwent full lumbar ranges of motion (ROM), bilateral lumbar SMT, and repeated full ROM. After full ROMs the participants received side-posture lumbar SMT on both sides by a licensed doctor of chiropractic. Accelerometer and microphone recordings were made during all pre- and post-SMT ROMs. Primary outcome was a descriptive report of crepitus prevalence (average number of crepitus events/participant). Participants were also divided into 3 age groups for comparisons (18-25, 26-45, and 46-65 years). RESULTS Overall, crepitus prevalence decreased pre-post SMT (average pre = 1.4 crepitus/participant vs post = 0.9). Prevalence progressively increased from the youngest to oldest age groups (pre-SMT = 0.0, 1.67, and 2.0, respectively; and post-SMT = 0.5, 0.83, and 1.5). Prevalence was higher in LBP participants compared with healthy (pre-SMT-LBP = 2.0, vs pre-SMT-healthy = 0.8; post-SMT-LBP = 1.0 vs post-SMT-healthy = 0.8), even though healthy participants were older than LBP participants (40.8 years vs 27.8 years); accounting for age: pre-SMT-LBP = 2.0 vs pre-SMT-healthy = 0.0; post-SMT-LBP = 1.0 vs post-SMT-healthy = 0.3. CONCLUSIONS Our findings indicated that a larger study is feasible. Other findings included that crepitus prevalence increased with age, was higher in participants with LBP than in healthy participants, and overall decreased after SMT. This study indicated that crepitus assessment using accelerometers has the potential of being an outcome measure or biomarker for assessing spinal joint (facet/zygapophyseal joint) function during movement and the effects of LBP treatments (eg, SMT) on zygapophyseal joint function.
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Affiliation(s)
- Gregory D Cramer
- Department of Research, National University of Health Sciences, Lombard, IL.
| | - Matthew Budavich
- Department of Research, National University of Health Sciences, Lombard, IL
| | | | - Kim Ross
- Department of Applied Chiropractic, Canadian Memorial Chiropractic College, Toronto, ON, Canada
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Mieritz RM, Thorhauge K, Forman A, Mieritz HB, Hartvigsen J, Christensen HW. Musculoskeletal Dysfunctions in Patients With Chronic Pelvic Pain: A Preliminary Descriptive Survey. J Manipulative Physiol Ther 2016; 39:616-622. [DOI: 10.1016/j.jmpt.2016.09.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 01/27/2016] [Accepted: 04/25/2016] [Indexed: 11/25/2022]
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Jones AR, Yelverton CJ, Bester C. Ultrasound imaging of the trapeziometacarpal articular cavity to investigate the presence of intraarticular gas bubbles after chiropractic manipulation. J Manipulative Physiol Ther 2014; 37:476-84. [PMID: 25113654 DOI: 10.1016/j.jmpt.2014.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2011] [Revised: 06/24/2014] [Accepted: 06/30/2014] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate the presence of intraarticular gas bubbles in the trapeziometacarpal joint cavity after chiropractic manipulation with audible cavitation and to assess the state of the gas bubbles after a 20-minute refractory period. METHODS This investigation included 18 asymptomatic male and female participants between the ages of 21 and 26 years. High-resolution (15 MHz) sonograms of the trapeziometacarpal articular cavity were obtained by an experienced musculoskeletal ultrasonographer at 3 intervals: premanipulation, within 30 seconds postmanipulation, and at 20 minutes postmanipulation. The sonograms were saved as digital copies for subsequent reports that were correlated with reports compiled during dynamic visualization of the articular cavity. Data were extracted from the reports for analysis. RESULTS The premanipulative sonograms showed that 27.78% of joints contained minute gas bubbles, also known as microcavities, within the synovial fluid before the joint was manipulated. The remaining 72.22% of joints contained no intraarticular microcavities. All of the postmanipulative sonograms revealed numerous large conspicuous gas bubbles within the synovial fluid. The postrefractory sonograms showed that, in 66.66% of the synovial fluid, gas bubbles were still visible, whereas the remaining 33.34% had no presence of gas bubbles or microcavities, and the synovial fluid had returned to its premanipulative state. CONCLUSION The findings of this study suggest that synovial fluid may contain intraarticular microcavities even before a manipulation is performed. Numerous large intraarticular gas bubbles are formed during manipulation due to cavitation of the synovial fluid and were observed in the absence of an axial distractive load at the time of imaging. In most cases, these gas bubbles remained within the joint for longer than 20 minutes.
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Affiliation(s)
- Allan R Jones
- Chiropractor, Department of Chiropractic, Faculty of Health Sciences, University of Johannesburg, Doornfontein, South Africa
| | - Christopher J Yelverton
- Head of Department, Department of Chiropractic, Faculty of Health Sciences, University of Johannesburg, Doornfontein, South Africa.
| | - Charmaine Bester
- Lecturer, Department of Chiropractic, Faculty of Health Sciences, University of Johannesburg, Doornfontein, South Africa
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Taber DJ, James GD, Jacon A. Manipulation under anesthesia for lumbopelvic pain: a retrospective review of 18 cases. J Chiropr Med 2014; 13:28-34. [PMID: 24711782 DOI: 10.1016/j.jcm.2014.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Revised: 12/02/2013] [Accepted: 12/02/2013] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE The purpose of this case series is to report the effects of manipulation under anesthesia (MUA) for patients with lumbopelvic (lumbar spine, sacroiliac and/or pelvic, hip) pain in an outpatient ambulatory/hospital-based setting. METHODS A retrospective chart review of cases treated at an outpatient ambulatory surgical center in New York and a general hospital in New York was performed. Patients with pre- and postintervention Oswestry Low Back Pain Disability Index (ODI) scores and lumbopelvic and hip complaints were included (N = 18). No intervention other than MUA was administered between the initial and follow-up ODI scoring. Scores on the ODI were assessed within 1 week prior to MUA and again within 2 weeks postprocedure. RESULTS Patients underwent 2 to 4 chiropractic MUA procedures over the course of 7 to 8 days as per National Academy of Manipulation Under Anesthesia physicians' protocols. Preprocedure ODI scores ranged from 38 to 76, with an average score of 53.4. Postprocedure scores ranged from 0 to 66, with an average score of 32.8. For each patient, ODI scores were lower after MUA, with an average decrease of 20.6. Sixteen of 18 patients experienced a clinically meaningful improvement in ODI score. No adverse reactions were reported. CONCLUSIONS For 16 of the 18 patients with chronic lumbopelvic pain reported in this study, MUA showed clinically meaningful reduction in low back pain disability.
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Affiliation(s)
- Douglas J Taber
- Doctor of Chiropractic, United Health Services, Binghamton, NY
| | - Gary D James
- Professor of Nursing, Anthropology and Bioengineering, Decker School of Nursing, Binghamton University, Binghamton, NY ; Director, Institute for Primary and Preventative Health Care Decker School of Nursing, Binghamton University, Binghamton, NY
| | - Alain Jacon
- Program Assistant, United Health Services Hospitals Graduate Medical Education/Institutional Review Board, Johnson City, NY
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Perle SM. Quantification of cavitation and gapping of lumbar zygapophyseal joints during spinal manipulative therapy. J Manipulative Physiol Ther 2013; 36:259. [PMID: 23816258 DOI: 10.1016/j.jmpt.2013.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Indexed: 11/30/2022]
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Cramer GD, Cambron J, Cantu JA, Dexheimer JM, Pocius JD, Gregerson D, Fergus M, McKinnis R, Grieve TJ. Magnetic resonance imaging zygapophyseal joint space changes (gapping) in low back pain patients following spinal manipulation and side-posture positioning: a randomized controlled mechanisms trial with blinding. J Manipulative Physiol Ther 2013; 36:203-17. [PMID: 23648055 DOI: 10.1016/j.jmpt.2013.04.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2012] [Revised: 02/22/2013] [Accepted: 03/25/2013] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The purpose of this study was to quantify lumbar zygapophyseal (Z) joint space separation (gapping) in low back pain (LBP) subjects after spinal manipulative therapy (SMT) or side-posture positioning (SPP). METHODS This was a controlled mechanisms trial with randomization and blinding. Acute LBP subjects (N = 112; four n = 28 magnetic resonance imaging [MRI] protocol groups) had 2 MRI appointments (initial enrollment and after 2 weeks of chiropractic treatment, receiving 2 MRI scans of the L4/L5 and L5/S1 Z joints at each MRI appointment. After the first MRI scan of each appointment, subjects were randomized (initial enrollment appointment) or assigned (after 2 weeks of chiropractic treatment appointment) into SPP (nonmanipulation), SMT (manipulation), or control MRI protocol groups. After SPP or SMT, a second MRI was taken. The central anterior-posterior joint space was measured. Difference between most painful side anterior-posterior measurements taken postintervention and preintervention was the Z joint "gapping difference." Gapping differences were compared (analysis of variance) among protocol groups. Secondary measures of pain (visual analog scale, verbal numeric pain rating scale) and function (Bournemouth questionnaire) were assessed. RESULTS Gapping differences were significant at the first (adjusted, P = .009; SPP, 0.66 ± 0.48 mm; SMT, 0.23 ± 0.86; control, 0.18 ± 0.71) and second (adjusted, P = .0005; SPP, 0.65 ± 0.92 mm; SMT, 0.89 ± 0.71; control, 0.35 ± 0.32) MRI appointments. Verbal numeric pain rating scale differences were significant at first MRI appointment (P = .04) with SMT showing the greatest improvement. Visual analog scale and Bournemouth questionnaire improved after 2 weeks of care in all groups (both P < .0001). CONCLUSIONS Side-posture positioning showed greatest gapping at baseline. After 2 weeks, SMT resulted in greatest gapping. Side-posture positioning appeared to have additive therapeutic benefit to SMT.
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Affiliation(s)
- Gregory D Cramer
- Department of Research, National University of Health Sciences, Lombard, IL 60148, USA.
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Cramer GD, Ross K, Raju PK, Cambron J, Cantu JA, Bora P, Dexheimer JM, McKinnis R, Habeck AR, Selby S, Pocius JD, Gregerson D. Quantification of cavitation and gapping of lumbar zygapophyseal joints during spinal manipulative therapy. J Manipulative Physiol Ther 2012; 35:614-21. [PMID: 22902194 DOI: 10.1016/j.jmpt.2012.06.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Revised: 05/24/2012] [Accepted: 06/07/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVES The purpose of this study was to use previously validated methods to quantify and relate 2 phenomena associated with chiropractic spinal manipulative therapy (SMT): (1) cavitation and (2) the simultaneous gapping (separation) of the lumbar zygapophyseal (Z) joint spaces. METHODS This was a randomized, controlled, mechanistic clinical trial with blinding. Forty healthy participants (18-30 years old) without a history of low-back pain participated. Seven accelerometers were affixed to the skin overlying the spinous processes of L1 to L5 and the S1 and S2 sacral tubercles. Two additional accelerometers were positioned 3 cm left and right lateral to the L4/L5 interspinous space. Participants were randomized into group 1, side-posture SMT (n = 30), or group 2, side-posture positioning (SPP, n = 10). Cavitations were determined by accelerometer recordings during SMT and SPP (left side = upside for both groups); gapping (gapping difference) was determined by the difference between pre- and postintervention magnetic resonance imaging scan joint space measurements. Results of mean gapping differences were compared. RESULTS Upside SMT and SPP joints gapped more than downside joints (0.69 vs -0.17 mm, P < .0001). Spinal manipulative therapy upside joints gapped more than SPP upside joints (0.75 vs 0.52 mm, P = .03). Spinal manipulative therapy upside joints gapped more in men than in women (1.01 vs 0.49 mm, P < .002). Overall, joints that cavitated gapped more than those that did not (0.56 vs 0.22 mm, P = .01). No relationship was found between the occurrence of cavitation and gapping with upside joints alone (P = .43). CONCLUSIONS Zygapophyseal joints receiving chiropractic SMT gapped more than those receiving SPP alone; Z joints of men gapped more than those of women, and cavitation indicated that a joint had gapped but not how much a joint had gapped.
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Affiliation(s)
- Gregory D Cramer
- Department of Research, National University of Health Sciences, Lombard, IL 60148, USA.
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Millan M, Leboeuf-Yde C, Budgell B, Amorim MA. The effect of spinal manipulative therapy on experimentally induced pain: a systematic literature review. Chiropr Man Therap 2012; 20:26. [PMID: 22883534 PMCID: PMC3527169 DOI: 10.1186/2045-709x-20-26] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Accepted: 06/08/2012] [Indexed: 01/25/2023] Open
Abstract
UNLABELLED BACKGROUND Although there is evidence that spinal manipulative therapy (SMT) can reduce pain, the mechanisms involved are not well established. There is a need to review the scientific literature to establish the evidence-base for the reduction of pain following SMT. OBJECTIVES To determine if SMT can reduce experimentally induced pain, and if so, if the effect is i) only at the level of the treated spinal segment, ii) broader but in the same general region as SMT is performed, or iii) systemic. DESIGN A systematic critical literature review. METHODS A systematic search was performed for experimental studies on healthy volunteers and people without chronic syndromes, in which the immediate effect of SMT was tested. Articles selected were reviewed blindly by two authors. A summary quality score was calculated to indicate level of manuscript quality. Outcome was considered positive if the pain-reducing effect was statistically significant. Separate evidence tables were constructed with information relevant to each research question. Results were interpreted taking into account their manuscript quality. RESULTS Twenty-two articles were included, describing 43 experiments, primarily on pain produced by pressure (n = 27) or temperature (n = 9). Their quality was generally moderate. A hypoalgesic effect was shown in 19/27 experiments on pressure pain, produced by pressure in 3/9 on pain produced by temperature and in 6/7 tests on pain induced by other measures. Second pain provoked by temperature seems to respond to SMT but not first pain. Most studies revealed a local or regional hypoalgesic effect whereas a systematic effect was unclear. Manipulation of a "restricted motion segment" ("manipulable lesion") seemed not to be essential to analgesia. In relation to outcome, there was no discernible difference between studies with higher vs. lower quality scores. CONCLUSIONS These results indicate that SMT has a direct local/regional hypoalgesic effect on experimental pain for some types of stimuli. Further research is needed to determine i) if there is also a systemic effect, ii) the exact mechanisms by which SMT attenuates pain, and iii) whether this response is clinically significant.
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Affiliation(s)
- Mario Millan
- EA 4532 CIAMS, UFR STAPS, University Paris-Sud, Paris, France
- The Research Department, The Spine Centre of Southern Denmark Hospital Lillebælt, Lillebælt, Denmark
| | - Charlotte Leboeuf-Yde
- The Research Department, The Spine Centre of Southern Denmark Hospital Lillebælt, Lillebælt, Denmark
- Institut Franco-Européen de Chiropratique, Paris, France
- Institute of Regional Health Services Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Brian Budgell
- Canadian Memorial Chiropractic College, Toronto, ON, Canada
| | - Michel-Ange Amorim
- EA 4532 CIAMS, UFR STAPS, University Paris-Sud, Paris, France
- Institut Universitaire de France, Paris, France
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Understanding inhibitory mechanisms of lumbar spinal manipulation using H-reflex and F-wave responses: a methodological approach. J Neurosci Methods 2012; 210:169-77. [PMID: 22878176 DOI: 10.1016/j.jneumeth.2012.07.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2012] [Revised: 07/13/2012] [Accepted: 07/23/2012] [Indexed: 12/18/2022]
Abstract
The purpose of this research was to characterize unique neurophysiologic events following a high velocity, low amplitude (HVLA) spinal manipulation (SM) procedure. Descriptive time series analysis techniques of time plots, outlier detection and autocorrelation functions were applied to time series of tibial nerve H-reflexes that were evoked at 10-s intervals from 100 s before the event until 100 s after three distinct events L5-S1 HVLA SM, or a L5-S1 joint pre-loading procedure, or the control condition. Sixty-six subjects were randomly assigned to three procedures, i.e., 22 time series per group. If the detection of outliers and correlograms revealed a pattern of non-randomness that was only time-locked to a single, specific event in the normalized time series, then an experimental effect would be inferred beyond the inherent variability of H-reflex responses. Tibial nerve F-wave responses were included to determine if any new information about central nervous function following a HVLA SM procedure could be ascertained. Time series analyses of H(max)/M(max) ratios, pre-post L5-S1 HVLA SM, substantiated the hypothesis that the specific aspects of the manipulative thrust lead to a greater attenuation of the H(max)/M(max) ratio as compared to the non-specific aspects related to the postural perturbation and joint pre-loading. The attenuation of the H(max)/M(max) ratio following the HVLA SM procedure was reliable and may hold promise as a translational tool to measure the consistency and accuracy of protocol implementation involving SM in clinical trials research. F-wave responses were not sensitive to mechanical perturbations of the lumbar spine.
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Clark BC, Goss DA, Walkowski S, Hoffman RL, Ross A, Thomas JS. Neurophysiologic effects of spinal manipulation in patients with chronic low back pain. BMC Musculoskelet Disord 2011; 12:170. [PMID: 21781310 PMCID: PMC3149032 DOI: 10.1186/1471-2474-12-170] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Accepted: 07/22/2011] [Indexed: 11/22/2022] Open
Abstract
Background While there is growing evidence for the efficacy of SM to treat LBP, little is known on the mechanisms and physiologic effects of these treatments. Accordingly, the purpose of this study was to determine whether SM alters the amplitude of the motor evoked potential (MEP) or the short-latency stretch reflex of the erector spinae muscles, and whether these physiologic responses depend on whether SM causes an audible joint sound. Methods We used transcranial magnetic stimulation to elicit MEPs and electromechanical tapping to elicit short-latency stretch reflexes in 10 patients with chronic LBP and 10 asymptomatic controls. Neurophysiologic outcomes were measured before and after SM. Changes in MEP and stretch reflex amplitude were examined based on patient grouping (LBP vs. controls), and whether SM caused an audible joint sound. Results SM did not alter the erector spinae MEP amplitude in patients with LBP (0.80 ± 0.33 vs. 0.80 ± 0.30 μV) or in asymptomatic controls (0.56 ± 0.09 vs. 0.57 ± 0.06 μV). Similarly, SM did not alter the erector spinae stretch reflex amplitude in patients with LBP (0.66 ± 0.12 vs. 0.66 ± 0.15 μV) or in asymptomatic controls (0.60 ± 0.09 vs. 0.55 ± 0.08 μV). Interestingly, study participants exhibiting an audible response exhibited a 20% decrease in the stretch reflex (p < 0.05). Conclusions These findings suggest that a single SM treatment does not systematically alter corticospinal or stretch reflex excitability of the erector spinae muscles (when assessed ~ 10-minutes following SM); however, they do indicate that the stretch reflex is attenuated when SM causes an audible response. This finding provides insight into the mechanisms of SM, and suggests that SM that produces an audible response may mechanistically act to decrease the sensitivity of the muscle spindles and/or the various segmental sites of the Ia reflex pathway.
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Affiliation(s)
- Brian C Clark
- Ohio Musculoskeletal and Neurological Institute (OMNI), Ohio University, 236 Irvine Hall, Athens, OH 45701, USA.
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Cramer GD, Ross JK, Raju PK, Cambron JA, Dexheimer JM, Bora P, McKinnis R, Selby S, Habeck AR. Distribution of cavitations as identified with accelerometry during lumbar spinal manipulation. J Manipulative Physiol Ther 2011; 34:572-83. [PMID: 21986305 DOI: 10.1016/j.jmpt.2011.05.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2011] [Revised: 04/14/2011] [Accepted: 05/07/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVE This project determined the location and distribution of cavitations (producing vibrations and audible sounds) in the lumbar zygapophyseal (Z) joints that were targeted by spinal manipulative therapy (SMT). METHODS This randomized, controlled, clinical study assessed 40 healthy subjects (20 men, 20 women) 18 to 30 years of age who were block randomized into SMT (group 1, n = 30) or side-posture positioning only (group 2; control, n = 10) groups. Nine accelerometers were placed on each patient (7 on spinous processes/sacral tubercles of L1-S2 and 2 placed 3 cm left and right lateral to the L4/L5 interspinous space). Accelerometer recordings were made during side-posture positioning (groups 1 and 2) and SMT (group 1 only). The SMT was delivered by a chiropractic physician with 19 years of practice experience and included 2 high-velocity, low-amplitude thrusts delivered in rapid succession. Comparisons using χ(2) or McNemar test were made between number of joints cavitating from group 1 vs group 2, upside (contact side for SMT) vs downside, and Z joints within the target area (L3/L4, L4L5, L5/S1) vs outside the target area (L1/L2, L2/L3, sacroiliac). RESULTS Fifty-six cavitations were recorded from 46 joints of 40 subjects. Eight joints cavitated more than once. Group 1 joints cavitated more than group 2 joints (P < .0001), upside joints cavitated more than downside joints (P < .0001), and joints inside the target area cavitated more than those outside the target area (P < .01). CONCLUSIONS Most cavitations (93.5%) occurred on the upside of SMT subjects in segments within the target area (71.7%). As expected, SMT subjects cavitated more frequently than did subjects with side-posture positioning only (96.7% vs 30%). Multiple cavitations from the same Z joints had not been previously reported.
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Affiliation(s)
- Gregory D Cramer
- Dean of Research, Department of Research, National University of Health Sciences, Lombard, IL, USA.
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