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Gorrell MChiroprac LM, Nyirö L, Pasquier M, Pagé I, Heneghan NR, Schweinhardt P, Descarreaux M. Spinal mobilization force-time characteristics: A scoping literature review. PLoS One 2023; 18:e0289462. [PMID: 37963125 PMCID: PMC10645339 DOI: 10.1371/journal.pone.0289462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 10/24/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Spinal mobilization (SMob) is often included in the conservative management of spinal pain conditions as a recommended and effective treatment. While some studies quantify the biomechanical (kinetic) parameters of SMob, interpretation of findings is difficult due to poor reporting of methodological details. The aim of this study was to synthesise the literature describing force-time characteristics of manually applied SMob. METHODS This study is reported in accordance with the Preferred Reporting Items for Scoping Reviews (PRISMA-ScR) statement. Databases were searched from inception to October 2022: MEDLINE (Ovid), Embase, CINAHL, ICL, PEDro and Cochrane Library. Data were extracted and reported descriptively for the following domains: general study characteristics, number of and characteristics of individuals who delivered/received SMob, region treated, equipment used and force-time characteristics of SMob. RESULTS There were 7,607 records identified and of these, 36 (0.5%) were included in the analysis. SMob was delivered to the cervical spine in 13 (36.1%), the thoracic spine in 3 (8.3%) and the lumbopelvic spine in 18 (50.0%) studies. In 2 (5.6%) studies, spinal region was not specified. For SMob applied to all spinal regions, force-time characteristics were: peak force (0-128N); duration (10-120s); frequency (0.1-4.5Hz); and force amplitude (1-102N). CONCLUSIONS This study reports considerable variability of the force-time characteristics of SMob. In studies reporting force-time characteristics, SMob was most frequently delivered to the lumbar and cervical spine of humans and most commonly peak force was reported. Future studies should focus on the detailed reporting of force-time characteristics to facilitate the investigation of clinical dose-response effects.
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Affiliation(s)
- Lindsay M. Gorrell MChiroprac
- Department of Chiropractic Medicine, Integrative Spinal Research Group, University Hospital Balgrist and University of Zürich, Zürich, Switzerland
| | - Luana Nyirö
- Department of Chiropractic Medicine, Integrative Spinal Research Group, University Hospital Balgrist and University of Zürich, Zürich, Switzerland
| | | | - Isabelle Pagé
- Department of chiropractic, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale (CIUSSS-CN), Québec City, QC, Canada
| | - Nicola R. Heneghan
- School of Sport, Exercise & Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Petra Schweinhardt
- Department of Chiropractic Medicine, Integrative Spinal Research Group, University Hospital Balgrist and University of Zürich, Zürich, Switzerland
| | - Martin Descarreaux
- Institut Franco-Européen de Chiropraxie, Toulouse, France
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
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Russell BS, Owens EF, Hosek RS, Dever LL, Weiner MT. Assessment of forces during side-posture adjustment with the use of a table-embedded force plate: Reference values for education. THE JOURNAL OF CHIROPRACTIC EDUCATION 2023; 37:73-81. [PMID: 37721390 PMCID: PMC11095653 DOI: 10.7899/jce-22-13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 01/26/2023] [Accepted: 03/18/2023] [Indexed: 09/19/2023]
Abstract
OBJECTIVE Force-sensing treatment tables are becoming more commonly used by chiropractic educational institutions. However, when a table-embedded force platform is the sole measurement method, there is little information available about what force-time values instructors and students should expect for side-posture spinal manipulative thrusts. The purpose of this report is to provide force-time values recorded with such a system during side-posture manipulation with human recipients. METHODS Student volunteers were examined by and received lumbar or pelvic side-posture manipulation from experienced chiropractors who were diplomates of the Gonstead Clinical Studies Society. Forces were recorded using proprietary software of a Bertec force platform; force and time data were analyzed with a custom-programmed software tool in Excel. RESULTS Seven doctors of chiropractic performed 24 thrusts on 23 student recipients. Preload forces, averaging 69.7 N, and thrust loading duration, averaging 167 milliseconds, were similar to previous studies of side-posture manipulation. Peak loads were higher than previous studies, averaging 1010.9 N. Other variables included prethrust liftoff force, times from thrust onset to peak force and peak load to resolution of thrust, and average rates of force loading and unloading. CONCLUSION The values we found will be used for reference at our institution and may be useful to instructors at other chiropractic educational institutions, in the teaching of lumbar side-posture manipulation. A caveat is that the values of this study reflect multiple sources of applied force, not solely the force applied directly to the spine.
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de Kock E, Yelverton C, Myburgh C. Developing spinal manipulation psychomotor skills competency: A systematic review of teaching methods. THE JOURNAL OF CHIROPRACTIC EDUCATION 2023; 37:116-123. [PMID: 37721391 PMCID: PMC11095646 DOI: 10.7899/jce-22-10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 10/13/2022] [Accepted: 05/05/2023] [Indexed: 09/19/2023]
Abstract
OBJECTIVE To update the state of the art regarding the acquisition of spinal high-velocity low-amplitude psychomotor skills competency among chiropractors and chiropractic students. METHODS Available electronic articles from 5 databases, published between June 2015 and August 2020, were obtained. Eligible studies underwent methodological quality assessments using the Joanna Briggs Institute Critical Appraisal Checklists and Cochrane Collaboration's Risk of Bias Tools. RESULTS Fourteen critically appraised studies were identified, including 10 cohort studies and 4 randomized controlled trials. There was no literature excluded due to high risk of bias. The type of augmented devices included a mannequin on a force platform, a computer-connected device, a human analogue mannequin, and a 3-dimensional electrogoniometer with an instrumented spatial linkage. CONCLUSION The use of augmented feedback devices such as human analogue mannequins with force-sensing table technology and computer-connected devices is potentially beneficial in the chiropractic curricula and may facilitate student learning and improvement of spinal manipulation. More studies are required to determine whether psychomotor skill aids translate directly into raised competency levels in novice clinicians.
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Owens EF, Dever LL, Hosek RS, Russell BS, Dc SS. Development of a mannequin lab for clinical training in a chiropractic program. THE JOURNAL OF CHIROPRACTIC EDUCATION 2022; 36:147-152. [PMID: 35394042 PMCID: PMC9536233 DOI: 10.7899/jce-21-10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 06/14/2021] [Accepted: 08/27/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Faced with COVID-19 safety protocols that severely limited the ability to conduct chiropractic technique instruction in the usual manner, our university invested the resources to develop a new mannequin lab for hands-on training, which would help supplement the loss of person-to-person contact. METHODS Training mannequins could enable student learning of palpation and adjustment skills while avoiding close human-human contact. The university had developed a mannequin over the previous 4 years consisting of a full-sized human torso with individually movable and palpable vertebrae, pelvis, and thighs. In the mannequin, 64 pressure sensors are attached to particular vertebral and skeletal landmarks and provide feedback on palpation location and level of force applied. We assembled 3 teams to produce 20 copies of that mannequin for student use. RESULTS Mannequins were produced in 7 weeks, and space was built out for a special lab. Faculty members are developing classroom procedures to introduce the mannequin to students, phase in the skills from static and motion palpation, and practice thrust performance. CONCLUSION The production run was successful, and the resulting equipment, well-received by students and faculty. In addition to helping teach manual skills, the lab serves as a platform for educational research to test the efficacy of mannequin-based training protocols. With the pressure sensors on known locations along the spine, future research may be able to test the ability of students to identify and contact specific target locations for adjustive thrusts.
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Owens EF, Hosek RS, Russell BS. Mechanical properties of a thoracic spine mannequin with variable stiffness control. THE JOURNAL OF CHIROPRACTIC EDUCATION 2021; 35:1-7. [PMID: 32930327 PMCID: PMC7958670 DOI: 10.7899/jce-19-14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 11/07/2019] [Accepted: 12/24/2019] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To test the posterior-to-anterior stiffness (PAS) of a new thoracic spine training simulator under different conditions of "fixation." METHODS We constructed a thoracic spine model using plastic bones and ribs mounted in a wooden box, with skin and soft tissue simulated by layers of silicone and foam. The spine segment could be stiffened with tension applied to cords running through the vertebrae and ribs. We tested PAS at 2 tension levels using a custom-built device to apply repetitive loads at the T6 spinous process (SP) and over adjacent soft tissue (TP) while measuring load and displacement. Stiffness was the slope of the force-displacement curve from 55 to 75 N. RESULTS Stiffness in the unconstrained (zero tension) condition over the SP averaged 11.98 N/mm and 6.72 N/mm over the TP. With tension applied, SP stiffness increased to 14.56 N/mm, and TP decreased to 6.15 N/mm. CONCLUSION Thoracic model compliance was similar to that reported for humans. The tension control system increased stiffness by 21.3% only over the SP. Stiffness over the TP was dominated by the lower stiffness of the thicker foam layer and did not change. The mannequin with these properties may be suitable for use in manual training of adjusting or PAS testing skills.
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Gorrell LM, Conway PJ, Herzog W. Differences in force-time parameters and electromyographic characteristics of two high-velocity, low-amplitude spinal manipulations following one another in quick succession. Chiropr Man Therap 2020; 28:67. [PMID: 33287851 PMCID: PMC7722317 DOI: 10.1186/s12998-020-00355-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 11/16/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Spinal manipulative therapy is an effective treatment for neck pain. However, the mechanisms underlying its clinical efficacy are not fully understood. Previous studies have not systematically compared force-time parameters and electromyographic responses associated with spinal manipulation. In this study, force-time parameters and electromyographic characteristics associated with multiple manual high-velocity, low-amplitude cervical and upper thoracic spinal manipulations were investigated. The purpose of this analysis was to compare the force-time parameters and electromyographic characteristics between two spinal manipulations delivered following one another in quick succession if the first thrust was not associated with an audible cavitation. METHODS Nine asymptomatic and eighteen symptomatic participants received six Diversified-style spinal manipulations to the cervical and upper thoracic spines during data collected February 2018 to September 2019. Peak force, rate of force application and thrust duration were measured using a pressure pad. Bipolar surface electrodes were used to measure the electromyographic responses and reflex delay times in sixteen neck, back and limb outlet muscles bilaterally. Differences in force-time parameters and electromyographic data were analyzed between the first and second thrust. RESULTS Fifty-two spinal manipulations were included in this analysis. Peak force was greater (p < 0.001) and rate of force application faster (p < 0.001) in the second thrust. Furthermore, peak electromyographic responses were higher following the second thrust in asymptomatic (p < 0.001) and symptomatic (p < 0.001) subjects. Also, electromyographic delays were shorter in the symptomatic compared to the asymptomatic participants for the second thrust (p = 0.039). There were no adverse patient events. CONCLUSION When a second manipulation was delivered because there was not audible cavitation during the first thrust, the second thrust was associated with greater treatment forces and faster thrust rates. Peak electromyographic responses were greater following the second thrust.
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Affiliation(s)
- Lindsay M. Gorrell
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta Canada
- Chiropractor, Private Practice, Calgary, Alberta Canada
| | | | - Walter Herzog
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta Canada
- Biomechanics Laboratory, School of Sports, Federal University of Santa Catarina, Florianopolis, SC Brazil
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Shannon ZK, Vining RD, Gudavalli MR, Boesch RJ. High-velocity, low-amplitude spinal manipulation training of prescribed forces and thrust duration: A pilot study. THE JOURNAL OF CHIROPRACTIC EDUCATION 2020; 34:107-115. [PMID: 30951380 PMCID: PMC7682642 DOI: 10.7899/jce-18-19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 10/18/2018] [Accepted: 11/20/2018] [Indexed: 05/14/2023]
Abstract
OBJECTIVE High-velocity, low-amplitude spinal manipulation (HVLA-SM) may generate different therapeutic effects depending on force and duration characteristics. Variability among clinicians suggests training to target specific thrust duration and force levels is necessary to standardize dosing. This pilot study assessed an HVLA-SM training program using prescribed force and thrust characteristics. METHODS Over 4 weeks, chiropractors and students at a chiropractic college delivered thoracic region HVLA-SM to a prone mannequin in six training sessions, each 30 minutes in duration. Force plates embedded in a treatment table were used to measure force over time. Training goals were 350 and 550 Newtons (N) for peak force and ≤150 ms for thrust duration. Verbal and visual feedback was provided after each training thrust. Assessments included 10 consecutive thrusts for each force target without feedback. Mixed-model regression was used to analyze assessments measured before, immediately following, and 1, 4, and 8 weeks after training. RESULTS Error from peak force target, expressed as adjusted mean constant error (standard deviation), went from 107 N (127) at baseline, to 0.2 N (41) immediately after training, and 32 N (53) 8 weeks after training for the 350 N target, and 63 N (148), -6 N (58), and 9 N (87) for the 550 N target. Student median values met thrust duration target, but doctors' were >150 ms immediately after training. CONCLUSION After participation in an HVLA-SM training program, participants more accurately delivered two prescribed peak forces, but accuracy decreased 1 week afterwards. Future HVLA-SM training research should include follow-up of 1 week or more to assess skill retention.
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Derian JM, Smith JA, Wang Y, Lam W, Kulig K. Biomechanical characteristics of lumbar manipulation performed by expert, resident, and student physical therapists. Musculoskelet Sci Pract 2020; 48:102150. [PMID: 32217304 DOI: 10.1016/j.msksp.2020.102150] [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: 07/10/2019] [Revised: 12/16/2019] [Accepted: 03/08/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Lumbar manipulation is a commonly used treatment for low back pain, but little research evidence exists regarding practitioner biomechanics during manipulation. Most existing evidence describes rate of force production through the hands into instrumented manikins and it is unclear how the practitioner moves their body and legs to generate this force. OBJECTIVES To identify and characterize important kinetic and kinematic factors in practitioners of varying experience performing lumbar manipulation in order to identify which factors distinguish experts from less experienced practitioners. STUDY DESIGN This was a cohort observational laboratory study. METHODS 43 male physical therapists (PT) and PT students (4 experts, 11 residents, 13 third year, and 15 first year students) performed 4 manipulations each on asymptomatic patient models. Angular and linear kinematics of the pelvis were measured using motion capture, and ground reaction forces were measured with force plates under the practitioner's feet. RESULTS Peak pelvic angular velocity was greater and in the opposite direction in experts compared to other groups in the frontal plane (p = 0.020) and transverse plane (p = 0.000). Experts had greater downward pelvic linear velocity than third year students and first year students (p = 0.000). Experts also demonstrated faster rate of vertical ground reaction force unloading during the manipulation (p = 0.002). CONCLUSIONS Expert performance of manipulation was characterized by increased speed of linear and angular pelvic motion, and increased modulation of vertical ground reaction force. These results help to inform educators and practitioners that teach and use this complex manual skill.
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Affiliation(s)
- Joseph M Derian
- University of Southern California, Division of Biokinesiology and Physical Therapy. Los Angeles, CA, USA
| | - Jo Armour Smith
- University of Southern California, Division of Biokinesiology and Physical Therapy. Los Angeles, CA, USA; Chapman University, Crean College of Health and Behavioral Sciences, Irvine, CA, USA.
| | - Yue Wang
- University of Southern California, Division of Biokinesiology and Physical Therapy. Los Angeles, CA, USA
| | - Wilson Lam
- University of Southern California, Division of Biokinesiology and Physical Therapy. Los Angeles, CA, USA
| | - Kornelia Kulig
- University of Southern California, Division of Biokinesiology and Physical Therapy. Los Angeles, CA, USA
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Dugailly PM, Michaud A, Feipel V, Beyer B. Reaction Force Magnitude and Orientation During Supine Thoracic Spine Thrust Manipulation: An Exploratory Analysis and Reliability of Preload and Impulse Phase. J Manipulative Physiol Ther 2020; 43:597-605. [PMID: 32593464 DOI: 10.1016/j.jmpt.2019.10.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 08/30/2019] [Accepted: 10/10/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The main purpose of this study was to explore specific kinetic parameters during supine thoracic thrust manipulation and to analyze task reliability and differences between various practitioners METHODS: Kinetic parameters were assessed by examining ground reaction force magnitude and orientation (on the basis of the zenithal angle) using force platforms. The manipulative procedure (consisting of the application of 3 preloads followed by 1 single thrust adjustment) was performed by different practitioners at 3 sessions. Application of thrust was allowed for trained practitioners only. Preload force, peak force, and vector force orientation were compared between sessions and practitioners. RESULTS Reliability analysis showed that practitioners achieved similar preload and peak force independent of the session, with comparable force orientation data. Differences between practitioners were observed for preload and peak force but not regarding the zenithal angle during the thrust phase. CONCLUSION This study is the first that explores kinetic parameters for supine thoracic thrust manipulation. Task repeatability was confirmed and several differences were observed between practitioners. Certainly, there is a need for further investigation examining both dynamic parameters (ie, velocity and accelerations) and the potential neurologic effect of such manipulative technique.
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Affiliation(s)
- Pierre-Michel Dugailly
- Laboratory for Functional Anatomy, Faculty for Motor Sciences, Université Libre de Bruxelles, Brussels, Belgium; Department of Osteopathy, CESPU-Escola Superior de Saúde do Vale do Ave, Vila Nova de Famalicão, Portugal.
| | - Antoine Michaud
- Laboratory for Functional Anatomy, Faculty for Motor Sciences, Université Libre de Bruxelles, Brussels, Belgium
| | - Véronique Feipel
- Laboratory for Functional Anatomy, Faculty for Motor Sciences, Université Libre de Bruxelles, Brussels, Belgium
| | - Benoît Beyer
- Laboratory for Functional Anatomy, Faculty for Motor Sciences, Université Libre de Bruxelles, Brussels, Belgium; Unité de Recherche en Lymphologie et en Réadaptation, Faculty for Motor Sciences, Université Libre de Bruxelles, Brussels, Belgium
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Lardon A, Pasquier M, Audo Y, Barbier-Cazorla F, Descarreaux M. Effects of an 8-week physical exercise program on spinal manipulation biomechanical parameters in a group of 1st-year chiropractic students. THE JOURNAL OF CHIROPRACTIC EDUCATION 2019; 33:118-124. [PMID: 30951379 PMCID: PMC6759008 DOI: 10.7899/jce-18-15] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To determine the effects of a physical exercise program on spinal manipulation (SM) performance in 1st-year chiropractic students. METHODS One hundred and thirteen students from 2 chiropractic schools were assigned to 1 of 2 groups: exercise group (EG) for campus A students or control group (CG) (no training) for campus B students. All participated in 2 1-hour experimental training sessions that were added to the usual technique curriculum. At the beginning and at the end of each session, SM thrust duration and preload force release were recorded as dependent variables in 5 trials performed on a force-sensing table for a total of 10 recorded trials per session. The session consisted of several drills during which augmented feedback was provided to students to improve their skills. The EG performed physical exercises (push-ups, core stabilization, and speeder board exercises) 3 times per week for an 8-week period between the 2 training sessions. RESULTS The mean thrust duration increased between the 2 sessions [+0.8 ms (±15.6)]. No difference between groups was found using a t test for independent samples (p = .94). The mean preload force release decreased between the 2 sessions (-6.1 N [±17.1]). Differences between groups were found using a t test for independent samples (p = .03); the results showed a reduction of preload force release in the participants in the EG group compared to those in the CG group (-8.1 N [±16.9] vs -0.3 N [±16.5]). CONCLUSION A physical exercise program seems to be beneficial in the SM learning process; chiropractic students should therefore be encouraged to do home physical exercises to develop their physical capabilities and improve SM delivery.
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Passmore SR, Gelley GM, Malone Q, MacNeil BJ. Tactile Perception of Pressure and Volitional Thrust Intensity Modulate Spinal Manipulation Dose Characteristics. J Manipulative Physiol Ther 2019; 42:335-342. [PMID: 31272711 DOI: 10.1016/j.jmpt.2018.11.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 10/25/2018] [Accepted: 11/15/2018] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The purpose of this study was to examine clinicians' ability to modulate spinal manipulation (SM) thrust characteristics based on their tactile perception of pressure and volitional intensity. METHODS In a cross-sectional, within-participants design, 13 doctors of chiropractic delivered SM thrusts of perceived least, appropriate, or greatest intensity of their perceived safe output level for an SM thrust on low-fidelity thoracic spine models of 4 different pressure levels. The participants performed SM over the course of 96 trials in a randomized order on combinations of thrust intensity and pressure. Dependent variables included normalized preload force, thrust force, thrust duration, peak acceleration, time to peak acceleration, and displacement. For all dependent measures, 2-factor within-participants analysis of variance models with repeated measures on both factors were performed. RESULTS Preload force increased with intensity (F2,24 = 9.72; P < .001) and model pressure (F3,36 = 4.27; P = .011). Participants modulated thrust force and displacement as each also increased with intensity escalation (F2,24 = 22.53, P < .001; F2,18 = 45.20, P < .001). The highest accelerations were observed during the greatest intensity. Increased thrust force was delivered at higher model pressures (F3,36 = 6.43; P < .001). A significant interaction demonstrated that as volitional thrust intensity increased, greater displacement was attained, particularly on low pressure models (F6,54 = 11.06; P < .001). Thrust duration and time to peak acceleration yielded no significant differences. CONCLUSION Spinal manipulation thrust dosage was modulated by the chiropractors' tactile perception of pressure and volitional intensity.
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Affiliation(s)
- Steven R Passmore
- Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, Canada; Health, Leisure, and Human Performance Research Institute, University of Manitoba, Winnipeg, Canada; College of Rehabilitation Sciences, University of Manitoba, Winnipeg, Canada; Research Department, New York Chiropractic College, Seneca Falls, New York.
| | - Geoffrey M Gelley
- College of Rehabilitation Sciences, University of Manitoba, Winnipeg, Canada
| | - Quinn Malone
- Faculty of Kinesiology & Recreation Management, University of Manitoba, Winnipeg, Canada
| | - Brian J MacNeil
- College of Rehabilitation Sciences, University of Manitoba, Winnipeg, Canada
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Moser N, Mior S, Noseworthy M, Côté P, Wells G, Behr M, Triano J. Effect of cervical manipulation on vertebral artery and cerebral haemodynamics in patients with chronic neck pain: a crossover randomised controlled trial. BMJ Open 2019; 9:e025219. [PMID: 31142519 PMCID: PMC6549698 DOI: 10.1136/bmjopen-2018-025219] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE It is hypothesised that cervical manipulation may increase the risk of cerebrovascular accidents. We aimed to determine whether cervical spine manipulation is associated with changes in vertebral artery and cerebrovascular haemodynamics measured with MRI compared with neutral neck position and maximum neck rotation in patients with chronic neck pain. SETTING The Imaging Research Centre at St. Joseph's Hospital in Hamilton, Ontario, Canada. PARTICIPANTS Twenty patients were included. The mean age was 32 years (SD ±12.5), mean neck pain duration was 5.3 years (SD ±5.7) and mean neck disability index score was 13/50 (SD ±6.4). INTERVENTIONS Following baseline measurement of cerebrovascular haemodynamics, we randomised participants to: (1) maximal neck rotation followed by cervical manipulation or (2) cervical manipulation followed by maximal neck rotation. The primary outcome, vertebral arteries and cerebral haemodynamics, was measured after each intervention and was obtained by measuring three-dimensional T1-weighted high-resolution anatomical images, arterial spin labelling and phase-contrast flow encoded MRI. Our secondary outcome was functional connectivity within the default mode network measured with resting state functional MRI. RESULTS Compared with neutral neck position, we found a significant change in contralateral blood flow following maximal neck rotation. There was also a significant change in contralateral vertebral artery blood velocity following maximal neck rotation and cervical manipulation. We found no significant changes within the cerebral haemodynamics following cervical manipulation or maximal neck rotation. However, we observed significant increases in functional connectivity in the posterior cerebrum and cerebellum (resting state MRI) after manipulation and maximum rotation. CONCLUSION Our results are in accordance with previous work, which has shown a decrease in blood flow and velocity in the contralateral vertebral artery with head rotation. This may explain why we also observed a decrease in blood velocity with manipulation because it involves neck rotation. Our work is the first to show that cervical manipulation does not result in brain perfusion changes compared with a neutral neck position or maximal neck rotation. The changes observed were found to not be clinically meaningful and suggests that cervical manipulation may not increase the risk of cerebrovascular events through a haemodynamic mechanism. TRIAL REGISTRATION NUMBER NCT02667821.
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Affiliation(s)
- Nicholas Moser
- Graduate Studies, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
| | - Silvano Mior
- Graduate Studies, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Ontario, Canada
| | - Michael Noseworthy
- Radiology, McMaster University Faculty of Engineering, Hamilton, Ontario, Canada
| | - Pierre Côté
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Ontario, Canada
| | - Greg Wells
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - Michael Behr
- Department of Medicine, Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, Ontario, Canada
| | - John Triano
- Graduate Studies, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
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Pasquier M, Barbier-Cazorla F, Audo Y, Descarreaux M, Lardon A. Learning spinal manipulation: Gender and expertise differences in biomechanical parameters, accuracy, and variability. THE JOURNAL OF CHIROPRACTIC EDUCATION 2019; 33:1-7. [PMID: 30408423 PMCID: PMC6417869 DOI: 10.7899/jce-18-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 06/23/2018] [Accepted: 07/21/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE: The purpose of this study was to investigate gender differences and expertise effects on biomechanical parameters as well as force accuracy and variability for students learning spinal manipulation. METHODS: A total of 137 fourth- and fifth-year students were recruited for the study. Biomechanical parameters (preload, time to peak force, peak force, rate of force), as well as accuracy and variability of thoracic spine manipulation performance, were evaluated during 5 consecutive trials using a force-sensing table and a target force of 450 N. Gender, expertise differences on biomechanical parameters, as well as constant, variable, and absolute error were assessed using 2-way analysis of variance. RESULTS: Analyses showed significant gender differences for several biomechanical parameters, as well as significant gender differences in accuracy and variability. Although women showed lower time to peak force and rate of force values, they were more precise and showed less variability than men when performing thoracic spine manipulations. Students with clinical expertise (fifth-year students) used less force and were more precise. CONCLUSION: Our results showed that gender differences in spinal manipulation performance exist and that these differences seem to be mainly explained by alternative motor strategies. To develop gender-specific teaching methods, future studies should explore why men and women approach spinal manipulation tasks differently.
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Van Geyt B, Dugailly PMA, De Page L, Feipel V. Relationship Between Subjective Experience of Individuals, Practitioner Seniority, Cavitation Occurrence, and 3-Dimensional Kinematics During Cervical Spine Manipulation. J Manipulative Physiol Ther 2017; 40:643-648. [PMID: 29229054 DOI: 10.1016/j.jmpt.2017.09.002] [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: 04/13/2017] [Revised: 08/24/2017] [Accepted: 09/08/2017] [Indexed: 01/05/2023]
Abstract
OBJECTIVE The purpose of this study was to assess individual subjective experience (ISE) of the recipients of a cervical manipulation and to analyze the influence of kinematics, cavitation occurrence, and practitioner seniority on individual experience. METHODS Practitioners with different seniority (years of experience) manipulated 20 asymptomatic volunteers at C3 and C5 on both sides. Kinematics were recorded using a 3-dimensional electrogoniometer, and ISE data were gathered through a questionnaire to explore the subjects' experiences of manipulation in terms of tactile sensations, relaxation, perception of the task, and therapist handling. Kinematics, occurrence of cavitation, practitioner's seniority, and ISE data were analyzed concurrently. RESULTS Motion parameters obtained during manipulation were found to be influenced by cavitation occurrence and differences between practitioners. Data analysis indicated that ISE could be grouped into 2 factors. The first revolved around grip firmness and range and speed of practitioner's gesture. The second factor represented patient's relaxation and the precision of handling. Also, most ISE data correlated with kinematics, although a subjective measurement did not always correlate the highest with its objective counterpart. When cavitation occurred, ISE ratings were higher, suggesting that participants may associate cavitation with the success of manipulations. Higher practitioner seniority (more years of experience) induced feelings of higher speed, amplitude, firmness, and precision. CONCLUSIONS Recipients of cervical manipulation experienced different subjective feelings that can be expressed in 2 dimensions. These feelings are influenced by cavitation occurrence and practitioner's seniority. A better understanding of an individual's subjective experience related to cervical manipulation could increase confidence and improve the patient-therapist relationship, and it may provide further therapeutic perspectives for the practitioners.
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Affiliation(s)
- Bernard Van Geyt
- Laboratory of Anatomy, Biomechanics and Organogenesis Faculty of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - Pierre-Michel A Dugailly
- Laboratory of Functional Anatomy, Faculty of Motor Sciences, Université Libre de Bruxelles, Brussels, Belgium.
| | | | - Veronique Feipel
- Laboratory of Anatomy, Biomechanics and Organogenesis Faculty of Medicine, Université Libre de Bruxelles, Brussels, Belgium; Laboratory of Functional Anatomy, Faculty of Motor Sciences, Université Libre de Bruxelles, Brussels, Belgium
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Owens EF, Hosek RS, Mullin L, Dever L, Sullivan SG, Russell BS. Thrust Magnitudes, Rates, and 3-Dimensional Directions Delivered in Simulated Lumbar Spine High-Velocity, Low-Amplitude Manipulation. J Manipulative Physiol Ther 2017. [DOI: 10.1016/j.jmpt.2017.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Pasquier M, Cheron C, Dugas C, Lardon A, Descarreaux M. The Effect of Augmented Feedback and Expertise on Spinal Manipulation Skills: An Experimental Study. J Manipulative Physiol Ther 2017; 40:404-410. [DOI: 10.1016/j.jmpt.2017.03.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 02/17/2017] [Accepted: 03/14/2017] [Indexed: 11/24/2022]
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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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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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Owens EF, Russell BS, Hosek RS, Sullivan SGB, Dever LL, Mullin L. Changes in adjustment force, speed, and direction factors in chiropractic students after 10 weeks undergoing standard technique training. THE JOURNAL OF CHIROPRACTIC EDUCATION 2017; 32:3-9. [PMID: 28768115 PMCID: PMC5834298 DOI: 10.7899/jce-173] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To assess the force profiles of high-velocity low-amplitude thrusts delivered to a mannequin on a force platform by novice students given only verbal instructions. METHODS Student volunteers untrained in adjusting delivered a series of adjustments to a mannequin on a force platform. Participants performed 3 light, 3 normal, and 3 heavy thrusts on 5 listings specifying contact point, hand, and direction. Force profiles were analyzed for speed and amplitude, consistency, and force discrimination. Two recording sessions occurred 10 weeks apart. RESULTS Sixteen participants (11 females, 5 male) completed the study. Peak forces ranged from 880 to 202 N for heavy thrusts and 322- to 66 N for light thrusts. Thrust rate was from 8.1 to 1.8 Newtons per millisecond. Average coefficients of variability (CV = STD/mean) at each load level (initial/final) were heavy: 17%/15%; normal: 16%/15%; and light: 20%/20%, with 0 as ideal. A force ratio measured students' abilities to distinguish thrust magnitude. The heavy/normal ratio (initial/final) was 1.35/1.39, and the light/normal ratio was 0.70/0.67. CONCLUSIONS At this point, without force feedback being used in the classroom, novice students can produce thrusts that look like those of their teachers and of experienced practitioners, but they may not produce similar speed and force values. They are consistent within and between sessions and can discriminate between light and heavy loads. A natural next step in our educational research will be to measure adjustment factors on more experienced cohorts of students with and without the presence of force-feedback training apparatus.
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Patient-Induced Reaction Forces and Moments Are Influenced by Variations in Spinal Manipulative Technique. Spine (Phila Pa 1976) 2017; 42:E71-E77. [PMID: 27270638 DOI: 10.1097/brs.0000000000001725] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN An in vivo biomechanical study. OBJECTIVE The aim of the present study was to quantify and compare the reaction loads for two spinal manipulation therapy (SMT) procedures commonly used for low back pain using a biomechanical computer model. SUMMARY OF BACKGROUND DATA Contemporary computer-driven rigid linked-segment models (LSMs) have made it feasible to analyze low back kinetics and kinematics during various activities including SMT procedures. Currently, a comprehensive biomechanical model analyzing actual differences in loading effects between different SMT procedures is lacking. METHODS Twenty-four healthy/asymptomatic participants received a total of six SMT applications, representing all combinations of two similar SMT procedures within three patient hip flexion angles. All contact forces, patient torso kinematics, and inertial properties were entered into a dynamic three-dimensional LSM to calculate lumbar reaction forces and moments. Peak net applied force along with the maximums, minimums, and ranges for each component of the three-dimensional reaction force and moment vectors during each SMT procedure was analyzed. RESULTS One specific SMT technique (lumbar spinous pull) produced greater maximum anterior-posterior reaction force and both lateral bending and axial twisting reaction moments compared to the other technique (lumbar push procedure [all P ≤ 0.034]). SMT trials without hip flexion had lower maximum medial-lateral reaction force and range compared to those with 45 and 90 degrees of hip flexion (all P ≤ 0.041). There were no interactions between procedure and hip angle for any of the dependent measurements. CONCLUSION The technique used to apply SMT and the participant's initial hip orientation induced significantly different actions on the low back. These findings and future research can improve patient outcomes and safety by informing clinicians on how to best use SMT given specific types of low back pain. LEVEL OF EVIDENCE 2.
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González-Sánchez M, Ruiz-Muñoz M, Ávila-Bolívar AB, Cuesta-Vargas AI. Kinematic real-time feedback is more effective than traditional teaching method in learning ankle joint mobilisation: a randomised controlled trial. BMC MEDICAL EDUCATION 2016; 16:261. [PMID: 27716215 PMCID: PMC5054622 DOI: 10.1186/s12909-016-0789-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 09/30/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND To analyse the effect of real-time kinematic feedback (KRTF) when learning two ankle joint mobilisation techniques comparing the results with the traditional teaching method. METHODS Double-blind randomized trial. SETTINGS Faculty of Health Sciences. PARTICIPANTS undergraduate students with no experience in manual therapy. Each student practised intensely for 90 min (45 min for each mobilisation) according to the random methodology assigned (G1: traditional method group and G2: KRTF group). G1: an expert professor supervising the student's practice, the professorstudent ratio was 1:8. G2: placed in front of a station where, while they performed the manoeuvre, they received a KRTF on a laptop. OUTCOME MEASURES total time of mobilisation, time to reach maximum amplitude, maximum angular displacement in the three axes, maximum and average velocity to reach the maximum angular displacement, average velocity during the mobilisation. RESULTS Among the pre-post intervention measurements, there were significant differences within the two groups for all outcome variables, however, G2 (KRTF) achieved significantly greater improvements in kinematic parameters for the two mobilisations (significant increase in displacement, velocity and significant reduction in the mobilisations runtime) than G1. Ankle plantar flexion: G1's measurement stability (post-intervention) ranged between 0.491 and 0.687, while G2's measurement stability ranged between 0.899 and 0.984. Ankle dorsal flexion mobilisation: G1 the measurement stability (post-intervention) ranged from 0.543 and 0.684 while G2 ranged between 0.899 and 0.974. CONCLUSION KRTF was proven to be more effective tool than traditional teaching method in the teaching - learning process of two joint mobilisation techniques. TRIAL REGISTRATION NCT02504710.
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Affiliation(s)
- Manuel González-Sánchez
- Departamento de Fisioterapia, Universidad de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Arquitecto Francisco Peñalosa s/n. (ampliación Campus Teatinos), 29071 Málaga, Spain
| | - Maria Ruiz-Muñoz
- Departamento de Enfermería y Podología, Universidad de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
| | | | - Antonio I. Cuesta-Vargas
- Departamento de Fisioterapia, Universidad de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Arquitecto Francisco Peñalosa s/n. (ampliación Campus Teatinos), 29071 Málaga, Spain
- School of Clinical Sciences at Queensland University, Brisbane, Australia
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Stainsby BE, Clarke MCS, Egonia JR. Learning spinal manipulation: A best-evidence synthesis of teaching methods. THE JOURNAL OF CHIROPRACTIC EDUCATION 2016; 30:138-151. [PMID: 26998630 PMCID: PMC5067123 DOI: 10.7899/jce-15-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate the effectiveness of different reported methods used to teach spinal manipulative therapy to chiropractic students. METHODS For this best-evidence literature synthesis, 5 electronic databases were searched from 1900 to 2015. Eligible studies were critically appraised using the criteria of the Scottish Intercollegiate Guidelines Network. Scientifically admissible studies were synthesized following best-evidence synthesis principles. RESULTS Twenty articles were critically appraised, including 9 randomized clinical trials, 9 cohort studies, and 2 systematic reviews/meta-analyses. Eleven articles were accepted as scientifically admissible. The type of teaching method aids included a Thrust in Motion cervical manikin, instrumented cardiopulmonary reanimation manikin, padded contact with a load cell, instrumented treatment table with force sensor/transducer, and Dynadjust instrument. CONCLUSIONS Several different methods exist in the literature for teaching spinal manipulative therapy techniques; however, future research in this developing area of chiropractic education is proposed. It is suggested that various teaching methods be included in the regular curricula of chiropractic colleges to aid in developing manipulation skills, efficiency, and knowledge of performance.
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O'Donnell M, Smith JA, Abzug A, Kulig K. How should we teach lumbar manipulation? A consensus study. ACTA ACUST UNITED AC 2016; 25:1-10. [PMID: 27422591 DOI: 10.1016/j.math.2016.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 05/16/2016] [Accepted: 05/20/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Spinal manipulation is an effective intervention for low back pain, yet there is little consistency in how this skill is taught. OBJECTIVES The purpose of this study was to identify what educators and clinicians believe are important characteristics of the patient and operator position prior to side-lying lumbar manipulation and the patient position and operator motion during the manipulative thrust. DESIGN A multi-disciplinary correspondence-based Delphi method. METHODS Three rounds of questionnaires were sent to physical therapists, osteopaths and chiropractors. Consensus was established in Round 3 if at least 75% of respondents identified a characteristic as very important/extremely important on a 5-point Likert scale. RESULTS 265 educators and clinicians completed the three rounds of questioning. There was consensus that localization to target segment, patient comfort, table height, and logrolling the patient towards the operator are important characteristics of patient position during the preparatory phase. During the manipulation phase, respondents agreed that it is important to maintain localization to the segment and rotate the patient's pelvis and lumbar spine. For the operator characteristics, consensus was reached for the following items; moving up and over the patient, maintaining contact using forearms, and close contact between the operator and patient (preparatory phase); generating force through the body and legs, dropping the body downwards, maintaining localization, and providing a high-velocity and low-amplitude thrust (manipulation phase). CONCLUSIONS This Delphi study successfully identified key characteristics of patient position and operator position and motion for effective delivery of side-lying lumbar spine manipulations.
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Affiliation(s)
- Michael O'Donnell
- Division of Biokinesiology and Physical Therapy, University of Southern California, 1540 East Alcazar Street, CHP-155, Los Angeles, CA 90089, USA
| | - Jo Armour Smith
- Division of Biokinesiology and Physical Therapy, University of Southern California, 1540 East Alcazar Street, CHP-155, Los Angeles, CA 90089, USA; Department of Physical Therapy, Chapman University, Irvine, CA, USA.
| | - Alex Abzug
- Paulseth and Associates Physical Therapy, Los Angeles, CA, USA
| | - Kornelia Kulig
- Division of Biokinesiology and Physical Therapy, University of Southern California, 1540 East Alcazar Street, CHP-155, Los Angeles, CA 90089, USA
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Howarth SJ, D'Angelo K, Triano JJ. Development of a Linked Segment Model to Derive Patient Low Back Reaction Forces and Moments During High-Velocity Low-Amplitude Spinal Manipulation. J Manipulative Physiol Ther 2016; 39:176-84. [PMID: 27034108 DOI: 10.1016/j.jmpt.2016.02.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 06/22/2015] [Accepted: 10/26/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The purpose of this paper is to present the experimental setup, the development, and implementation of a new scalable model capable of efficiently handling data required to determine low back kinetics during high-velocity low-amplitude spinal manipulation (HVLA-SM). METHODS The model was implemented in Visual3D software. All contact forces and moments between the patient and the external environment (2 clinician hand contact forces, 1 contact force between the patient and the treatment table), the patient upper body kinematics, and inertial properties were used as input. Spine kinetics and kinematics were determined from a single HVLA-SM applied to one healthy participant in a right side-lying posture to demonstrate the model's utility. The net applied force was used to separate the spine kinetic and kinematic time-series data from the HVLA-SM into preload as well as early and late impulse phases. RESULTS Time-series data obtained from the HVLA-SM procedure showed that the participant's spine underwent left axial rotation, combined with extension, and a reduction in left lateral bending during the procedure. All components of the reaction force, as well as the axial twist and flexion/extension reaction moments demonstrated a sinusoidal pattern during the early and late impulse phases. During the early impulse phase, the participant's spine experienced a leftward axial twisting moment of 37.0 Nm followed by a rightward moment of -45.8 Nm. The lateral bend reaction moment exhibited a bimodal pattern during the early and late impulse phases. CONCLUSION This model was the first attempt to directly measure all contact forces acting on the participant/patient's upper body, and integrate them with spine kinematic data to determine patient low back reaction forces and moments during HVLA-SM in a side-lying posture. Advantages of this model include the brevity of data collection (<1 hour), and adaptability for different patient anthropometries and clinician-patient contacts.
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Affiliation(s)
- Samuel J Howarth
- Associate Professor, McMorland Family Research Chair in Mechanobiology, Graduate Education and Research Programs, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada.
| | - Kevin D'Angelo
- Graduate Resident, Department of Graduate Education and Research Programs, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
| | - John J Triano
- Professor, Department of Graduate Education and Research Programs, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
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Lardon A, Cheron C, Pagé I, Dugas C, Descarreaux M. Systematic Augmented Feedback and Dependency in Spinal Manipulation Learning: a Randomized Comparative Study. J Manipulative Physiol Ther 2016; 39:185-91. [DOI: 10.1016/j.jmpt.2016.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 11/19/2015] [Accepted: 01/20/2016] [Indexed: 10/22/2022]
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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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Owens EF, Hosek RS, Sullivan SGB, Russell BS, Mullin LE, Dever LL. Establishing force and speed training targets for lumbar spine high-velocity, low-amplitude chiropractic adjustments. THE JOURNAL OF CHIROPRACTIC EDUCATION 2016; 30:7-13. [PMID: 26600272 PMCID: PMC4771001 DOI: 10.7899/jce-15-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE We developed an adjusting bench with a force plate supporting the lumbar portion to measure loads transmitted during lumbar manual adjustment. It will be used to provide force-feedback to enhance student learning in technique labs. The study goal is to define the learning target loads and speeds, with instructors as expert models. METHODS A total of 11 faculty members experienced in teaching Gonstead technique methods performed 81 simulated adjustments on a mannequin on the force plate. Adjustments were along 9 lumbopelvic "listings" at 3 load levels: light, normal, and heavy. We analyzed the thrusts to find preload, peak load, duration, and thrust rate. RESULTS Analysis of 891 thrusts showed wide variations between doctors. Peak loads ranged from 100 to 1400 N. All doctors showed clear distinctions between peak load levels, but there was overlap between high and low loads. Thrust rates were more uniform across doctors, averaging 3 N/ms. CONCLUSION These faculty members delivered a range of thrusts, not unlike those seen in the literature for high velocity, low amplitude manipulation. We have established at least minimum force and speed targets for student performance, but more work must be done to create a normative adjustment to guide refinement of student learning.
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Engell S, Triano JJ, Fox JR, Langevin HM, Konofagou EE. Differential displacement of soft tissue layers from manual therapy loading. Clin Biomech (Bristol, Avon) 2016; 33:66-72. [PMID: 26954891 DOI: 10.1016/j.clinbiomech.2016.02.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 01/05/2016] [Accepted: 02/17/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Understanding the biomechanics of spinal manipulative therapy requires knowing how loads are transmitted to deeper structures. This investigation monitored displacement at sequential depths in thoracic paraspinal tissues parallel with surface load directions. METHODS Participants were prone and a typical preload maneuver was applied to thoracic tissues. Ultrasound speckle tracking synchronously monitored displacement and shear deformation of tissue layers in a region of interest adjacent to load application to a depth of 4 cm. Cumulative and shearing displacements along with myoelectric activity were quantitatively estimated adjacent to loading site. FINDINGS The cephalocaudal cumulative displacement in layers parallel to the surface were, in order of depth, 1.27 (SD=0.03), 1.18 (SD=0.02), and 1.06 (SD=0.01) mm (P<0.000), respectively. The superficial/intermediate shear was 2.1 ± 2.3% whereas the intermediate/deep shear was 4.4% (SE=3.7, P=0.014). Correlation of tissue layers was stronger with application site displacement at the surface (0.87<r<0.89) than with muscle activation (0.65<r<0.67). INTERPRETATION Surface loading of the torso in combined posteroanterior and caudocephalic directions result in both displacement of tissues anteriorly and in shearing between tissue layers in the plane of the tissues strata to depths that could plausibly affect spinal tissues. Displacements of tissues more likely arise passively, consistent with load transmitted by the retinacula cutis and epimuscular force pathways. Displacements are similar in magnitude to those known to evoke biologically relevant responses in both animal and human studies.
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Affiliation(s)
- Shawn Engell
- Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - John J Triano
- Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada; Graduate Education and Research, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada.
| | - James R Fox
- Department of Neurological Sciences, College of Medicine, University of Vermont, Burlington, VT, USA
| | - Helene M Langevin
- Department of Neurological Sciences, College of Medicine, University of Vermont, Burlington, VT, USA; Osher Center for Integrative Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, MA, USA
| | - Elisa E Konofagou
- Biomedical Engineering and Radiology, Columbia University, New York, NY, USA
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Cuesta-Vargas AI, González-Sánchez M, Lenfant Y. Inertial Sensors as Real-Time Feedback Improve Learning Posterior-Anterior Thoracic Manipulation: A Randomized Controlled Trial. J Manipulative Physiol Ther 2015. [DOI: 10.1016/j.jmpt.2015.04.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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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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Gudavalli MR. Instantaneous rate of loading during manual high-velocity, low-amplitude spinal manipulations. J Manipulative Physiol Ther 2015; 37:294-9. [PMID: 24928638 DOI: 10.1016/j.jmpt.2014.01.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Revised: 01/09/2014] [Accepted: 01/09/2014] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of this study was to determine the instantaneous rate of loading during manual high-velocity, low-amplitude spinal manipulations (HVLA SMs) in the lumbar and thoracic regions and compare to the average rates of loading. METHODS Force-time profiles were recorded using a hand force transducer placed between the hand of a doctor of chiropractic and the subject's back during 14 HVLA SM thrusts on asymptomatic volunteers while 3 doctors of chiropractic delivered the spinal manipulations. Doctors also delivered 36 posterior to anterior thoracic manipulations on a mannequin. Data were collected at a sampling rate of 1000 Hz using Motion Monitor software. Force-time profile data were differentiated to obtain instantaneous rates of loading. The data were reduced using a custom-written MathCad program and analyzed descriptively. RESULTS The instantaneous rates of loading were 1.7 to 1.8 times higher than average rates of loading, and instantaneous rates of unloading were 2.1 to 2.6 times the average rates of unloading during HVLA SMs. Maximum instantaneous rates of loading occurred 102 to 111 milliseconds prior to peak load. Maximum instantaneous rates of unloading occurred 121 to 154 milliseconds after the peak load. These data may be useful for further understanding of HVLA SMs. CONCLUSIONS The instantaneous rates of loading and where they occurred may be useful data for understanding and describing HVLA SMs.
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Gudavalli MR, Vining RD, Salsbury SA, Goertz CM. Training and certification of doctors of chiropractic in delivering manual cervical traction forces: Results of a longitudinal observational study. THE JOURNAL OF CHIROPRACTIC EDUCATION 2014; 28:130-8. [PMID: 25237767 PMCID: PMC4211585 DOI: 10.7899/jce-14-18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Revised: 07/03/2014] [Accepted: 07/19/2014] [Indexed: 05/27/2023]
Abstract
Objective : Doctors of chiropractic (DCs) use manual cervical distraction to treat patients with neck pain. Previous research demonstrates variability in traction forces generated by different DCs. This article reports on a training protocol and monthly certification process using bioengineering technology to standardize cervical traction force delivery among clinicians. Methods : This longitudinal observational study evaluated a training and certification process for DCs who provided force-based manual cervical distraction during a randomized clinical trial. The DCs completed a 7-week initial training that included instructional lectures, observation, and guided practice by a clinical expert, followed by 3 hours of weekly practice sessions delivering the technique to asymptomatic volunteers who served as simulated patients. An instrument-modified table and computer software provided the DCs with real-time audible and visual feedback on the traction forces they generated and graphical displays of the magnitude of traction forces as a function of time immediately after the delivery of the treatment. The DCs completed monthly certifications on traction force delivery throughout the trial. Descriptive accounts of certification attempts are provided. Results : Two DCs achieved certification in traction force delivery over 10 consecutive months. No certification required more than 3 attempts at C5 and occiput contacts for 3 force ranges (0-20 N, 21-50 N, and 51-100 N). Conclusions : This study demonstrates the feasibility of a training protocol and certification process using bioengineering technology for training DCs to deliver manual cervical distraction within specified traction force ranges over a 10-month period.
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Cuesta-Vargas AI, Williams J. Inertial sensor real-time feedback enhances the learning of cervical spine manipulation: a prospective study. BMC MEDICAL EDUCATION 2014; 14:120. [PMID: 24942483 PMCID: PMC4075507 DOI: 10.1186/1472-6920-14-120] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Accepted: 06/12/2014] [Indexed: 06/01/2023]
Abstract
BACKGROUND Cervical Spinal Manipulation (CSM) is considered a high-level skill of the central nervous system because it requires bimanual coordinated rhythmical movements therefore necessitating training to achieve proficiency. The objective of the present study was to investigate the effect of real-time feedback on the performance of CSM. METHODS Six postgraduate physiotherapy students attending a training workshop on Cervical Spine Manipulation Technique (CSMT) using inertial sensor derived real-time feedback participated in this study. The key variables were pre-manipulative position, angular displacement of the thrust and angular velocity of the thrust. Differences between variables before and after training were investigated using t-tests. RESULTS There were no significant differences after training for the pre-manipulative position (rotation p = 0.549; side bending p = 0.312) or for thrust displacement (rotation p = 0.247; side bending p = 0.314). Thrust angular velocity demonstrated a significant difference following training for rotation (pre-training mean (sd) 48.9°/s (35.1); post-training mean (sd) 96.9°/s (53.9); p = 0.027) but not for side bending (p = 0.521). CONCLUSION Real-time feedback using an inertial sensor may be valuable in the development of specific manipulative skill. Future studies investigating manipulation could consider a randomized controlled trial using inertial sensor real time feedback compared to traditional training.
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Affiliation(s)
- Antonio I Cuesta-Vargas
- Departamento de Psiquiatría y Fisioterapia, Facultad de Ciencias de la Salud, Universidad de Málaga, Andalucia Tech, Cátedra de Fisioterapia y Discapacidad, Instituto de Biomedicina de Málaga (IBIMA), Grupo de Clinimetria (AE-14), Malaga, Spain
- School of Clinical Science, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Jonathan Williams
- School of Health and Social Care, Bournemouth University, Bournemouth, UK
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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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Gudavalli MR, Cox JM. Real-time force feedback during flexion-distraction procedure for low back pain: A pilot study. THE JOURNAL OF THE CANADIAN CHIROPRACTIC ASSOCIATION 2014; 58:193-200. [PMID: 24932023 PMCID: PMC4025089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
A form of chiropractic procedure known as Cox flexion-distraction is used by chiropractors to treat low back pain. Patient lies face down on a specially designed table having a stationery thoracic support and a moveable caudal support for the legs. The Doctor of Chiropractic (DC) holds a manual contact applying forces over the posterior lumbar spine and press down on the moving leg support to create traction effects in the lumbar spine. This paper reports on the development of real-time feedback on the applied forces during the application of the flexion-distraction procedure. In this pilot study we measured the forces applied by experienced DCs as well as novice DCs in using this procedure. After a brief training with real-time feedback novice DCs have improved on the magnitude of the applied forces. This real-time feedback technology is promising to do systematic studies in training DCs during the application of this procedure.
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Affiliation(s)
- Maruti Ram Gudavalli
- Associate Professor, Palmer Center for Chiropractic Research, 741 Brady Street, Tel. (563) 884-5260, Fax (563) 884-5227,
| | - James M Cox
- Cox Chiropractic Medicine Inc, Fort Wayne, IN 46805
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Pagé I, Nougarou F, Dugas C, Descarreaux M. The effect of spinal manipulation impulse duration on spine neuromechanical responses. THE JOURNAL OF THE CANADIAN CHIROPRACTIC ASSOCIATION 2014; 58:141-148. [PMID: 24932018 PMCID: PMC4025084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
INTRODUCTION Spinal manipulation therapy (SMT) is characterized by specific kinetic and kinematic parameters that can be modulated. The purpose of this study is to investigate fundamental aspects of SMT dose-physiological response relation in humans by varying SMT impulse duration. METHODS Twenty healthy adults were subjected to four different SMT force-time profiles delivered by a servo-controlled linear actuator motor and differing in their impulse duration. EMG responses of the left and right thoracic paraspinal muscles (T6 and T8 levels) and vertebral displacements of T7 and T8 were evaluated for all SMT phases. RESULTS Significant differences in paraspinal EMG were observed during the "Thrust phase" and immediately after ("Post-SMT1") (all T8 ps < 0.01 and T6 during the thrust ps < 0.05). Sagittal vertebral displacements were similar across all conditions (p > 0.05). CONCLUSION Decreasing SMT impulse duration leads to a linear increase in EMG response of thoracic paraspinal during and following the SMT thrust.
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Affiliation(s)
- Isabelle Pagé
- Département des sciences de l’activité physique, Université du Québec à Trois-Rivières
| | - François Nougarou
- Département des sciences de l’activité physique, Université du Québec à Trois-Rivières
| | - Claude Dugas
- Département des sciences de l’activité physique, Université du Québec à Trois-Rivières
| | - Martin Descarreaux
- Département des sciences de l’activité physique, Université du Québec à Trois-Rivières
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Williams JM, Cuesta-Vargas A. Quantification of Prone Thoracic Manipulation Using Inertial Sensor–Derived Accelerations. J Manipulative Physiol Ther 2014; 37:230-5. [DOI: 10.1016/j.jmpt.2014.02.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Revised: 01/04/2014] [Accepted: 01/09/2014] [Indexed: 10/25/2022]
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Force-Time Profile Differences in the Delivery of Simulated Toggle-Recoil Spinal Manipulation by Students, Instructors, and Field Doctors of Chiropractic. J Manipulative Physiol Ther 2013; 36:342-8. [DOI: 10.1016/j.jmpt.2013.05.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Revised: 04/19/2013] [Accepted: 05/17/2013] [Indexed: 11/22/2022]
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Entwicklung und Relevanz biomechanischer Parameter einer Manipulationstechnik. MANUELLE MEDIZIN 2013. [DOI: 10.1007/s00337-013-1033-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Myers CA, Enebo BA, Davidson BS. Optimized prediction of contact force application during side-lying lumbar manipulation. J Manipulative Physiol Ther 2013. [PMID: 23206961 DOI: 10.1016/j.jmpt.2012.10.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVES The purposes of this study included the following: (1) to predict L3 contact force during side-lying lumbar manipulation by combining direct and indirect measurements into a single mathematical framework and (2) to assess the accuracy and confidence of predicting L3 contact force using common least squares (CLS) and weighted least squares (WLS) methods. METHODS Five participants with no history of lumbar pain underwent 10 high-velocity, low-amplitude lumbar spinal manipulations at L3 in a side-lying position. Data from 5 low-force criterion standard trials where the L3 contact force was directly measured were used to generate participant-specific force prediction algorithms. These algorithms were used to predict L3 contact force in 5 experimental trials performed at therapeutic levels. The accuracy and effectiveness of CLS and WLS methods were compared. RESULTS Differences between the CLS-predicted forces and the criterion standard-measured forces were 621.0 ± 193.5 N. Differences between the WLS-predicted forces and the criterion standard-measured forces were -3.6 ± 9.1 N. The 95% limits of agreement ranged from 234.0 to 1008.0 N for the CLS and -21.9 to 14.7 N for the WLS. During both the criterion standard and experimental trials, the CLS overestimated contact forces with larger variance than the WLS. CONCLUSION This novel method to predict spinal contact force combines direct and indirect measurements into a single framework and preserves clinically relevant practitioner-participant contacts. As advanced instrumentation becomes available, this framework will enable advancements in training and high-quality research on mechanisms of spinal manipulative therapy.
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Affiliation(s)
- Casey A Myers
- Mechanical and Materials Engineering, University of Denver, Denver, CO, USA
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Descarreaux M, Nougarou F, Dugas C. Standardization of Spinal Manipulation Therapy in Humans: Development of a Novel Device Designed to Measure Dose-Response. J Manipulative Physiol Ther 2013; 36:78-83. [DOI: 10.1016/j.jmpt.2012.12.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Revised: 11/07/2012] [Accepted: 11/08/2012] [Indexed: 10/27/2022]
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Biomechanics – Review of approaches for performance training in spinal manipulation. J Electromyogr Kinesiol 2012; 22:732-9. [DOI: 10.1016/j.jelekin.2012.03.011] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2011] [Revised: 03/15/2012] [Accepted: 03/27/2012] [Indexed: 11/23/2022] Open
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Hirthe L, Möller C. Evidenz für die Effekte von Feedbackmethoden beim Erlernen von manuellen Behandlungstechniken. MANUELLE MEDIZIN 2012. [DOI: 10.1007/s00337-012-0915-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Triano JJ, Gissler T, Forgie M, Milwid D. Maturation in Rate of High-Velocity, Low-Amplitude Force Development. J Manipulative Physiol Ther 2011; 34:173-80. [DOI: 10.1016/j.jmpt.2011.02.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2010] [Revised: 01/04/2011] [Accepted: 01/14/2011] [Indexed: 10/18/2022]
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Harvey MP, Wynd S, Richardson L, Dugas C, Descarreaux M. Learning spinal manipulation: a comparison of two teaching models. THE JOURNAL OF CHIROPRACTIC EDUCATION 2011; 25:125-131. [PMID: 22069337 PMCID: PMC3204948 DOI: 10.7899/1042-5055-25.2.125] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2011] [Revised: 05/18/2011] [Accepted: 05/26/2011] [Indexed: 05/27/2023]
Abstract
PURPOSE The goal of the present study was to quantify the high-velocity, low-amplitude spinal manipulation biomechanical parameters in two cohorts of students from different teaching institutions. The first cohort of students was taught chiropractic techniques in a patient-doctor positioning practice setting, while the second cohort of students was taught in a "complete practice" manipulation setting, thus performing spinal manipulation skills on fellow student colleagues. It was hypothesized that the students exposed to complete practice would perform the standardized spinal manipulation with better biomechanical parameters. METHODS Participants (n = 88) were students enrolled in two distinct chiropractic programs. Thoracic spine manipulation skills were assessed using an instrumented manikin, which allowed the measurement of applied force. Dependent variables included peak force, time to peak force, rate of force production, peak force variability, and global coordination. RESULTS The results revealed that students exposed to complete practice demonstrated lower time to peak force values, higher peak force, and a steeper rate of force production compared with students in the patient-doctor positioning scenario. A significant group by gender interaction was also noted for the time to peak force and rate of force production variables. CONCLUSION The results of the present study confirm the importance of chiropractic technique curriculum and perhaps gender in spinal manipulation skill learning. It also stresses the importance of integrating spinal manipulation skills practice early in training to maximize the number and the quality of significant learner-instructor interactions.
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Affiliation(s)
| | | | | | | | - Martin Descarreaux
- Address correspondence to Martin Descarreaux, Département de Chiropratique, Université du Québec à Trois-Rivières, 3604 Pavillon de Chiropratique, Trois-Rivières, Québec, Canada G9A 5H7 (e-mail: )
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Quantifying the High-Velocity, Low-Amplitude Spinal Manipulative Thrust: A Systematic Review. J Manipulative Physiol Ther 2010; 33:542-53. [DOI: 10.1016/j.jmpt.2010.08.001] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2009] [Revised: 05/25/2010] [Accepted: 06/08/2010] [Indexed: 11/19/2022]
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Descarreaux M, Dugas C. Learning Spinal Manipulation Skills: Assessment of Biomechanical Parameters in a 5-Year Longitudinal Study. J Manipulative Physiol Ther 2010; 33:226-30. [DOI: 10.1016/j.jmpt.2010.01.011] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2009] [Revised: 11/27/2009] [Accepted: 12/09/2009] [Indexed: 10/19/2022]
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Descarreaux M, Dugas C, Lalanne K, Vincelette M, Normand MC. Learning spinal manipulation: the importance of augmented feedback relating to various kinetic parameters. Spine J 2006; 6:138-45. [PMID: 16517384 DOI: 10.1016/j.spinee.2005.07.001] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2005] [Revised: 06/29/2005] [Accepted: 07/07/2005] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Spinal manipulation is a widely accepted therapeutic approach in the treatment of back pain. In standard training programs, feedback on student performances is provided by an instructor based on teaching and clinical experience. Systematic study of the type of augmented feedback provided and skill learning is lacking in the literature. PURPOSE The goal of this investigation is to compare the performance of two groups of chiropractic students, one receiving traditional training from experienced instructors, and the other, augmented feedback on specific biomechanical aspects of spinal manipulation therapy using an instrumented manikin. STUDY DESIGN Randomized controlled study. PATIENT SAMPLE Thirty-one fourth-year students from the Department of Chiropractic of Université du Québec à Trois-Rivières participated in this study. OUTCOME MEASURES Kinetic parameters (force-time curves) of spinal manipulation were evaluated. METHODS Spinal manipulation parameters were measured before and after a 5-week training period in which one group received standard chiropractic training while a second group received augmented feedback about specific biomechanical parameters of spinal manipulation. For both groups, practice scheduling and time duration were similar and consisted of a weekly practice session of 90 minutes for five consecutive weeks. Both groups had to practice thoracic spine manipulation throughout the training period. RESULTS Both groups showed a decrease in peak force applied, with a diminution in the number of trials where a downward incisural point was present in preload force. Participants in the feedback training group significantly reduced their peak force variability and significantly increased their preload force. No significant difference was observed for time to peak force. CONCLUSIONS The results of this study highlight the merits of practicing with an instrumented manikin or other instrumented training aids. Such a device can provide specific feedback on specific parameters of the task during learning; it can also serve as a tool to assess the progress of students and eliminate the risks relating to repetitive spinal manipulative therapy practice on student colleagues.
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Affiliation(s)
- Martin Descarreaux
- Département de Chiropratique, Université du Québec à Trois-Rivières, 3351 boul, Des Forges, Trois-Rivières, Qc, Canada G9A 5H7.
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