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Gorrell LM, Kuntze G, Ronsky JL, Carter R, Symons B, Triano JJ, Herzog W. Kinematics of the head and associated vertebral artery length changes during high-velocity, low-amplitude cervical spine manipulation. Chiropr Man Therap 2022; 30:28. [PMID: 35650649 PMCID: PMC9158147 DOI: 10.1186/s12998-022-00438-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 05/19/2022] [Indexed: 12/01/2022] Open
Abstract
Background Cervical spine manipulation (CSM) is a frequently used treatment for neck pain. Despite its demonstrated efficacy, concerns regarding the potential of stretch damage to vertebral arteries (VA) during CSM remain. The purpose of this study was to quantify the angular displacements of the head relative to the sternum and the associated VA length changes during the thrust phase of CSM. Methods Rotation and lateral flexion CSM procedures were delivered bilaterally from C1 to C7 to three male cadaveric donors (Jan 2016–Dec 2019). For each CSM the force–time profile was recorded using a thin, flexible pressure pad (100–200 Hz), to determine the timing of the thrust. Three dimensional displacements of the head relative to the sternum were recorded using an eight-camera motion analysis system (120–240 Hz) and angular displacements of the head relative to the sternum were computed in Matlab. Positive kinematic values indicate flexion, left lateral flexion, and left rotation. Ipsilateral refers to the same side as the clinician's contact and contralateral, the opposite. Length changes of the VA were recorded using eight piezoelectric ultrasound crystals (260–557 Hz), inserted along the entire vessel. VA length changes were calculated as D = (L1 − L0)/L0, where L0 = length of the whole VA (sum of segmental lengths) or the V3 segment at CSM thrust onset; L1 = whole VA or V3 length at peak force during the CSM thrust. Results Irrespective of the type of CSM, the side or level of CSM application, angular displacements of the head and associated VA length changes during the thrust phase of CSM were small. VA length changes during the thrust phase were largest with ipsilateral rotation CSM (producing contralateral head rotation): [mean ± SD (range)] whole artery [1.3 ± 1.0 (− 0.4 to 3.3%)]; and V3 segment [2.6 ± 3.6 (− 0.4 to 11.6%)]. Conclusions Mean head angular displacements and VA length changes were small during CSM thrusts. Of the four different CSM measured, mean VA length changes were largest during rotation procedures. This suggests that if clinicians wish to limit VA length changes during the thrust phase of CSM, consideration should be given to the type of CSM used.
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Affiliation(s)
- Lindsay M Gorrell
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Canada. .,Integrative Spinal Research Group, Department of Chiropractic Medicine, University Hospital Balgrist and University of Zürich, Zurich, Switzerland.
| | - Gregor Kuntze
- Sports Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Canada
| | - Janet L Ronsky
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Canada.,Mechanical and Manufacturing Engineering, Schulich School of Engineering, University of Calgary, Calgary, Canada
| | | | | | - John J Triano
- Canadian Memorial Chiropractic College, Toronto, Canada
| | - Walter Herzog
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Canada
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Investigation of reaction force magnitude and orientation during supine thoracic thrust manipulation applied to intervertebral and costovertebral regions. Musculoskelet Sci Pract 2020; 49:102217. [PMID: 32861370 DOI: 10.1016/j.msksp.2020.102217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 06/09/2020] [Accepted: 06/30/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Spinal manipulative techniques are commonly used in manual therapies but quantified descriptive and reliability data are lacking considering supine thoracic thrust manipulation. OBJECTIVES The purpose of this study is to explore and compare kinetic parameters during supine thoracic thrust manipulation performed at two different thoracic regions. Intra-rater task repeatability and influence of practitioners were estimated. DESIGN Exploratory and agreement study. METHODS Kinetic parameters were assessed by examining reaction force magnitude and orientation (on the basis of the zenithal angle) using force platforms. Manipulative procedure (consisting in the application of 3 preloads followed by one thrust adjustment) at both intervertebral and costovertebral region was performed by different practitioners at three sessions. Application of thrust was allowed for experienced practitioners only. Preload force, peak force magnitude and vector force orientation were compared between anatomical sites, sessions and practitioners, and bias with limit of agreement were estimated. RESULTS Repeatability analysis showed that practitioners achieved similar preload and peak force independent of the session, with comparable force orientation. Differences between practitioners were observed for preload and peak force but not regarding the zenithal angle during the thrust phase. CONCLUSIONS The present study is the first that explores kinetic parameters for supine thoracic thrust manipulation applied on two different regions of the thorax. Results confirm consistency of performance among practitioners for supine manipulative techniques at intervertebral and costovertebral region. While task repeatability was confirmed, several differences were observed between practitioners. Further investigations would examine velocity, acceleration and potential neurophysiological effect of such manipulative technique.
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Van Geyt B, Dugailly PM, Klein P, Lepers Y, Beyer B, Feipel V. Assessment of in vivo 3D kinematics of cervical spine manipulation: Influence of practitioner experience and occurrence of cavitation noise. Musculoskelet Sci Pract 2017; 28:18-24. [PMID: 28715298 DOI: 10.1016/j.msksp.2017.01.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 12/20/2016] [Accepted: 01/03/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Investigations on 3D kinematics during spinal manipulation are widely reported for assessing motion data, task reliability and clinical effects. However the link between cavitation occurrence and specific kinematics remains questionable. OBJECTIVES This paper investigates the 3D head-trunk kinematics during high velocity low amplitude (HVLA) manipulation for different practitioners with respect to the occurrence of cavitation. METHODS Head-trunk 3D motions were sampled during HVLA manipulation in twenty asymptomatic volunteers manipulated by four practitioners with different seniority (years of experience). Four target levels were selected, C3 and C5 on each side, and were randomly allocated to the different practitioners. The data was recorded before, during and after each set of trial in each anatomical plane. The number of trials with cavitation occurrence was collected for each practitioner. RESULTS The manipulation task was performed using extension, ipsilateral side bending and contra-lateral axial rotation independent of side or target level. The displayed angular motion magnitudes did not exceed normal active ROM. Regardless cavitation occurrence, wide variations were observed between practitioners, especially in terms of velocity and acceleration. Cavitation occurrence was related to several kinematics features (i.e. frontal ROM and velocity, sagittal acceleration) and practitioner experience. In addition, multilevel cavitation was observed regularly. CONCLUSIONS Kinematics of cervical manipulation is dependent on practitioner and years of experience. Cavitation occurrence could be related to particular kinematics features. These aspects should be further investigated in order to improve teaching and learning of cervical manipulation technique.
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Affiliation(s)
- Bernard Van Geyt
- Laboratory of Anatomy, Biomechanics and Organogenesis (LABO), Faculty of Medicine, Université Libre de Bruxelles (ULB), Brussels, Belgium.
| | - Pierre-Michel Dugailly
- Research Unit in Osteopathy, Faculty of Motor Sciences, Université Libre de Bruxelles (ULB), Brussels, Belgium; Laboratory of Functional Anatomy, Faculty of Motor Sciences, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Paul Klein
- Research Unit in Osteopathy, Faculty of Motor Sciences, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Yves Lepers
- Research Unit in Osteopathy, Faculty of Motor Sciences, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Benoît Beyer
- Laboratory of Anatomy, Biomechanics and Organogenesis (LABO), Faculty of Medicine, Université Libre de Bruxelles (ULB), Brussels, Belgium; Laboratory of Functional Anatomy, Faculty of Motor Sciences, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Véronique Feipel
- Laboratory of Anatomy, Biomechanics and Organogenesis (LABO), Faculty of Medicine, Université Libre de Bruxelles (ULB), Brussels, Belgium; Laboratory of Functional Anatomy, Faculty of Motor Sciences, Université Libre de Bruxelles (ULB), Brussels, Belgium
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Bell S, D'Angelo K, Kawchuk GN, Triano JJ, Howarth SJ. Procedure Selection and Patient Positioning Influence Spine Kinematics During High-Velocity, Low-Amplitude Spinal Manipulation Applied to the Low Back. J Manipulative Physiol Ther 2017; 40:147-155. [PMID: 28196632 DOI: 10.1016/j.jmpt.2016.10.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 10/11/2016] [Accepted: 10/17/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVES This investigation compared indirect 3-dimensional angular kinematics (position, velocity, and acceleration) of the lumbar spine for 2 different high-velocity, low-amplitude (HVLA) spinal manipulation procedures (lumbar spinous pull or push), and altered initial patient lower limb posture. METHODS Twenty-four participants underwent 6 HVLA procedures directed toward the presumed L4 vertebra, reflecting each combination of 2 variants of a spinal manipulation application technique (spinous pull and push) and 3 initial hip flexion angles (0°, 45°, and 90°) applied using a right lateral recumbent patient position. All contact forces and moments between the patient and the external environment, as well as 3-dimensional kinematics of the patient's pelvis and thorax, were recorded. Lumbar spine angular positions, velocities, and accelerations were analyzed within the preload and impulse stages of each HVLA trial. RESULTS Lumbar spine left axial rotation was greater for the pull HVLA. The pull HVLA also generated a greater maximum (leftward) and lower minimum (rightward) axial rotation velocity and deceleration and greater leftward and rightward lateral bend velocities, acceleration, and deceleration components. Not flexing the hip produced the greatest amount of extension, as well as the lowest axial rotation and maximum axial rotation acceleration during the impulse. CONCLUSIONS This investigation provides basic kinematic information for clinicians to understand the similarities and differences between 2 HVLA side-lying manipulations in the lumbar spine. Use of these findings and novel technology can drive future research initiatives that can both affect clinical decision making and influence teaching environments surrounding spinal manipulative therapy skill acquisition.
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Affiliation(s)
- Spencer Bell
- Department of Graduate Education and Research Programs, Canadian Memorial Chiropractic College, Toronto, ON, Canada
| | - Kevin D'Angelo
- Department of Graduate Education and Research Programs, Canadian Memorial Chiropractic College, Toronto, ON, Canada
| | - Gregory N Kawchuk
- Department of Physical Therapy, University of Alberta, Alberta, BC, Canada
| | - John J Triano
- Department of Graduate Education and Research Programs, Canadian Memorial Chiropractic College, Toronto, ON, Canada
| | - Samuel J Howarth
- Department of Graduate Education and Research Programs, Canadian Memorial Chiropractic College, Toronto, ON, Canada.
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Buzzatti L, Provyn S, Van Roy P, Cattrysse E. Atlanto-axial facet displacement during rotational high-velocity low-amplitude thrust: An in vitro 3D kinematic analysis. ACTA ACUST UNITED AC 2015; 20:783-9. [DOI: 10.1016/j.math.2015.03.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2014] [Revised: 03/03/2015] [Accepted: 03/11/2015] [Indexed: 11/29/2022]
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Beyer B, Sobczak S, Salem W, Feipel V, Dugailly PM. 3D motion reliability of occipital condylar glide testing: From concept to kinematics evidence. ACTA ACUST UNITED AC 2015; 21:159-64. [PMID: 26261003 DOI: 10.1016/j.math.2015.07.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 07/03/2015] [Accepted: 07/09/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND To date, segmental data analyzing kinematics of occipital condylar testing or mobilization is lacking. OBJECTIVES The objective of this study was to assess occipitoatlantal 3D motion components and to analyze inter- and intra-rater reliability during in vitro condylar glide test. METHODS To conduct this study, four fresh cadavers were included. Dissection was carried out to ensure technical clusters placement to skull, C1 and C2. During condylar glide test, bone motion data was computed using an optoelectronic system. The reliability of motion kinematics was assessed for three skilled practitioners performing two sessions of 3 trials on two days interval. FINDINGS During testing, average absolute motion ROM (±SD) were up to 4.1 ± 2.1°, 0.7 ± 1.3° and 10.3 ± 2.5° for occipitoatlantal lateral bending, axial rotation and flexion-extension, respectively. For position variation, magnitudes were 2.3 ± 1.8 mm, 1.1 ± 1.3 mm and 2.6 ± 0.8 mm for anteroposterior, cephalocaudal and mediolateral displacements. Concerning motion reliability, variation ranged from 0.6° to 3.4° and from 0.3 mm to 1.6 mm for angular displacement and condyle position variation, respectively. In general, good to excellent agreement was observed (ICC ranging from 0.728 to 0.978) for the same operator, while consistency was limited to lateral/side bending and lateral condyle displacement between operators, with respective ICCs of 0.800 and 0.955. CONCLUSIONS This study shows specific motion patterns involving extension and lateral bending of the occipitoatlantal level for anterior condylar glide test. In addition, condyle position variation demonstrated coupled components in forward and heterolateral directions. However, task seems not to be side specific. In general, reliability of 3D motion components showed good intra-operator agreement and limited inter-operator agreement.
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Affiliation(s)
- Benoît Beyer
- Research Unit in Osteopathy, Faculty of Motor Sciences, Université Libre de Bruxelles (ULB), Brussels, Belgium; Laboratory of Functional Anatomy, Faculty of Motor Sciences, Université Libre de Bruxelles (ULB), Brussels, Belgium; Laboratory of Anatomy, Biomechanics and Organogenesis (LABO), Faculty of Medicine, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Stéphane Sobczak
- Research Unit in Osteopathy, Faculty of Motor Sciences, Université Libre de Bruxelles (ULB), Brussels, Belgium; Laboratory of Functional Anatomy, Faculty of Motor Sciences, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Walid Salem
- Research Unit in Osteopathy, Faculty of Motor Sciences, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Véronique Feipel
- Laboratory of Functional Anatomy, Faculty of Motor Sciences, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Pierre-Michel Dugailly
- Research Unit in Osteopathy, Faculty of Motor Sciences, Université Libre de Bruxelles (ULB), Brussels, Belgium; Laboratory of Functional Anatomy, Faculty of Motor Sciences, Université Libre de Bruxelles (ULB), Brussels, Belgium.
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