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Farley J, Taylor-Swanson L, Koppenhaver S, Thackeray A, Magel J, Fritz JM. The Effect of Combining Spinal Manipulation and Dry Needling in Individuals With Nonspecific Low Back Pain. THE JOURNAL OF PAIN 2024:104506. [PMID: 38484853 DOI: 10.1016/j.jpain.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 03/05/2024] [Accepted: 03/08/2024] [Indexed: 05/12/2024]
Abstract
Low back pain (LBP) is one of the most common and costly musculoskeletal conditions impacting health care in the United States. The development of multimodal strategies of treatment is imperative in order to curb the growing incidence and prevalence of LBP. Spinal manipulative therapy (SMT), dry needling (DN), and exercise are common nonpharmacological treatments for LBP. This study is a 3-armed parallel-group design randomized clinical trial. We enrolled and randomized 96 participants with LBP into a multimodal strategy of treatment consisting of a combination of DN and SMT, DN only, and SMT only, followed by an at-home exercise program. All participants received 4 treatment sessions in the first 2 weeks followed by a 2-week home exercise program. Outcomes included clinical (Oswestry Disability Index, numeric pain intensity rating) and mechanistic (lumbar multifidus, erector spinae, and gluteus medius muscle activation) measures at baseline, 2, and 4 weeks. Participants in the DN and SMT groups showed larger effects and statistically significant improvement in pain and disability scores, and muscle percent thickness change at 2 weeks and 4 weeks of treatment when compared to the other groups. This study was registered prior to participant enrollment. PERSPECTIVE: This article presents the process of developing an optimized multimodal treatment plan utilizing SMT, DN, and exercise to address the burden of LBP for impacted individuals and the health care system. This method could potentially help clinicians who treat LBP to lower initial pain and increase exercise compliance. (clinicaltrials.gov NCT05802901).
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Affiliation(s)
- Jedidiah Farley
- Department of Physical Therapy & Athletic Training, University of Utah, Salt Lake City, Utah
| | | | | | - Anne Thackeray
- Department of Physical Therapy & Athletic Training, University of Utah, Salt Lake City, Utah
| | - Jake Magel
- Department of Physical Therapy & Athletic Training, University of Utah, Salt Lake City, Utah
| | - Julie M Fritz
- Department of Physical Therapy & Athletic Training, University of Utah, Salt Lake City, Utah
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Choi G, Giuliano D, Tibbles A, Howarth SJ, Tran S, Lee J, Funabashi M. Investigating force-time characteristics of prone thoracic SMT and self-reported patient outcome measures: a feasibility study. Chiropr Man Therap 2023; 31:19. [PMID: 37420257 DOI: 10.1186/s12998-023-00491-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 06/13/2023] [Indexed: 07/09/2023] Open
Abstract
BACKGROUND Spinal manipulative therapy (SMT) is commonly used to treat musculoskeletal conditions, including thoracic spine pain. Applying patient-specific force-time characteristics are believed to be important to improve SMT's effectiveness. Investigating SMT as part of a multimodal approach is fundamental to account for the complexity of chiropractic clinical practice. Therefore, pragmatic investigations balancing minimal disruptions to the clinical encounter at the same time as ensuring a robust data quality with rigorous protocols are needed. Consequently, preliminary studies are required to assess the study protocol, quality of data recorded and the sustainability of such investigation. Therefore, this study examined the feasibility of investigating SMT force-time characteristics and clinical outcome measures in a clinical setting. METHODS In this mixed-methods study, providers recorded thoracic SMT force-time characteristics delivered to patients with thoracic spinal pain during regular clinical encounters. Self-reported clinical outcomes of pain, stiffness, comfort during the SMT (using an electronic visual analogue scale), and global rating of change scale were measured before and after each SMT application. Feasibility was quantitatively assessed for participant recruitment, data collection and data quality. Qualitative data assessed participants' perceptions on the impact of data collection on patient management and clinical flow. RESULTS Twelve providers (58% female, 27.3 ± 5.0 years old) and twelve patients (58% female, 37.2 ± 14.0 years old) participated in the study. Enrolment rate was greater than 40%, data collection rate was 49% and erroneous data was less than 5%. Participant acceptance was good with both providers and patients reporting positive experience with the study. CONCLUSIONS Recording SMT force-time characteristics and self-reported clinical outcome measures during a clinical encounter may be feasible with specific modification to the current protocol. The study protocol did not negatively impact patient management. Specific strategies to optimize the data collection protocol for the development of a large clinical database are being developed.
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Affiliation(s)
- Grand Choi
- Canadian Memorial Chiropractic College, 6100 Leslie St, Toronto, ON, M2H 3J1, Canada
| | - Dominic Giuliano
- Canadian Memorial Chiropractic College, 6100 Leslie St, Toronto, ON, M2H 3J1, Canada
| | - Anthony Tibbles
- Canadian Memorial Chiropractic College, 6100 Leslie St, Toronto, ON, M2H 3J1, Canada
| | - Samuel J Howarth
- Canadian Memorial Chiropractic College, 6100 Leslie St, Toronto, ON, M2H 3J1, Canada
| | - Steve Tran
- Canadian Memorial Chiropractic College, 6100 Leslie St, Toronto, ON, M2H 3J1, Canada
| | - Joyce Lee
- Canadian Memorial Chiropractic College, 6100 Leslie St, Toronto, ON, M2H 3J1, Canada
| | - Martha Funabashi
- Canadian Memorial Chiropractic College, 6100 Leslie St, Toronto, ON, M2H 3J1, Canada.
- Université du Québec à Trois-Rivières, 3351, boulevard des Forges, Trois-Rivières, QC, G9A 5H7, Canada.
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Jonely H, Jayaseelan D, Costello E, Signorino J, Wooten L, Murray D, Woolstenhulme J. Changes in pulmonary function following thoracic spine manipulation in a healthy inactive older adult population-a pilot study. J Phys Ther Sci 2023; 35:492-496. [PMID: 37405180 PMCID: PMC10315198 DOI: 10.1589/jpts.35.492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 04/03/2023] [Indexed: 07/06/2023] Open
Abstract
[Purpose] Pulmonary function pathology is primarily treated pharmacologically, with a range of medication side effects. Few studies have systematically examined non-pharmacologic approaches such as joint manipulation effects on pulmonary function. This study examined the immediate and short-term effects of thoracic manipulation on pulmonary function. [Participants and Methods] Twenty-one physically inactive otherwise healthy participants aged 50 years or older were randomly assigned to either receive three sessions of thoracic manipulation (n=10) or three sessions of "sham intercostal training" (n=11). Outcome measures included forced vital capacity, maximal voluntary ventilation and thoracic excursion during maximal inhalation and exhalation. [Results] There was a statistically significant difference in maximal voluntary ventilation in the manipulation group, when measured within a week of the third intervention session and immediate effects in thoracic excursion during exhalation in the sham group following a single intervention session. There were no significant changes in other measures. [Conclusion] Spinal manipulation had no immediate effect on pulmonary function, however, affected an improvement in maximal voluntary ventilation within 7 days following a third session. The sham intervention showed a change in thoracic excursion during exhalation after the first session. Future research is necessary to further explore the relationship between thoracic manipulation and pulmonary function.
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Affiliation(s)
- Holly Jonely
- The School of Medicine & Health Sciences, Physical
Therapy & Health Care Sciences, The George Washington University: 2000 Pennsylvania
Ave, NW, Suite 2000, Washington, DC 20006, USA
| | - Dhinu Jayaseelan
- The School of Medicine & Health Sciences, Physical
Therapy & Health Care Sciences, The George Washington University: 2000 Pennsylvania
Ave, NW, Suite 2000, Washington, DC 20006, USA
| | - Ellen Costello
- The School of Medicine & Health Sciences, Physical
Therapy & Health Care Sciences, The George Washington University: 2000 Pennsylvania
Ave, NW, Suite 2000, Washington, DC 20006, USA
| | - Joseph Signorino
- The School of Medicine & Health Sciences, Physical
Therapy & Health Care Sciences, The George Washington University: 2000 Pennsylvania
Ave, NW, Suite 2000, Washington, DC 20006, USA
- Division of Physical Therapy, Shenandoah University,
USA
| | - Liana Wooten
- Department of Public Health and Community Medicine, School
of Medicine, Doctor of Physical Therapy Program, Tufts University, USA
| | - Donal Murray
- The School of Medicine & Health Sciences, Physical
Therapy & Health Care Sciences, The George Washington University: 2000 Pennsylvania
Ave, NW, Suite 2000, Washington, DC 20006, USA
| | - Josh Woolstenhulme
- The School of Medicine & Health Sciences, Physical
Therapy & Health Care Sciences, The George Washington University: 2000 Pennsylvania
Ave, NW, Suite 2000, Washington, DC 20006, USA
- Department of Physical Therapy and Athletic Training,
Meridian Health Sciences Center, Idaho State University, USA
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De Carvalho DE, Callaghan JP. The effect of lumbar spinal manipulation on biomechanical factors and perceived transient pain during prolonged sitting: a laboratory-controlled cross-sectional study. Chiropr Man Therap 2022; 30:62. [PMID: 36585725 PMCID: PMC9805135 DOI: 10.1186/s12998-022-00472-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 12/21/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Spinal manipulation has been shown to affect muscle activity, posture, and pain. To date, no studies have examined the effect of manipulation on biomechanical factors during sitting. Therefore, the purpose of this study was to investigate the immediate effect of lumbar spinal manipulation on trunk muscle activation, spine posture and movements, and perceived ratings of transient pain in asymptomatic adults during prolonged office sitting. METHODS Twenty healthy adults were recruited for a single laboratory session that included a standardized office sitting/data entry protocol (120 min total, 3 blocks of 40 min). Data were collected between July and August 2012. The first block (baseline) was immediately followed by two experimental blocks. Prior to the start of each experimental block, participants were transferred to a therapy plinth and placed side lying (right side down), and a random presentation of either a control or high velocity low amplitude thrust directed at L4/L5 was delivered. Continuous measures of muscle activity, spine posture, and spine movements were recorded throughout the sitting trials. Perceived transient pain was measured by visual analogue scale at 10-min intervals (including immediately before and after the randomized maneuvers). RESULTS There were no significant differences in spine or pelvic posture or perceived back pain following either the manipulation or control maneuvers. Significantly reduced muscle activity and increased shifts of the lumbar spine angle were identified in the block following manipulation compared to both baseline and post control blocks. CONCLUSIONS Spinal manipulation does not appear to have an immediate impact on spine or pelvic posture in healthy adults but does appear to reduce muscle activity and increase spine movement during sitting. Future work should replicate this study with a larger population in a field setting. It may be worthwhile to explore the implication of reduced muscle activation and increased spine movements during prolonged sitting for office workers that receive manipulations or mobilizations during their workday.
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Affiliation(s)
- D. E. De Carvalho
- grid.25055.370000 0000 9130 6822Faculty of Medicine, Memorial University of Newfoundland, St. John’s, NL A1B 3V6 Canada
| | - J. P. Callaghan
- grid.46078.3d0000 0000 8644 1405Department of Kinesiology & Health Sciences, Faculty of Health, University of Waterloo, Waterloo, ON N2L 3G1 Canada
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Comparison of Forces Exerted by a Chiropractor on Children and Adults During High-Speed, Low-Amplitude Spinal Manipulations: A Feasibility Study. J Manipulative Physiol Ther 2022. [DOI: 10.1016/j.jmpt.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Lardon A, Pagé I, Nougarou F, Descarreaux M. Neuromechanical Responses to Spinal Manipulation and Mobilization: A Crossover Randomized Clinical Trial. J Manipulative Physiol Ther 2022; 45:1-8. [PMID: 35753884 DOI: 10.1016/j.jmpt.2022.03.016] [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: 10/09/2019] [Revised: 10/06/2021] [Accepted: 03/17/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The purpose of this study was to compare the immediate effect of spinal manipulation (SMa) and spinal mobilization (SMo) on muscular responses, spinal stiffness, and segmental spinal pressure evoked pain in a population of participants with chronic middle back pain (MBP). METHODS In a crossover randomized trial, 2 experienced chiropractors assessed whether volunteers were eligible for the protocol according to a list of specific inclusion and exclusion criteria. Individuals with MBP participated in 2 experimental sessions within 72 hours. During the first session, participants randomly received a SMa or SMo delivered by an apparatus using a servolinear motor. During the second session, the other modality was delivered. Spinal stiffness and pressure-provoked pain intensity outcomes were assessed before and after each therapy, and muscular responses were recorded during the treatment using surface electromyographic sensors. Signed-rank Wilcoxon tests for muscular responses and generalized model for repeated measure for spinal stiffness and pressure-provoked pain were used for statistical analyses. RESULTS Among the 32 potential participants, 26 (mean age 29.9 [±9.14], 15 women) completed both sessions. Between-group differences were observed for the muscular response amplitude (P < .001), and indeed the normalized RMS muscular response was found to be higher during SMa than SMo. Similar results were observed for pressure-provoked pain intensity at the level of therapeutic modality application (P = .002) as a higher decrease in pain was found after SMa (47.9 [±22.8] to 36.6 [±23.7]) compared with SMo (47.2 [±23.2] to 45.5 [±24.3]). No between-group differences were found for spinal stiffness change, nor for terminal (P = .08) and global spinal stiffness (P = .06). CONCLUSION In a controlled environment, spinal manipulation and mobilization generated different muscle responses and had different immediate effects on pressure-provoked pain intensity for subjects with MBP.
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Affiliation(s)
- Arnaud Lardon
- Department of Human Kinetics, University of Québec, Trois-Rivières, Québec, Canada; Franco-European Institute of Chiropractic, Ivry-sur Seine, France.
| | - Isabelle Pagé
- Department of Human Kinetics, University of Québec, Trois-Rivières, Québec, Canada
| | - François Nougarou
- Department of Electrical Engineering, University of Québec, Trois-Rivières, Québec, Canada
| | - Martin Descarreaux
- Department of Human Kinetics, University of Québec, Trois-Rivières, Québec, Canada
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Funabashi M, Breen AC, De Carvalho D, Pagé I, Nougarou F, Descarreaux M, Kawchuk GN. Force Distribution Within Spinal Tissues During Posterior to Anterior Spinal Manipulative Therapy: A Secondary Analysis. Front Integr Neurosci 2022; 15:809372. [PMID: 35185486 PMCID: PMC8855051 DOI: 10.3389/fnint.2021.809372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 12/31/2021] [Indexed: 12/20/2022] Open
Abstract
Background Previous studies observed that the intervertebral disc experiences the greatest forces during spinal manipulative therapy (SMT) and that the distribution of forces among spinal tissues changes as a function of the SMT parameters. However, contextualized SMT forces, relative to the ones applied to and experienced by the whole functional spinal unit, is needed to understand SMT’s underlying mechanisms. Aim To describe the percentage force distribution between spinal tissues relative to the applied SMT forces and total force experienced by the functional unit. Methods This secondary analysis combined data from 35 fresh porcine cadavers exposed to a simulated 300N SMT to the skin overlying the L3/L4 facet joint via servo-controlled linear motor actuator. Vertebral kinematics were tracked optically using indwelling bone pins. The functional spinal unit was then removed and mounted on a parallel robotic platform equipped with a 6-axis load cell. The kinematics of the spine during SMT were replayed by the robotic platform. By using serial dissection, peak and mean forces induced by the simulated SMT experienced by spinal structures in all three axes of motion were recorded. Forces experienced by spinal structures were analyzed descriptively and the resultant force magnitude was calculated. Results During SMT, the functional spinal unit experienced a median peak resultant force of 36.4N (IQR: 14.1N) and a mean resultant force of 25.4N (IQR: 11.9N). Peak resultant force experienced by the spinal segment corresponded to 12.1% of the total applied SMT force (300N). When the resultant force experienced by the functional spinal unit was considered to be 100%, the supra and interspinous ligaments experienced 0.3% of the peak forces and 0.5% of the mean forces. Facet joints and ligamentum flavum experienced 0.7% of the peak forces and 3% of the mean forces. Intervertebral disc and longitudinal ligaments experienced 99% of the peak and 96.5% of the mean forces. Conclusion In this animal model, a small percentage of the forces applied during a posterior-to-anterior SMT reached spinal structures in the lumbar spine. Most SMT forces (over 96%) are experienced by the intervertebral disc. This study provides a novel perspective on SMT force distribution within spinal tissues.
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Affiliation(s)
- Martha Funabashi
- Division of Research and Innovation, Canadian Memorial Chiropractic College, Toronto, ON, Canada
- Chiropractic Department, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
- *Correspondence: Martha Funabashi,
| | | | - Diana De Carvalho
- Faculty of Medicine, Memorial University of Newfoundland, St. John’s, NL, Canada
| | - Isabelle Pagé
- Chiropractic Department, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - François Nougarou
- Department of Electrical and Computer Engineering, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Martin Descarreaux
- Human Kinetics Department, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Gregory N. Kawchuk
- Department of Physical Therapy, University of Alberta, Edmonton, AB, Canada
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Hegarty AK, Hsu M, Roy JS, Kardouni JR, Kutch JJ, Michener LA. Evidence for increased neuromuscular drive following spinal manipulation in individuals with subacromial pain syndrome. Clin Biomech (Bristol, Avon) 2021; 90:105485. [PMID: 34571486 PMCID: PMC8793937 DOI: 10.1016/j.clinbiomech.2021.105485] [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: 02/19/2021] [Revised: 06/16/2021] [Accepted: 09/13/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Thoracic spinal manipulation can improve pain and function in individuals with shoulder pain; however, the mechanisms underlying these benefits remain unclear. Here, we evaluated the effects of thoracic spinal manipulation on muscle activity, as alteration in muscle activity is a key impairment for those with shoulder pain. We also evaluated the relationship between changes in muscle activity and clinical outcomes, to characterize the meaningful context of a change in neuromuscular drive. METHODS Participants with shoulder pain related to subacromial pain syndrome (n = 28) received thoracic manipulation of low amplitude high velocity thrusts to the lower, middle and upper thoracic spine. Electromyographic muscle activity (trapezius-upper, middle, lower; serratus anterior; deltoid; infraspinatus) and shoulder pain (11-point scale) was collected pre and post-manipulation during arm elevation, and normalized to a reference contraction. Clinical benefits were assessed using the Pennsylvania Shoulder Score (Penn) at baseline and 2-3 days post-intervention. FINDINGS A significant increase in muscle activity was observed during arm ascent (p = 0.002). Using backward stepwise regression analysis, a specific increase in the serratus anterior muscle activity during arm elevation explained improved Penn scores following post-manipulation (p < 0.05). INTERPRETATION Thoracic spinal manipulation immediately increases neuromuscular drive. In addition, increased serratus anterior muscle activity, a key muscle for scapular motion, is associated with short-term improvements in shoulder clinical outcomes.
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Affiliation(s)
- Amy K. Hegarty
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
| | - Melody Hsu
- Johns Hopkins University, Baltimore, MD, USA
| | - Jean-Sébastien Roy
- Faculty of Medicine, Department of Rehabilitation, Laval University; Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, QC, Canada
| | - Joseph R. Kardouni
- FORSCOM Holistic Health and Fitness (H2F) Field Test, U.S. Army Forces Command, Fort Bragg, NC, USA
| | - Jason J. Kutch
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
| | - Lori A. Michener
- Division of Biokinesiology and Physical Therapy, University of Southern California, 1540 E. Alcazar Street, CHP155, Los Angeles, CA 90089; USA
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Effects of biomechanical parameters of spinal manipulation: A critical literature review. JOURNAL OF INTEGRATIVE MEDICINE-JIM 2021; 20:4-12. [PMID: 34756673 DOI: 10.1016/j.joim.2021.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 08/10/2021] [Indexed: 11/23/2022]
Abstract
Spinal manipulation is a manual treatment technique that delivers a thrust, using specific biomechanical parameters to exert its therapeutic effects. These parameters have been shown to have a unique dose-response relationship with the physiological responses of the therapy. So far, however, there has not been a unified approach to standardize these biomechanical characteristics. In fact, it is still undetermined how they affect the observed clinical outcomes of spinal manipulation. This study, therefore, reviewed the current body of literature to explore these dosage parameters and evaluate their significance, with respect to physiological and clinical outcomes. From the experimental studies reviewed herein, it is evident that the modulation of manipulation's biomechanical parameters elicits transient physiological responses, including changes in neuronal activity, electromyographic responses, spinal stiffness, muscle spindle responses, paraspinal muscle activity, vertebral displacement, and segmental and intersegmental acceleration responses. However, to date, there have been few clinical trials that tested the therapeutic relevance of these changes. In addition, there were some inherent limitations in both human and animal models due to the use of mechanical devices to apply the thrust. Future studies evaluating the effects of varying biomechanical parameters of spinal manipulation should include clinicians to deliver the therapy in order to explore the true clinical significance of the dose-response relationship.
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Gevers-Montoro C, Provencher B, Northon S, Stedile-Lovatel JP, Ortega de Mues A, Piché M. Chiropractic Spinal Manipulation Prevents Secondary Hyperalgesia Induced by Topical Capsaicin in Healthy Individuals. FRONTIERS IN PAIN RESEARCH 2021; 2:702429. [PMID: 35295504 PMCID: PMC8915757 DOI: 10.3389/fpain.2021.702429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 06/18/2021] [Indexed: 12/28/2022] Open
Abstract
Background and Aims: Spinal manipulation (SM) is currently recommended for the management of back pain. Experimental studies indicate that the hypoalgesic mechanisms of SM may rely on inhibition of segmental processes related to temporal summation of pain and, possibly, on central sensitization, although this remains unclear. The aim of this study was to determine whether experimental back pain, secondary hyperalgesia, and pain-related brain activity induced by capsaicin are decreased by segmental SM. Methods: Seventy-three healthy volunteers were randomly allocated to one of four experimental groups: SM at T5 vertebral level (segmental), SM at T9 vertebral level (heterosegmental), placebo intervention at T5 vertebral level, or no intervention. Topical capsaicin was applied to the area of T5 vertebra for 40 min. After 20 min, the interventions were administered. Pressure pain thresholds (PPTs) were assessed outside the area of capsaicin application at 0 and 40 min to examine secondary hyperalgesia. Capsaicin pain intensity and unpleasantness were reported every 4 min. Frontal high-gamma oscillations were also measured with electroencephalography. Results: Pain ratings and brain activity were not significantly different between groups over time (p > 0.5). However, PPTs were significantly decreased in the placebo and control groups (p < 0.01), indicative of secondary hyperalgesia, while no hyperalgesia was observed for groups receiving SM (p = 1.0). This effect was independent of expectations and greater than placebo for segmental (p < 0.01) but not heterosegmental SM (p = 1.0). Conclusions: These results indicate that segmental SM can prevent secondary hyperalgesia, independently of expectations. This has implications for the management of back pain, particularly when central sensitization is involved.
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Affiliation(s)
- Carlos Gevers-Montoro
- Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
- CogNAC Research Group, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
- Madrid College of Chiropractic, RCU Maria Cristina, Madrid, Spain
| | - Benjamin Provencher
- Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
- CogNAC Research Group, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Stéphane Northon
- Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
- CogNAC Research Group, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | | | | | - Mathieu Piché
- Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
- CogNAC Research Group, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
- *Correspondence: Mathieu Piché
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The contemporary model of vertebral column joint dysfunction and impact of high-velocity, low-amplitude controlled vertebral thrusts on neuromuscular function. Eur J Appl Physiol 2021; 121:2675-2720. [PMID: 34164712 PMCID: PMC8416873 DOI: 10.1007/s00421-021-04727-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 05/20/2021] [Indexed: 02/08/2023]
Abstract
Purpose There is growing evidence that vertebral column function and dysfunction play a vital role in neuromuscular control. This invited review summarises the evidence about how vertebral column dysfunction, known as a central segmental motor control (CSMC) problem, alters neuromuscular function and how spinal adjustments (high-velocity, low-amplitude or HVLA thrusts directed at a CSMC problem) and spinal manipulation (HVLA thrusts directed at segments of the vertebral column that may not have clinical indicators of a CSMC problem) alters neuromuscular function.
Methods The current review elucidates the peripheral mechanisms by which CSMC problems, the spinal adjustment or spinal manipulation alter the afferent input from the paravertebral tissues. It summarises the contemporary model that provides a biologically plausible explanation for CSMC problems, the manipulable spinal lesion. This review also summarises the contemporary, biologically plausible understanding about how spinal adjustments enable more efficient production of muscular force. The evidence showing how spinal dysfunction, spinal manipulation and spinal adjustments alter central multimodal integration and motor control centres will be covered in a second invited review. Results Many studies have shown spinal adjustments increase voluntary force and prevent fatigue, which mainly occurs due to altered supraspinal excitability and multimodal integration. The literature suggests physical injury, pain, inflammation, and acute or chronic physiological or psychological stress can alter the vertebral column’s central neural motor control, leading to a CSMC problem. The many gaps in the literature have been identified, along with suggestions for future studies. Conclusion Spinal adjustments of CSMC problems impact motor control in a variety of ways. These include increasing muscle force and preventing fatigue. These changes in neuromuscular function most likely occur due to changes in supraspinal excitability. The current contemporary model of the CSMC problem, and our understanding of the mechanisms of spinal adjustments, provide a biologically plausible explanation for how the vertebral column’s central neural motor control can dysfunction, can lead to a self-perpetuating central segmental motor control problem, and how HVLA spinal adjustments can improve neuromuscular function.
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Gevers-Montoro C, Provencher B, Descarreaux M, Ortega de Mues A, Piché M. Neurophysiological mechanisms of chiropractic spinal manipulation for spine pain. Eur J Pain 2021; 25:1429-1448. [PMID: 33786932 DOI: 10.1002/ejp.1773] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 03/05/2021] [Accepted: 03/27/2021] [Indexed: 12/19/2022]
Abstract
Together, neck pain and back pain are the first cause of disability worldwide, accounting for more than 10% of the total years lived with disability. In this context, chiropractic care provides a safe and effective option for the management of a large proportion of these patients. Chiropractic is a healthcare profession mainly focused on the spine and the treatment of spinal disorders, including spine pain. Basic studies have examined the influence of chiropractic spinal manipulation (SM) on a variety of peripheral, spinal and supraspinal mechanisms involved in spine pain. While spinal cord mechanisms of pain inhibition contribute at least partly to the pain-relieving effects of chiropractic treatments, the evidence is weaker regarding peripheral and supraspinal mechanisms, which are important components of acute and chronic pain. This narrative review highlights the most relevant mechanisms of pain relief by SM and provides a perspective for future research on SM and spine pain, including the validation of placebo interventions that control for placebo effects and other non-specific effects that may be induced by SM. SIGNIFICANCE: Spinal manipulation inhibits back and neck pain partly through spinal segmental mechanisms and potentially through peripheral mechanisms regulating inflammatory responses. Other mechanisms remain to be clarified. Controls and placebo interventions need to be improved in order to clarify the contribution of specific and non-specific effects to pain relief by spinal manipulative therapy.
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Affiliation(s)
- Carlos Gevers-Montoro
- Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada.,CogNAC Research Group, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada.,Madrid College of Chiropractic - RCU María Cristina, Madrid, Spain
| | - Benjamin Provencher
- Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada.,CogNAC Research Group, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Martin Descarreaux
- Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada.,GRAN Research Group, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | | | - Mathieu Piché
- Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada.,CogNAC Research Group, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
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13
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Mikhail J, Funabashi M, Descarreaux M, Pagé I. Assessing forces during spinal manipulation and mobilization: factors influencing the difference between forces at the patient-table and clinician-patient interfaces. Chiropr Man Therap 2020; 28:57. [PMID: 33168008 PMCID: PMC7654015 DOI: 10.1186/s12998-020-00346-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 10/19/2020] [Indexed: 01/16/2023] Open
Abstract
Background Spinal manipulative therapy (SMT) and mobilization (MOB) effects are believed to be related to their force characteristics. Most previous studies have either measured the force at the patient-table interface or at the clinician-patient interface. The objectives of this study were to determine 1) the difference between the force measured at the patient-table interface and the force applied at the clinician-patient interface during thoracic SMT and MOB, and 2) the influence of the SMT/MOB characteristics, participants’ anthropometry and muscle activity (sEMG) on this difference. Methods An apparatus using a servo-linear motor executed 8 SMT/MOB at the T7 vertebrae in 34 healthy adults between May and June 2019. SMT and MOB were characterized by a 20 N preload, total peak forces of 100 N or 200 N, and thrust durations of 100 ms, 250 ms, 1 s or 2 s. During each trial, thoracic sEMG, apparatus displacement as well as forces at the patient-table interface and the clinician-patient interface were recorded. The difference between the force at both interfaces was calculated. The effect of SMT/MOB characteristics on the difference between forces at both interfaces and correlations between this difference and potential influencing factors were evaluated. Results Force magnitudes at the patient-table interface were, in most trials, greater than the force at the clinician-patient interface (up to 135 N). SMT/MOB characteristics (total peak force, thrust duration and rate of force application) affected the difference between forces at both interfaces (all p-values< 0.05). No factor showed significant correlations with the difference between forces at both interfaces for the 8 SMT/MOB. Conclusions The results revealed that the force measured at the patient-table interface is greater than the applied force at the clinician-patient interface during thoracic SMT and MOB. By which mechanism the force is amplified is not yet fully understood.
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Affiliation(s)
- Jérémie Mikhail
- Department of Chiropractic, Université du Québec à Trois-Rivières, 3351 boul. Des Forges, Trois-Rivières, G8Z 4M3, Québec, Canada
| | - Martha Funabashi
- Department of Chiropractic, Université du Québec à Trois-Rivières, 3351 boul. Des Forges, Trois-Rivières, G8Z 4M3, Québec, Canada.,Division of Research and Innovation, Canadian Memorial Chiropractic College, 6100 Leslie St, Toronto, Ontario, M2H 3J1, Canada
| | - Martin Descarreaux
- Department of Human Kinetics, Université du Québec à Trois-Rivières, 3351 boul. Des Forges, Trois-Rivières, G8Z 4M3, Québec, Canada
| | - Isabelle Pagé
- Department of Chiropractic, Université du Québec à Trois-Rivières, 3351 boul. Des Forges, Trois-Rivières, G8Z 4M3, Québec, Canada. .,Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), 25 Wilfrid-Hamel Blvd., Québec, G1M 2S8, Québec, Canada.
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González-Rueda V, López-de-Celis C, Bueno-Gracia E, Rodríguez-Sanz J, Pérez-Bellmunt A, Barra-López ME, Hidalgo García C. "Short- and mid-term effects of adding upper cervical manual therapy to a conventional physical therapy program in patients with chronic mechanical neck pain. Randomized controlled clinical trial.". Clin Rehabil 2020; 35:378-389. [PMID: 33076707 DOI: 10.1177/0269215520965054] [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] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate the effect of adding an Upper Cervical Translatoric Mobilization (UCTM) or an Inhibitory Suboccipital Technique (IST) to a physiotherapy treatment in the symptomatology and function of mechanical chronic neck pain patients. DESIGN Randomized controlled trial. SETTING Primary Care Center in Cornellà, Spain. SUBJECTS 78 patients (64 women), with mean age (SD) of 59.96 (13.30) years with mechanical chronic neck pain were divided in three groups: control, IST and UCTM groups. INTERVENTIONS All groups received 15 physiotherapy sessions for three weeks. The UCTM and IST groups added 5 minutes of the assigned technique during six sessions. MAIN MEASURES Neck disability index (NDI) and numeric pain rating scale (NPRS) for neck pain were measured baseline, three-weeks and 15-weeks follow-up. RESULTS NDI (SD) at baseline, three-weeks and 15-weeks were 11.62 (7.08), 9.65 (6.25), 7.58 (5.64) for the control group, 14.38 (6.92), 8.50 (6.11), 7.12 (4.98) for the IST group and 13.19(7.23), 5.35(6.10), 4.35(2.76) for the UCTM group. NPRS (SD) at baseline, three-weeks and 15-weeks were 58.69 (19.46), 45.19 (23.43), 44.58 (24.08) for the control group; 64.08 (19.26), 42.19 (19.69), 34 (21.14) for the IST group; and 67.65 (20.65), 36.23 (20.10), 39.85 (25.44) for the UCTM group. CONCLUSIONS Compared with no treatment, both forms of mobilization were associated with reduced disability at three weeks, and UCTM remained better than control at 15 weeks; there were no significant differences between the two mobilization groups. TRIAL REGISTRATION This study was registered in Clinicaltrials.gov (NCT02832232).
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Affiliation(s)
- Vanessa González-Rueda
- Facultat de Medicina i Ciències de la Salut, Universitat Intenacional de Catalunya, Barcelona, Spain.,Fundació Institut Universitari per a la recerca a l'Atenció Primaria de Salut Jordi Gol i Gurina, Barcelona, Spain
| | - Carlos López-de-Celis
- Facultat de Medicina i Ciències de la Salut, Universitat Intenacional de Catalunya, Barcelona, Spain.,Fundació Institut Universitari per a la recerca a l'Atenció Primaria de Salut Jordi Gol i Gurina, Barcelona, Spain
| | - Elena Bueno-Gracia
- Unidad de Investigación en Fisioterapia, Facultad de Ciencias de la Salud, Universidad de Zaragoza, Zaragoza, Spain
| | - Jacobo Rodríguez-Sanz
- Facultat de Medicina i Ciències de la Salut, Universitat Intenacional de Catalunya, Barcelona, Spain
| | - Albert Pérez-Bellmunt
- Facultat de Medicina i Ciències de la Salut, Universitat Intenacional de Catalunya, Barcelona, Spain
| | | | - César Hidalgo García
- Unidad de Investigación en Fisioterapia, Facultad de Ciencias de la Salud, Universidad de Zaragoza, Zaragoza, Spain
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Nogueira N, Oliveira-Campelo N, Lopes Â, Torres R, Sousa ASP, Ribeiro F. The Acute Effects of Manual and Instrument-Assisted Cervical Spine Manipulation on Pressure Pain Threshold, Pressure Pain Perception, and Muscle-Related Variables in Asymptomatic Subjects: A Randomized Controlled Trial. J Manipulative Physiol Ther 2020; 43:179-188. [PMID: 32951766 DOI: 10.1016/j.jmpt.2019.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 04/26/2019] [Accepted: 05/08/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The purpose of this study was to compare the immediate effects in asymptomatic participants of manual and instrument-assisted cervical manipulation on pressure pain thresholds, pressure pain perception, and muscle mechanical properties (tone, stiffness, and elasticity) over muscles anatomically related and unrelated to the manipulated level. METHODS Fifty-nine asymptomatic participants (34 women and 25 men; age [mean ± standard deviation] = 21.1 ± 1.6 years) were randomly assigned to 4 groups in a double-blind, randomized, placebo-controlled trial. Two groups received cervical (C3/C4) manipulation, 1 manual and the other instrument-assisted; the third group received a sham manipulation; and the fourth group served as the control. Bilateral pressure pain threshold, pressure pain perception, muscle tone, stiffness, and elasticity in the upper trapezius and biceps brachii were evaluated before and immediately after the interventions. RESULTS At baseline, there were no differences among the groups on any variable. After the interventions, a significant increase in pressure pain threshold was observed with both manual and instrument-assisted manipulation at local and distal sites (P < .05), whereas no changes were observed in either the control or the placebo group. The perception of pain pressure did not change significantly in any group. The interventions did not promote any statistically significant differences in muscle tone, elasticity, or stiffness at any site (local or distal). CONCLUSION Cervical (C3/C4) manual and instrument-assisted manipulations produced an increase in pressure pain threshold bilaterally and over muscles related and unrelated to the vertebral segment, but had no effect on muscle tone, elasticity, or stiffness.
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Affiliation(s)
- Nuno Nogueira
- Vale do Sousa Higher School of Health, Polytechnic Health School of the North, Cooperativa de Ensino Superior Politécnico e Universitário (CESPU), Gandra, Portugal; Physiotherapy Department, School of Health, Polytechnic Institute of Porto, Center for Rehabilitation Research-Center of Human Studies and Human Activity, Porto, Portugal.
| | - Natália Oliveira-Campelo
- Physiotherapy Department, School of Health, Polytechnic Institute of Porto, Center for Rehabilitation Research-Center of Human Studies and Human Activity, Porto, Portugal
| | - Ângela Lopes
- Physiotherapy Department, School of Health, Polytechnic Institute of Porto, Center for Rehabilitation Research-Center of Human Studies and Human Activity, Porto, Portugal
| | - Rui Torres
- Vale do Sousa Higher School of Health, Polytechnic Health School of the North, Cooperativa de Ensino Superior Politécnico e Universitário (CESPU), Gandra, Portugal; Physiotherapy Department, School of Health, Polytechnic Institute of Porto, Center for Rehabilitation Research-Center of Human Studies and Human Activity, Porto, Portugal
| | - Andreia S P Sousa
- Physiotherapy Department, School of Health, Polytechnic Institute of Porto, Center for Rehabilitation Research-Center of Human Studies and Human Activity, Porto, Portugal
| | - Fernando Ribeiro
- School of Health Sciences and Institute of Biomedicine (iBiMED), University of Aveiro, Aveiro, Portugal
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The Effectiveness of Spinal Manipulation in Increasing Muscle Strength in Healthy Individuals: A Systematic Review and Meta-Analysis. J Manipulative Physiol Ther 2020; 42:148-158. [PMID: 31126523 DOI: 10.1016/j.jmpt.2018.10.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 09/24/2018] [Accepted: 10/21/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The purpose of this study was to systematically review the effects of spinal manipulation on muscular strength in healthy individuals and conduct a meta-analysis to appraise the quality of evidence. METHODS Articles were searched and retrieved from MEDLINE, EMBASE, CINAHL, Cochrane Library, PubMed, Academic Search Premier, SPORTDiscus, and AMED. Searches were conducted in September 2017 without a limit on the starting period. The Physiotherapy Evidence Database scale was used to appraise the quality of the included studies. Data from eligible articles were pooled, and meta-analyses were conducted. The quality of evidence was appraised by the Grading of Recommendations, Assessment, Development and Evaluations approach. The registration number for the review on PROSPERO is CRD42017075215. RESULTS A total of 911 records were screened, and 3 randomized controlled trials were eligible to be included in this review. There was a significant pooled standardized mean difference in isometric strength (0.93, 95% confidence interval [CI], 0.17-1.68; P = .02) between the experimental and control groups, with a moderate level of heterogeneity. CONCLUSION This review suggests that spinal manipulative therapy augments the percentage of change in isometric strength gain among healthy participants when compared to no intervention or sham manipulation. However, the heterogeneity of pooled studies in this review suggests that the results should be interpreted with caution.
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17
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Picchiottino M, Honoré M, Leboeuf-Yde C, Gagey O, Cottin F, Hallman DM. The effect of a single spinal manipulation on cardiovascular autonomic activity and the relationship to pressure pain threshold: a randomized, cross-over, sham-controlled trial. Chiropr Man Therap 2020; 28:7. [PMID: 31988711 PMCID: PMC6971986 DOI: 10.1186/s12998-019-0293-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 12/23/2019] [Indexed: 02/06/2023] Open
Abstract
Background The autonomic nervous system interacts with the pain system. Knowledge on the effects of high velocity low amplitude spinal manipulations (SM) on autonomic activity and experimentally induced pain is limited. In particular, the effects of SM on autonomic activity and pain beyond the immediate post intervention period as well as the relationship between these two outcomes are understudied. Thus, new research is needed to provide further insight on this issue. Objectives The aim was to assess the effect of a single SM (i.e. SM vs. sham) on cardiovascular autonomic activity. Also, we assessed the relationship between cardiovascular autonomic activity and level of pain threshold after the interventions. Method We conducted a randomized, cross-over, sham-controlled trial on healthy first-year chiropractic students comprising two experimental sessions separated by 48 h. During each session, subjects received, in a random order, either a thoracic SM or a sham manipulation. Cardiovascular autonomic activity was assessed using heart rate and systolic blood pressure variabilities. Pain sensitivity was assessed using pressure pain threshold. Measurements were performed at baseline and repeated three times (every 12 min) during the post intervention period. Participants and outcome assessors were blinded. The effect of the SM was tested with linear mixed models. The relationship between autonomic outcomes and pressure pain threshold was tested with bivariate correlations. Results Fifty-one participants were included, forty-one were finally analyzed. We found no statistically significant difference between SM and sham in cardiovascular autonomic activity post intervention. Similarly, we found no post-intervention relationship between cardiovascular autonomic activity and pressure pain threshold. Conclusion Our results suggest that a single SM of the thoracic spine has no specific effect on cardiovascular autonomic activity. Also, we found no relationship between cardiovascular autonomic activity and pressure pain threshold after the SM. Further experimental research should consider the use of several markers of autonomic activity and a more comprehensive pain assessment. Trial registration N° NCT03273868. Registered September 6, 2017.
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Affiliation(s)
- Mathieu Picchiottino
- Université Paris-Saclay CIAMS, 91405 Orsay, France
- CIAMS, Université d’Orléans, 45067 Orléans, France
- Institut Franco-européen de Chiropraxie (IFEC), Ivry-sur-Seine, Toulouse, France
| | - Margaux Honoré
- Université Paris-Saclay CIAMS, 91405 Orsay, France
- CIAMS, Université d’Orléans, 45067 Orléans, France
- Institut Franco-européen de Chiropraxie (IFEC), Ivry-sur-Seine, Toulouse, France
| | - Charlotte Leboeuf-Yde
- Université Paris-Saclay CIAMS, 91405 Orsay, France
- CIAMS, Université d’Orléans, 45067 Orléans, France
- Institut Franco-européen de Chiropraxie (IFEC), Ivry-sur-Seine, Toulouse, France
- Institute for Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Olivier Gagey
- Université Paris-Saclay CIAMS, 91405 Orsay, France
- CIAMS, Université d’Orléans, 45067 Orléans, France
| | - François Cottin
- Université Paris-Saclay CIAMS, 91405 Orsay, France
- CIAMS, Université d’Orléans, 45067 Orléans, France
| | - David M. Hallman
- Centre for Musculoskeletal Research, Department of Occupational and Public Health Sciences, University of Gävle, Gävle, Sweden
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18
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Pagé I, Biner É, Descarreaux M. Vertebral Displacements and Muscle Activity During Manual Therapy: Distinct Behaviors Between Spinal Manipulation and Mobilization. J Manipulative Physiol Ther 2019; 41:753-761. [PMID: 30871712 DOI: 10.1016/j.jmpt.2018.07.004] [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] [Received: 03/22/2018] [Revised: 06/20/2018] [Accepted: 07/06/2018] [Indexed: 12/27/2022]
Abstract
OBJECTIVE The purpose of this study was to compare vertebral displacements (absolute and relative) and muscle responses induced by spinal manipulative therapy of short (spinal manipulation) and long (spinal mobilization) impulse duration. METHODS Twenty-five healthy adults (without thoracic pain) were recruited for this crossover study. Six spinal manipulative therapies (255 N peak force) of different impulse durations (100, 125, 200, 500, 1000, and 1500 ms) were delivered to each participant's T7 transverse process using a mechanical device. Impulse duration effect on the vertebral displacement (absolute displacement of T6, T7, and T8 and relative displacement between T7 and T6 and between T7 and T8) and the thoracic muscle response (surface electromyography) were assessed using mixed-model analyses of variance and predefined linear trend analyses. RESULTS Results showed a linear increase in the absolute vertebral displacement for T8 (P = .002) and a linear decrease in the T7/T6 and T7/T8 relative displacement (P < .0001) when impulse duration was increased. The data of 24 participants were available for electromyography analysis. A significant main effect of impulse duration on surface electromyography response was observed (P < .0001, ƞp2=0.43). Planned comparisons for a linear trend between these variables revealed a negative relationship (P < .0001). Only 13 of the 24 participants with available data presented a muscle response at every impulse duration. CONCLUSION These results support the assumption that spinal manipulation and spinal mobilization might operate under distinct mechanisms.
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Affiliation(s)
- Isabelle Pagé
- Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada.
| | - Éric Biner
- Department of Chiropractic, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada
| | - Martin Descarreaux
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada
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Estébanez-de-Miguel E, Jimenez-Del-Barrio S, Fortún-Agud M, Bueno-Gracia E, Caudevilla-Polo S, Malo-Urriés M, Ceballos-Laita L. Comparison of high, medium and low mobilization forces for reducing pain and improving physical function in patients with hip osteoarthritis: Secondary analysis of a randomized controlled trial. Musculoskelet Sci Pract 2019; 41:43-48. [PMID: 30909110 DOI: 10.1016/j.msksp.2019.03.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 03/16/2019] [Accepted: 03/18/2019] [Indexed: 01/22/2023]
Abstract
BACKGROUND Long-axis distraction mobilization (LADM) of the hip has been shown to reduce pain and improve physical function in hip osteoarthritis (OA). The optimal intensity of mobilization force necessary to reduce pain and improve physical function is unknown. OBJECTIVE To compare the effects on pain and physical function of three different intensities of LADM mobilization force in hip OA patients. DESIGN Randomized controlled trial. METHODS Sixty patients with unilateral hip OA were randomized to three groups: low, medium or high force mobilization group. Participants received three treatment sessions of LADM. Pressure pain thresholds (PPT) at hip, knee and heel, physical function (Western Ontario and McMaster Universities physical function subscale, timed up and go and 40 m self-placed walk test) and pain after the physical function tests (visual analogic scale) were assessed before and after the intervention. RESULTS The three treatment groups showed significant improvements in pain and in physical function (p < 0.05). The low-force group showed the largest effects size for pain (d = 2.0) and the greatest mean percentage increase in PPTs (hip = 30.3%, knee = 34.6%, heel = 25.6%). The high-force group showed the largest effects size for physical function (d = 0.5-0.7). CONCLUSION A low-force LADM produced the largest reduction in pain and a high-force LADM the largest improvement in physical function in hip OA patients. The improvements in pain and physical function after LADM in hip OA patients appear to be modulated by the intensity of the mobilization force.
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Affiliation(s)
- Elena Estébanez-de-Miguel
- Department of Physiatrist and Nursery, Faculty of Heath Sciences, University of Zaragoza, Zaragoza, Spain.
| | | | | | - Elena Bueno-Gracia
- Department of Physiatrist and Nursery, Faculty of Heath Sciences, University of Zaragoza, Zaragoza, Spain
| | - Santos Caudevilla-Polo
- Department of Physiatrist and Nursery, Faculty of Heath Sciences, University of Zaragoza, Zaragoza, Spain
| | - Miguel Malo-Urriés
- Department of Physiatrist and Nursery, Faculty of Heath Sciences, University of Zaragoza, Zaragoza, Spain
| | - Luis Ceballos-Laita
- Department of Surgery, Ophthalmology and Physiotherapy, University of Valladolid, Valladolid, Spain
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Pasquier M, Daneau C, Marchand AA, Lardon A, Descarreaux M. Spinal manipulation frequency and dosage effects on clinical and physiological outcomes: a scoping review. Chiropr Man Therap 2019; 27:23. [PMID: 31139346 PMCID: PMC6530068 DOI: 10.1186/s12998-019-0244-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 03/13/2019] [Indexed: 12/29/2022] Open
Abstract
Introduction The burden of musculoskeletal disorders increases every year, with low back and neck pain being the most frequently reported conditions for seeking manual therapy treatment. In recent years, manual therapy research has begun exploring the dose-response relationship between spinal manipulation treatment characteristics and both clinical and physiological response to treatment. Objective The purpose of this scoping review was to identify and appraise the current state of scientific knowledge regarding the effects of spinal manipulation frequency and dosage on both clinical and physiological responses. Methods A scoping review was conducted to identify all available studies pertaining to our research question. Retrieved papers were screened using a 2-phase method, a selective sorting with titles and abstracts. Potentially relevant studies were read, and data was extracted for all included studies. Randomized control trials were assessed using the Cochrane Risk of Bias Tool for quality assessment. Results The search yielded 4854 publications from which 32 were included for analysis. Results were sorted by dosage or frequency outcomes, and divided into human or animal studies. Animal studies mainly focused on dosage and evaluated physiological outcomes only. Studies investigating spinal manipulation dosage effects involved both human and animal research, and showed that varying thrust forces, or thrust durations can impact vertebral displacement, muscular response amplitude or muscle spindle activity. Risk of bias analysis indicated only two clinical trials assessing frequency effects presented a low risk of bias. Although trends in improvement were observed and indicated that increasing the number of SM visits in a short period of time (few weeks) decreased pain and improve disability, the differences between the studied treatment frequencies, were often not statistically significant and therefore not clinically meaningful. Conclusion The results of this study showed that SM dosage and frequency effects have been mostly studied over the past two decades. Definitions for these two concepts however differ across studies. Overall, the results showed that treatment frequency does not significantly affect clinical outcomes during and following a SM treatment period. Dosage effects clearly influence short-term physiological responses to SM treatment, but relationships between these responses and clinical outcomes remains to be investigated.
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Affiliation(s)
- Mégane Pasquier
- 1Department of Anatomy, Université du Québec à Trois-Rivières, Trois- Rivières, Québec Canada.,Institut Franco-Européen de Chiropraxie, Ivry-sur-Seine, France
| | - Catherine Daneau
- 3Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois- Rivières, Québec Canada
| | - Andrée-Anne Marchand
- 1Department of Anatomy, Université du Québec à Trois-Rivières, Trois- Rivières, Québec Canada
| | - Arnaud Lardon
- Institut Franco-Européen de Chiropraxie, Ivry-sur-Seine, France.,4CIAMS, Université Paris-Sud, Université Paris-Saclay, Orsay, France.,5CIAMS, Université d'Orléans, Orléans, France
| | - Martin Descarreaux
- 3Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois- Rivières, Québec Canada
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Díez Valdés S, Vega JA, Martínez-Pubil JA. Upper Limb Neurodynamic Test 1 in patients with Acquired Brain Injury: a cross-sectional study. Brain Inj 2019; 33:1039-1044. [PMID: 31026183 DOI: 10.1080/02699052.2019.1606441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Introduction: Neurodynamic intervention is used in the treatment of patients with Acquired Brain Injury as a method to inhibit the spasticity or reduce the sensory impairment. Purpose of the study: Assess and compare bilateral median nerve mechanosensitivity and its relationship with physical and functional status in patients with hemiparesis or upper limb paresis after ABI. Materials and Methods: Volunteer Patients from the Brain Injury Rehabilitation Unit of the Hospital Universitario Central de Asturias were evaluated for six months. Taking into account inclusion and exclusion criteria, from the 98 original patients having treatment in the Unit included, only 32 were admitted to the final study. The assessment protocol incorporated as main outcomes: bilateral mechanosensitivity of the median nerve (sensory responses, structural differentiation and maximum range of movement in Upper Limb Neurodynamic Test 1) and as secondary outcomes: hypertonia, sensory impairment, upper limb motor function and Activities of Daily Living performance. Results: Significant differences were found when comparing the bilateral maximum range of movement in Upper Limb Neurodynamic Test 1. No relationship was found between the results of the neurodynamic test of the affected upper limb and the secondary outcomes. Conclusions: Mechanosensitivity disturbance observed in the affected upper limb may benefit from neurodynamic treatment.
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Affiliation(s)
- Silvia Díez Valdés
- a Departamento de Morfología y Biología Celular, Grupo SINPOS , Universidad de Oviedo , Oviedo , Spain
| | - José A Vega
- a Departamento de Morfología y Biología Celular, Grupo SINPOS , Universidad de Oviedo , Oviedo , Spain.,b Facultad de Medicina y Ciencias de la Salud , Universidad Autónoma de Chile , Temuco , Chile
| | - José A Martínez-Pubil
- c Departamento de Cirugía y Especialidades Médico-Quirúrgicas , Universidad de Oviedo , Oviedo , Spain
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Pagé I, Descarreaux M. Effects of spinal manipulative therapy biomechanical parameters on clinical and biomechanical outcomes of participants with chronic thoracic pain: a randomized controlled experimental trial. BMC Musculoskelet Disord 2019; 20:29. [PMID: 30658622 PMCID: PMC6339327 DOI: 10.1186/s12891-019-2408-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 01/08/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Spinal manipulative therapy (SMT) includes biomechanical parameters that vary between clinicians, but for which the influence on the therapy clinical effects is unknown. This parallel-randomized controlled trial aimed to investigate the effect of SMT biomechanical parameters on the outcomes of participants with chronic thoracic pain (CTP) following three treatment sessions (follow-up at one week). METHODS Adults reporting CTP (pain within the evaluated region [T6 to T8] for ≥3 months) were asked to participate in a four-session trial. At the first session, participants were randomly assigned to one of three experimental groups (different SMT doses) or the control group (no SMT). During the first three sessions, one SMT was executed at T7 for the experimental groups, while a 5-min rest was provided to the control group. SMT were delivered through an apparatus using a servo-controlled linear actuator motor and doses consisted of peak forces, impulse durations, and rates of force application set at 135 N, 125 ms and 920 N/s (group 1), at 250 N, 125 ms and 1840 N/s (group 2), and at 250 N, 250 ms, 920 N/s (group 3). Disability and pain intensity were evaluated at each session (primary outcomes). Spinal stiffness was assessed before-and-after each SMT/rest and at follow-up. Tenderness and muscle activity were evaluated during each spinal stiffness trial. Improvement was evaluated at follow-up. Differences in outcomes between groups and sessions were evaluated as well as factors associated with clinical improvement. RESULTS Eighty-one participants were recruited and 17, 20, 20 participants of the three experimental groups and 18 of the control group completed the protocol. In exception of higher pain intensity at baseline in the control group, no between-group differences were found for any of the outcomes. A decrease in pain intensity, disability, spinal stiffness, and tenderness during spinal stiffness were observed (p-values< 0.05). At follow-up, 24% of participants were classified as 'improved'. Predictors of improvement were a greater decrease in pain intensity and in tenderness (p-values< 0.05). CONCLUSIONS In an experimental setting, the delivery of a SMT does not lead to significantly different outcomes in participants with CTP than a control condition (spinal stiffness assessment). Studies are still required to explore the mechanisms underlying SMT effects. TRIAL REGISTRATION ClinicalTrials.gov NCT03063177 , registered 24 February 2017).
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Affiliation(s)
- Isabelle Pagé
- Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada. .,Neuromusculoskeletal Research Group, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada. .,Present address: Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada.
| | - Martin Descarreaux
- Neuromusculoskeletal Research Group, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada.,Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada
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Nougarou F, Massicotte D, Descarreaux M. Efficient procedure to remove ECG from sEMG with limited deteriorations: Extraction, quasi-periodic detection and cancellation. Biomed Signal Process Control 2018. [DOI: 10.1016/j.bspc.2017.07.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Neural Responses to Physical Characteristics of a High-velocity, Low-amplitude Spinal Manipulation: Effect of Thrust Direction. Spine (Phila Pa 1976) 2018; 43:1-9. [PMID: 26863348 PMCID: PMC4894003 DOI: 10.1097/brs.0000000000001344] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Electrophysiological recordings were obtained from proprioceptors in deep lumbar paraspinal muscles of anesthetized cats during high-velocity low-amplitude spinal manipulation (HVLA-SM). OBJECTIVE To determine how thrust direction of an HVLA-SM affects neural input from back musculature. SUMMARY OF BACKGROUND DATA A clinician's ability to apply the thrust of an HVLA-SM in a specified direction is considered an important component of its optimal delivery. However, previous biomechanical studies indicate that the shear force component of the thrust vector is not actually transmitted to paraspinal tissues deep to the thoracolumbar fascia because the skin-fascia interface is frictionless. METHODS Neural activity from muscle spindles in the multifidus and longissimus muscles was recorded from L6 dorsal rootlets in 18 anesthetized cats. After preload to the spinal tissues, HVLA-SMs (100-ms thrust duration) were applied through the intact skin overlying the L6 lamina. Thrusts were applied at angles oriented perpendicularly to the back and obliquely at 15° and 30° medialward or cranialward using a 6 × 6 Latin square design with three replicates. The normal force component was kept constant at 21.3 N. HVLA-SMs were preceded and followed by simulated spinal movement applied to the L6 vertebra. Changes in mean instantaneous discharge frequency (ΔMIF) of muscle spindles were determined both during the thrust and spinal movement. RESULTS ΔMIFs during the HVLA-SM thrust were significantly greater in response to all thrust directions compared with the preload alone, but there was no difference in ΔMIF for any of the thrust directions during the HVLA-SM. HVLA-SM decreased some of the responses to simulated spinal movement but thrust direction had no effect on these changes. CONCLUSION The shear force component of an HVLA-SM's thrust vector is not transmitted to the underlying vertebra sufficient to activate muscle spindles of the attached muscles. Implications for clinical practice and clinical research are discussed. LEVEL OF EVIDENCE N/A.
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Fryer G. Integrating osteopathic approaches based on biopsychosocial therapeutic mechanisms. Part 1: The mechanisms. INT J OSTEOPATH MED 2017. [DOI: 10.1016/j.ijosm.2017.05.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Influence of Spinal Manipulative Therapy Force Magnitude and Application Site on Spinal Tissue Loading: A Biomechanical Robotic Serial Dissection Study in Porcine Motion Segments. J Manipulative Physiol Ther 2017; 40:387-396. [PMID: 28822473 DOI: 10.1016/j.jmpt.2017.05.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Revised: 05/22/2017] [Accepted: 05/25/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVE In order to define the relation between spinal manipulative therapy (SMT) input parameters and the distribution of load within spinal tissues, the aim of this study was to determine the influence of force magnitude and application site when SMT is applied to cadaveric spines. METHODS In 10 porcine cadavers, a servo-controlled linear actuator motor provided a standardized SMT simulation using 3 different force magnitudes (100N, 300N, and 500N) to 2 different cutaneous locations: L3/L4 facet joint (FJ), and L4 transverse processes (TVP). Vertebral kinematics were tracked optically using indwelling bone pins, the motion segment removed and mounted in a parallel robot equipped with a 6-axis load cell. The kinematics of each SMT application were replicated robotically. Serial dissection of spinal structures was conducted to quantify loading characteristics of discrete spinal tissues. Forces experienced by the L3/L4 segment and spinal structures during SMT replication were recorded and analyzed. RESULTS Spinal manipulative therapy force magnitude and application site parameters influenced spinal tissues loading. A significant main effect (P < .05) of force magnitude was observed on the loads experienced by the intact specimen and supra- and interspinous ligaments. The main effect of application site was also significant (P < .05), influencing the loading of the intact specimen and facet joints, capsules, and ligamentum flavum (P < .05). CONCLUSION Spinal manipulative therapy input parameters of force magnitude and application site significantly influence the distribution of forces within spinal tissues. By controlling these SMT parameters, clinical outcomes may potentially be manipulated.
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Fryer G, Bird M, Robbins B, Johnson JC. Acute electromyographic responses of deep thoracic paraspinal muscles to spinal manual therapy interventions. An experimental, randomized cross-over study. J Bodyw Mov Ther 2017; 21:495-502. [PMID: 28750955 DOI: 10.1016/j.jbmt.2017.04.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 04/24/2017] [Accepted: 04/25/2017] [Indexed: 11/27/2022]
Abstract
This single group, randomized, cross-over study explored whether manual therapy alters motor tone of deep thoracic back muscles by examining resting electromyographic activity (EMG) after 2 types of manual therapy and a sham control intervention. Twenty-two participants with thoracic spinal pain (15 females, 7 males, mean age 28.1 ± 6.4 years) had dual fine-wire, intramuscular electrodes inserted into deep transversospinalis muscles at a thoracic level where tissues appeared abnormal to palpation (AbP) and at 2 sites above and below normal and non-tender to palpation (NT). A surface electrode was on the contralateral paraspinal mass at the level of AbP. EMG signals were recorded for resting prone, two 3-s free neck extension efforts, two 3-s resisted maximal voluntary isometric contractions (MVIC), and resting prone before the intervention. Randomized spinal manipulation, counterstrain, or sham manipulation was delivered and EMG re-measured. Participants returned 1 and 2 weeks later for the remaining 2 treatments. Reductions in resting EMG followed counterstrain in AbP (median decrease 3.3%, P = 0.01) and NT sites (median decrease 1.0%, P = 0.05) and for the surface electrode site (median decrease 2.0%, P = 0.009). Reduction in EMG following counterstrain during free neck extension was found for the surface electrode site (median decrease 2.7%, P < 0.01). Spinal manipulation produced no change in EMG, whereas counterstrain technique produced small significant reductions in paraspinal muscle activity during prone resting and free neck extension conditions. The clinical relevance of these changes is unclear.
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Affiliation(s)
- Gary Fryer
- A.T. Still Research Institute, A.T. Still University, Kirksville, MO, USA; College of Health and Biomedicine, Victoria University, Melbourne, Australia.
| | - Michael Bird
- Department of Health and Exercise Sciences, Truman State University, Kirksville, MO, USA.
| | - Barry Robbins
- Department of Neurobehavioral Sciences, Kirksville College of Osteopathic Medicine, A.T. Still University, Kirksville, MO, USA.
| | - Jane C Johnson
- A.T. Still Research Institute, A.T. Still University, Kirksville, MO, USA.
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Reed WR, Cranston JT, Onifer SM, Little JW, Sozio RS. Decreased spontaneous activity and altered evoked nociceptive response of rat thalamic submedius neurons to lumbar vertebra thrust. Exp Brain Res 2017; 235:2883-2892. [PMID: 28687855 DOI: 10.1007/s00221-017-5013-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 06/14/2017] [Indexed: 12/18/2022]
Abstract
The thalamus is a central structure important to modulating and processing all mechanoreceptor input destined for the cortex. A large number of diverse mechanoreceptor endings are stimulated when a high velocity low amplitude thrust is delivered to the lumbar spine during spinal manipulation. The objective of this study was to determine if a lumbar thrust alters spontaneous and/or evoked nociceptive activity in medial thalamic submedius (Sm) neurons. Extracellular recordings were obtained from 94 thalamic Sm neurons in 54 urethane-anesthetized adult Wistar rats. Spontaneous activity was recorded 5 min before and after an L5 control (no thrust) and thrust (85% rat body weight; 100 ms) procedure. In a subset of responsive nociceptive-specific neurons, mean changes in noxious-evoked response (10-s pinch with clip; 795 g) at three sites (tail, contra- and ipsilateral hindpaw) were determined following an L5 thrust. Mean changes in Sm spontaneous activity (60 s bins) and evoked noxious response were compared using a mixed model repeated measures ANOVA with Bonferroni post hoc t tests and paired t tests, respectively. Compared to control, spontaneous Sm activity decreased 180-240 s following the lumbar thrust (p < 0.005). Inhibitory evoked responses were attenuated in the contralateral hindpaw following an L5 thrust compared to control (p < 0.05). No other changes in spontaneous or noxious-evoked Sm activity were found. A delayed, but prolonged suppression of spontaneous Sm activity along with changes in noxious-evoked inhibitory responses in the contralateral hindpaw following lumbar vertebra thrust suggest that thalamic submedius neurons may play a role in central pain modulation related to manual therapy intervention.
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Affiliation(s)
- William R Reed
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, IA, USA.
- Department of Physical Therapy, School of Health Professions, UAB, The University of Alabama at Birmingham, Webb 318, 1720 2nd Avenue South, Birmingham, AL, 35294-1212, USA.
| | - Jamie T Cranston
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, IA, USA
| | - Stephen M Onifer
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, IA, USA
| | - Joshua W Little
- Department of Surgery, Center for Anatomical Science and Education, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Randall S Sozio
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, IA, USA
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Abstract
STUDY DESIGN Comparative study using robotic replication of spinal manipulative therapy (SMT) vertebral kinematics together with serial dissection. OBJECTIVE The aim of this study was to quantify loads created in cadaveric spinal tissues arising from three different forms of SMT application. SUMMARY OF BACKGROUND DATA There exist many distinct methods by which to apply SMT. It is not known presently whether different forms of SMT application have different effects on spinal tissues. Should the method of SMT application modulate spinal tissue loading, quantifying this relation may help explain the varied outcomes of SMT in terms of effect and safety. METHODS SMT was applied to the third lumbar vertebra in 12 porcine cadavers using three SMT techniques: a clinical device that applies forces through a hand-held instrument (INST), a manual technique of applying SMT clinically (MAN) and a research device that applies parameters of manual SMT through a servo-controlled linear actuator motor (SERVO). The resulting kinematics from each SMT application were tracked optically via indwelling bone pins. The L3/L4 segment was then removed, mounted in a parallel robot and the resulting kinematics from SMT replayed for each SMT application technique. Serial dissection of spinal structures was conducted to quantify loading characteristics of discrete spinal tissues. RESULTS In terms of load magnitude, SMT application with MAN and SERVO created greater forces than INST in all conditions (P < 0.05). Additionally, MAN and SERVO created comparable posterior forces in the intact specimen, but MAN created greater posterior forces on IVD structures compared to SERVO (P < 0.05). CONCLUSION Specific methods of SMT application create unique vertebral loading characteristics, which may help explain the varied outcomes of SMT in terms of effect and safety. LEVEL OF EVIDENCE N/A.
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Triano JJ, Lester S, Starmer D, Hewitt EG. Manipulation Peak Forces Across Spinal Regions for Children Using Mannequin Simulators. J Manipulative Physiol Ther 2017; 40:139-146. [PMID: 28274487 DOI: 10.1016/j.jmpt.2017.01.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 10/25/2016] [Accepted: 01/10/2017] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The purpose of this work was to create an exploratory database of manipulation treatment force variability as a function of the intent of an experienced clinician sub-specializing in the care of children to match treatment to childhood category. Data of this type are necessary for realistic planning of dose-response and safety studies on therapeutic benefit. METHODS The project evaluated the transmitted peak forces of procedures applied to mannequins of different stature for younger and older children. Common procedures for the cervical, thoracic, and lumbar spine and sacroiliac joint were administered to estimate variability by a single experienced practitioner and educator in pediatric manipulation attempting to modulate for childhood category. Results described for peak components in the cardinal axes and for peak total forces were cataloged and compared with consensus estimates of force from the literature. RESULTS Mean force values for both components and total force peaks monotonically increased with childhood category analogous to consensus expectations. However, a mismatch was observed between peak values measured and consensus predictions that ranged by a factor of 2 to 3.5, particularly in the upper categories. Quantitative data permit a first estimate of effect size for future clinical studies. CONCLUSIONS The findings of this study indicate that recalibration of spinal manipulation performance of experienced clinicians toward arbitrary target values similar to consensus estimates is feasible. What is unclear from the literature or these results is the identity of legitimate target values that are both safe and clinically effective based on childhood categories in actual practice.
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Affiliation(s)
- John J Triano
- Graduate Education and Research, Canadian Memorial Chiropractic College, Toronto, ON, Canada.
| | - Steven Lester
- Undergraduate Education, Canadian Memorial Chiropractic College, Toronto, ON, Canada
| | - David Starmer
- Simulation Lab, Canadian Memorial Chiropractic College, Toronto, ON, Canada
| | - Elise G Hewitt
- Adjunct Faculty, University of Western States, Portland, OR
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Nougarou F, Pagé I, Loranger M, Dugas C, Descarreaux M. Neuromechanical response to spinal manipulation therapy: effects of a constant rate of force application. Altern Ther Health Med 2016; 16:161. [PMID: 27249939 PMCID: PMC4890324 DOI: 10.1186/s12906-016-1153-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 05/28/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND Neuromechanical responses to spinal manipulation therapy (SMT) have been shown to be modulated through the variation of SMT biomechanical parameters: peak force, time to peak force, and preload force. Although rate of force application was modulated by the variation of these parameters, the assumption that neuromuscular responses are modulated by the rate of force application remains to be confirmed. Therefore, the purpose of the present study was to evaluate the effect of a constant rate of force application in neuromechanical responses to SMT in healthy adults. METHODS Four SMT force-time profiles presenting different time to peak force and peak force, but with a constant rate of force application were applied on 25 healthy participants' T7 transverse processes. Muscular responses were recorded through surface electromyography electrodes (T6 and T8 levels), while vertebral displacements were assessed through pasted kinematic markers on T6 to T8 spinous processes. Effects of SMT force-time profiles on neuromechanical responses were assessed using repeated-measures ANOVAs. RESULTS There was no main effect of SMT force-time profile modulation on muscular responses (ps > .05) except for the left T8 (F (3, 72) = 3.23, p = .03) and left T6 (F (3, 72) = 2.94, p = .04). Muscular responses were significantly lower for the lowest peak force condition than the highest (for T8) or second highest (for T6). Analysis showed that increasing the SMT peak force (and concomitantly time to peak force) led to a significant vertebral displacement increase for the contacted vertebra (F T7 (1, 17) = 354.80, p < .001) and both adjacent vertebras (F T6 (1, 12) = 104.71, p < .001 and F T8 (1, 19) = 468.68, p < .001). CONCLUSION This study showed that peak force modulation using constant rate of force application leads to similar neuromuscular responses. Coupled with previous investigations of SMT peak force and duration effects, the results suggest that neuromuscular responses to SMT are mostly influenced by the rate of force application, while peak force modulation yields changes in the vertebral displacement. Rate of force application should therefore be defined in future studies. Clinical implications of various SMT dosages in patients with spine related pain should also be investigated. TRIAL REGISTRATION ClinicalTrials.gov NCT02550132 . Registered 8 September 2015.
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Gorrell LM, Beath K, Engel RM. Manual and Instrument Applied Cervical Manipulation for Mechanical Neck Pain: A Randomized Controlled Trial. J Manipulative Physiol Ther 2016; 39:319-329. [PMID: 27180949 DOI: 10.1016/j.jmpt.2016.03.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 10/01/2015] [Accepted: 10/14/2015] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The purpose of this study was to compare the effects of 2 different cervical manipulation techniques for mechanical neck pain (MNP). METHODS Participants with MNP of at least 1 month's duration (n = 65) were randomly allocated to 3 groups: (1) stretching (control), (2) stretching plus manually applied manipulation (MAM), and (3) stretching plus instrument-applied manipulation (IAM). MAM consisted of a single high-velocity, low-amplitude cervical chiropractic manipulation, whereas IAM involved the application of a single cervical manipulation using an (Activator IV) adjusting instrument. Preintervention and postintervention measurements were taken of all outcomes measures. Pain was the primary outcome and was measured using visual analogue scale and pressure pain thresholds. Secondary outcomes included cervical range of motion, hand grip-strength, and wrist blood pressure. Follow-up subjective pain scores were obtained via telephone text message 7 days postintervention. RESULTS Subjective pain scores decreased at 7-day follow-up in the MAM group compared with control (P = .015). Cervical rotation bilaterally (ipsilateral: P = .002; contralateral: P = .015) and lateral flexion on the contralateral side to manipulation (P = .001) increased following MAM. Hand grip-strength on the contralateral side to manipulation (P = .013) increased following IAM. No moderate or severe adverse events were reported. Mild adverse events were reported on 6 occasions (control, 4; MAM, 1; IAM, 1). CONCLUSION This study demonstrates that a single cervical manipulation is capable of producing immediate and short-term benefits for MNP. The study also demonstrates that not all manipulative techniques have the same effect and that the differences may be mediated by neurological or biomechanical factors inherent to each technique.
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Affiliation(s)
- Lindsay M Gorrell
- Sessional Academic, Department of Chiropractic, Macquarie University, Sydney, NSW, Australia
| | - Kenneth Beath
- Lecturer, Department of Statistics, Macquarie University, Sydney, NSW, Australia
| | - Roger M Engel
- Senior Lecturer, Department of Chiropractic, Macquarie University, Sydney, NSW, Australia.
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Starmer DJ, Guist BP, Tuff TR, Warren SC, Williams MGR. Changes in Manipulative Peak Force Modulation and Time to Peak Thrust among First-Year Chiropractic Students Following a 12-Week Detraining Period. J Manipulative Physiol Ther 2016; 39:311-7. [PMID: 27059248 DOI: 10.1016/j.jmpt.2016.02.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 09/05/2015] [Accepted: 09/18/2015] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The purpose of this study was to analyze differences in peak force modulation and time-to-peak thrust in posterior-to-anterior (PA) high-velocity-low-amplitude (HVLA) manipulations in first-year chiropractic students prior to and following a 12-week detraining period. METHODS Chiropractic students (n=125) performed 2 thrusts prior to and following a 12-week detraining period: total peak force targets were 400 and 600 N, on a force-sensing table using a PA hand contact of the participant's choice (bilateral hypothenar, bilateral thenar, or cross bilateral). Force modulation was compared to defined target total peak force values of 600 and 400 N, and time-to-peak thrust was compared between data sets using 2-tailed paired t-tests. RESULTS Total peak force for the 600 N intensity varied by 124.11 + 65.77 N during the pre-test and 123.29 + 61.43 N during the post-test compared to the defined target of 600 N (P = .90); total peak force for the 400 N intensity varied by 44.91 + 34.67 N during the pre-test and 44.60 + 32.63 N during the post-test compared to the defined target of 400 N (P = .57). Time-to-peak thrust for the 400 N total peak force was 137.094 + 42.47 milliseconds during the pre-test and 125.385 + 37.46 milliseconds during the post-test (P = .0004); time-to-peak thrust for the 600 N total peak force was 136.835 + 40.48 milliseconds during the pre-test and 125.385 + 33.78 milliseconds during the post-test (P = .03). CONCLUSIONS The results indicate no drop-off in the ability to modulate force for either thrust intensity, but did indicate a statistically significant change in time-to-peak thrust for the 400 N total peak force thrust intensity in first-year chiropractic students following a 12-week detraining period.
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Affiliation(s)
- David J Starmer
- Education Coordinator, Simulation Lab, Canadian Memorial Chiropractic College, Toronto, ON, Canada; Chair, Faculty Council, Canadian Memorial Chiropractic College, Toronto, ON, Canada
| | - Brett P Guist
- Research Assistant, Canadian Memorial Chiropractic College, Toronto, ON, Canada.
| | - Taylor R Tuff
- Sports Science Resident, Department of Graduate Education and Research, Canadian Memorial Chiropractic College, Toronto, ON, Canada
| | - Sarah C Warren
- Research Assistant, Canadian Memorial Chiropractic College, Toronto, ON, Canada
| | - Matthew G R Williams
- Research Assistant, Canadian Memorial Chiropractic College, Toronto, ON, Canada; Research Assistant, University of New Brunswick, Fredericton, NB, Canada
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Pagé I, Nougarou F, Descarreaux M. Neuromuscular response amplitude to mechanical stimulation using large-array surface electromyography in participants with and without chronic low back pain. J Electromyogr Kinesiol 2016; 27:24-9. [DOI: 10.1016/j.jelekin.2016.01.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 12/21/2015] [Accepted: 01/02/2016] [Indexed: 11/17/2022] Open
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Loranger M, Treboz J, Boucher JA, Nougarou F, Dugas C, Descarreaux M. Correlation of expertise with error detection skills of force application during spinal manipulation learning. THE JOURNAL OF CHIROPRACTIC EDUCATION 2016; 30:1-6. [PMID: 26270897 PMCID: PMC4770989 DOI: 10.7899/jce-15-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE Most studies on spinal manipulation learning demonstrate the relevance of including motor learning strategies in chiropractic curricula. Two outcomes of practice are the production of movement in an efficient manner and the improved capability of learners to evaluate their own motor performance. The goals of this study were to evaluate if expertise is associated with increased spinal manipulation proficiency and if error detection skills of force application during a high-velocity low-amplitude spinal manipulation are related to expertise. METHODS Three groups of students and 1 group of expert chiropractors completed 10 thoracic spine manipulations on an instrumented device with the specific goal of reaching a maximum peak force of 300 N after a brief period of practice. After each trial, participants were asked to give an estimate of their maximal peak force. Force-time profiles were analyzed to determine the biomechanical parameters of each participant and the participant's capacity to estimate his or her own performance. RESULTS Significant between-group differences were found for each biomechanical parameter. No significant difference was found between groups for the error detection variables (p > .05). The lack of significant effects related to the error detection capabilities with expertise could be related to the specificity of the task and how the training process was structured. CONCLUSION This study confirms that improvements in biomechanical parameters of spinal manipulation are related to expertise. Feedback based on error detection could be implemented in chiropractic curricula to improve trainee abilities in detecting motor execution errors.
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Bishop MD, Torres-Cueco R, Gay CW, Lluch-Girbés E, Beneciuk JM, Bialosky JE. What effect can manual therapy have on a patient's pain experience? Pain Manag 2015; 5:455-64. [PMID: 26401979 DOI: 10.2217/pmt.15.39] [Citation(s) in RCA: 98] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Manual therapy (MT) is a passive, skilled movement applied by clinicians that directly or indirectly targets a variety of anatomical structures or systems, which is utilized with the intent to create beneficial changes in some aspect of the patient pain experience. Collectively, the process of MT is grounded on clinical reasoning to enhance patient management for musculoskeletal pain by influencing factors from a multidimensional perspective that have potential to positively impact clinical outcomes. The influence of biomechanical, neurophysiological, psychological and nonspecific patient factors as treatment mediators and/or moderators provides additional information related to the process and potential mechanisms by which MT may be effective. As healthcare delivery advances toward personalized approaches there is a crucial need to advance our understanding of the underlying mechanisms associated with MT effectiveness.
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Affiliation(s)
- Mark D Bishop
- Department of Physical Therapy, PO Box 100154, University of Florida, Gainesville, FL 32610, USA.,Center for Pain Research & Behavioral Health, PO Box 100165, University of Florida, Gainesville, FL 32610, USA.,Pain Research & Investigation Center of Excellence, 2004 Mowry Road, University of Florida, Gainesville, FL 32610, USA
| | - Rafael Torres-Cueco
- Department of Physical Therapy, University of Valencia, Av. de Blasco Ibáñez, 13, 46010 València, Spain
| | - Charles W Gay
- Department of Physical Therapy, PO Box 100154, University of Florida, Gainesville, FL 32610, USA.,Center for Pain Research & Behavioral Health, PO Box 100165, University of Florida, Gainesville, FL 32610, USA
| | - Enrique Lluch-Girbés
- Department of Physical Therapy, University of Valencia, Av. de Blasco Ibáñez, 13, 46010 València, Spain
| | - Jason M Beneciuk
- Department of Physical Therapy, PO Box 100154, University of Florida, Gainesville, FL 32610, USA.,Brooks Rehabilitation-College of Public Health & Health Professions Research Collaboration, PO Box 100154, University of Florida, Gainesville, FL, 32610, USA
| | - Joel E Bialosky
- Department of Physical Therapy, PO Box 100154, University of Florida, Gainesville, FL 32610, USA.,Center for Pain Research & Behavioral Health, PO Box 100165, University of Florida, Gainesville, FL 32610, USA
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37
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Consistency and Malleability of Manipulation Performance in Experienced Clinicians: A Pre-Post Experimental Design. J Manipulative Physiol Ther 2015. [DOI: 10.1016/j.jmpt.2015.05.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Neural responses to the mechanical characteristics of high velocity, low amplitude spinal manipulation: Effect of specific contact site. ACTA ACUST UNITED AC 2015; 20:797-804. [PMID: 25841562 DOI: 10.1016/j.math.2015.03.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 02/25/2015] [Accepted: 03/17/2015] [Indexed: 11/21/2022]
Abstract
BACKGROUND Systematic investigations are needed identifying how variability in the biomechanical characteristics of spinal manipulation affects physiological responses. Such knowledge may inform future clinical practice and research study design. OBJECTIVE To determine how contact site for high velocity, low amplitude spinal manipulation (HVLA-SM) affects sensory input to the central nervous system. DESIGN HVLA-SM was applied to 4 specific anatomic locations using a no-HVLA-SM control at each location randomized in an 8×8 Latin square design in an animal model. METHODS Neural activity from muscle spindles in the multifidus and longissimus muscles were recorded from L6 dorsal rootlets in 16 anesthetized cats. A posterior to anterior HVLA-SM was applied through the intact skin overlying the L6 spinous process, lamina, inferior articular process and L7 spinous process. HVLA-SMs were preceded and followed by simulated spinal movement applied to the L6 vertebra. Change in mean instantaneous discharge frequency (ΔMIF) was determined during the thrust and the simulated spinal movement. RESULTS All contact sites increased L6 muscle spindle discharge during the thrust. Contact at all L6 sites significantly increased spindle discharge more than at the L7 site when recording at L6. There were no differences between L6 contact sites. For simulated movement, the L6 contact sites but not the L7 contact site significantly decreased L6 spindle responses to a change in vertebral position but not to movement to that position. CONCLUSIONS This animal study showed that contact site for an HVLA-SM can have a significant effect on the magnitude of sensory input arising from muscle spindles in the back.
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Reed WR, Pickar JG, Sozio RS, Long CR. Effect of spinal manipulation thrust magnitude on trunk mechanical activation thresholds of lateral thalamic neurons. J Manipulative Physiol Ther 2015; 37:277-86. [PMID: 24928636 DOI: 10.1016/j.jmpt.2014.04.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 04/16/2014] [Accepted: 04/29/2014] [Indexed: 12/27/2022]
Abstract
OBJECTIVES High-velocity low-amplitude spinal manipulation (HVLA-SM), as performed by doctors who use manual therapy (eg, doctors of chiropractic and osteopathy), results in mechanical hypoalgesia in clinical settings. This hypoalgesic effect has previously been attributed to alterations in peripheral and/or central pain processing. The objective of this study was to determine whether thrust magnitude of a simulated HVLA-SM alters mechanical trunk response thresholds in wide dynamic range (WDR) and/or nociceptive specific (NS) lateral thalamic neurons. METHODS Extracellular recordings were carried out in the thalamus of 15 anesthetized Wistar rats. Lateral thalamic neurons having receptive fields, which included the lumbar dorsal-lateral trunk, were characterized as either WDR (n=22) or NS (n=25). Response thresholds to electronic von Frey (rigid tip) mechanical trunk stimuli were determined in 3 directions (dorsal-ventral, 45° caudalward, and 45° cranialward) before and immediately after the dorsal-ventral delivery of a 100-millisecond HVLA-SM at 3 thrust magnitudes (control, 55%, 85% body weight). RESULTS There was a significant difference in mechanical threshold between 85% body weight manipulation and control thrust magnitudes in the dorsal-ventral direction in NS neurons (P=.01). No changes were found in WDR neurons at either HVLA-SM thrust magnitude. CONCLUSIONS This study is the first to investigate the effect of HVLA-SM thrust magnitude on WDR and NS lateral thalamic mechanical response threshold. Our data suggest that, at the single lateral thalamic neuron level, there may be a minimal spinal manipulative thrust magnitude required to elicit an increase in trunk mechanical response thresholds.
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Affiliation(s)
- William R Reed
- Associate Professor, Palmer Center for Chiropractic Research, Davenport, Iowa.
| | - Joel G Pickar
- Professor Emeritus, Palmer Center for Chiropractic Research, Davenport, Iowa
| | - Randall S Sozio
- Research Associate, Palmer Center for Chiropractic Research, Davenport, Iowa
| | - Cynthia R Long
- Professor, Director, Palmer Center of Chiropractic Research, Davenport, Iowa
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Gay CW, Robinson ME, George SZ, Perlstein WM, Bishop MD. Immediate changes after manual therapy in resting-state functional connectivity as measured by functional magnetic resonance imaging in participants with induced low back pain. J Manipulative Physiol Ther 2014; 37:614-27. [PMID: 25284739 DOI: 10.1016/j.jmpt.2014.09.001] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Revised: 08/18/2014] [Accepted: 09/01/2014] [Indexed: 01/30/2023]
Abstract
OBJECTIVE The purposes of this study were to use functional magnetic resonance imaging to investigate the immediate changes in functional connectivity (FC) between brain regions that process and modulate the pain experience after 3 different types of manual therapies (MT) and to identify reductions in experimentally induced myalgia and changes in local and remote pressure pain sensitivity. METHODS Twenty-four participants (17 men; mean age ± SD, 21.6 ± 4.2 years) who completed an exercise-injury protocol to induce low back pain were randomized into 3 groups: chiropractic spinal manipulation (n = 6), spinal mobilization (n = 8), or therapeutic touch (n = 10). The primary outcome was the immediate change in FC as measured on functional magnetic resonance imaging between the following brain regions: somatosensory cortex, secondary somatosensory cortex, thalamus, anterior and posterior cingulate cortices, anterior and poster insula, and periaqueductal gray. Secondary outcomes were immediate changes in pain intensity, measured with a 101-point numeric rating scale, and pain sensitivity, measured with a handheld dynamometer. Repeated-measures analysis of variance models and correlation analyses were conducted to examine treatment effects and the relationship between within-person changes across outcome measures. RESULTS Changes in FC were found between several brain regions that were common to all 3 MT interventions. Treatment-dependent changes in FC were also observed between several brain regions. Improvement was seen in pain intensity after all interventions (P < .05) with no difference between groups (P > .05). There were no observed changes in pain sensitivity, or an association between primary and secondary outcome measures. CONCLUSION These results suggest that MTs (chiropractic spinal manipulation, spinal mobilization, and therapeutic touch) have an immediate effect on the FC between brain regions involved in processing and modulating the pain experience. This suggests that neurophysiologic changes after MT may be an underlying mechanism of pain relief.
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Affiliation(s)
- Charles W Gay
- Postdoctoral Research Fellow, Rehabilitation Science, College of Public and Health and Health Professions, University of Florida, Gainesville, Fla.
| | - Michael E Robinson
- Professor, Department of Clinical and Health Psychology, College of Public and Health and Health Professions, University of Florida, Gainesville, FL
| | - Steven Z George
- Associate Professor and Assistant Department Chair, Department of Physical Therapy, College of Public and Health and Health Professions, University of Florida, Gainesville, FL
| | - William M Perlstein
- Associate Professor, Department of Clinical and Health Psychology, College of Public and Health and Health Professions, University of Florida, Gainesville, FL; Research Health Scientist, VA RR&D Brain Rehabilitation Research Center of Excellence (151A), Malcom Randall Veterans Administration Medical Center, Gainesville, FL
| | - Mark D Bishop
- Associate Professor, Department of Physical Therapy, College of Public and Health and Health Professions, University of Florida, Gainesville, FL
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Cho I, Hwangbo G, Lee D, Lee S. The effects of closed kinetic chain exercises and open kinetic chain exercises using elastic bands on electromyographic activity in degenerative gonarthritis. J Phys Ther Sci 2014; 26:1481-4. [PMID: 25276041 PMCID: PMC4175262 DOI: 10.1589/jpts.26.1481] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 03/31/2014] [Indexed: 12/13/2022] Open
Abstract
[Purpose] The purpose of this study was to examine the effects of closed kinetic chain
exercises (CKCEs) and open kinetic chain exercises (OKCEs) with elastic bands on the
electromyographic activity of patients with degenerative gonarthritis. [Subjects] The
study subjects were 30 degenerative gonarthritis patients who were divided into a CKCE
group (CKCEG, n=10), an OKCE group (OKCEG, n=10), and a control group (CG, n=10).
[Methods] The CKCEG and the OKCEG performed exercises with elastic bands, and the CG took
part in a quadriceps strengthening exercise. All three groups performed the exercises
three times per week for four weeks. The electromyographic activities of the subjects’
vastus medialis (VM), rectus femoris (RF), vastus lateralis (VL), semitendinosus (ST), and
biceps femoris (BF) muscles were measured and compared. [Results] Within-group comparisons
revealed that the electromyographic activities of the VM, RF, VL, ST, and BF muscles
increased significantly in the CKCEG. The OKCEG displayed significant increases in the
electromyographic activity of the VM, RF, ST, and BF muscles, and the CG showed
significant increases in the electromyographic activities of the RF, VL, ST, and BF
muscles. In between-group comparisons after the intervention, the electromyographic
activities of the VM, RF, and VL muscles of the CKCEG were significantly higher than those
of the CG. The electromyographic activities of the VM, RF, and ST muscles of the OKCEG
were significantly higher than those of the CG. [Conclusion] We consider CKCEs with
elastic bands are an effective intervention for increasing the electromyographic
activities of the VM, RF, VL, ST, and BF muscles of degenerative gonarthritis patients,
and OKCEs with elastic bands are an effective intervention for increasing the
electromyographic activities of the VM, RF, ST, and BF muscles of degenerative
gonarthritis patients.
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Affiliation(s)
- Igsoo Cho
- Department of Rehabilitation Science, Graduate School of Daegu University, Republic of Korea
| | - Gak Hwangbo
- Department of Physical Therapy, College of Rehabilitation Science, Daegu University, Republic of Korea
| | - Daehee Lee
- Department of Physical Therapy, Youngdong University, Republic of Korea
| | - Sangyong Lee
- Department of Physical Therapy, Youngdong University, Republic of Korea
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Reed WR, Sozio R, Pickar JG, Onifer SM. Effect of spinal manipulation thrust duration on trunk mechanical activation thresholds of nociceptive-specific lateral thalamic neurons. J Manipulative Physiol Ther 2014; 37:552-60. [PMID: 25220757 DOI: 10.1016/j.jmpt.2014.08.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Revised: 07/23/2014] [Accepted: 07/23/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The objective of this preliminary study was to determine if high-velocity, low-amplitude spinal manipulation (HVLA-SM) thrust duration alters mechanical trunk activation thresholds of nociceptive-specific (NS) lateral thalamic neurons. METHODS Extracellular recordings were obtained from 18 NS neurons located in 2 lateral thalamic nuclei (ventrolateral [n = 12] and posterior [n = 6]) in normal anesthetized Wistar rats. Response thresholds to electronic von Frey anesthesiometer (rigid tip) mechanical trunk stimuli applied in 3 lumbar directions (dorsal-ventral, 45° caudal, and 45° cranial) were determined before and immediately after the delivery of 3 HVLA-SM thrust durations (time control 0, 100, and 400 milliseconds). Mean changes in mechanical trunk activation thresholds were compared using a mixed model analysis of variance. RESULTS High-velocity, low-amplitude spinal manipulation duration did not significantly alter NS lateral thalamic neurons' mechanical trunk responses to any of the 3 directions tested with the anesthesiometer. CONCLUSIONS This study is the first to examine the effect of HVLA-SM thrust duration on NS lateral thalamic mechanical response thresholds. High-velocity, low-amplitude spinal manipulation thrust duration did not affect mechanical trunk thresholds.
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Affiliation(s)
- William R Reed
- Associate Professor, Palmer Center for Chiropractic Research, Davenport, IA.
| | - Randall Sozio
- Research Associate, Palmer Center for Chiropractic Research, Davenport, IA
| | - Joel G Pickar
- Professor Emeritus, Palmer Center for Chiropractic Research, Davenport, IA
| | - Stephen M Onifer
- Associate Professor, Palmer Center for Chiropractic Research, Davenport, IA
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The Role of Preload Forces in Spinal Manipulation: Experimental Investigation of Kinematic and Electromyographic Responses in Healthy Adults. J Manipulative Physiol Ther 2014; 37:287-93. [DOI: 10.1016/j.jmpt.2014.04.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 04/14/2014] [Accepted: 04/29/2014] [Indexed: 11/18/2022]
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