1
|
Mikhail J, Funabashi M, Sobczak S, Descarreaux M, Pagé I. Investigation of the factors influencing spinal manipulative therapy force transmission through the thorax: a cadaveric study. Chiropr Man Therap 2023; 31:24. [PMID: 37550682 PMCID: PMC10405484 DOI: 10.1186/s12998-023-00493-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 06/16/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND Spinal manipulative therapy (SMT) clinical effects are believed to be linked to its force-time profile characteristics. Previous studies have revealed that the force measured at the patient-table interface is most commonly greater than the one applied at the clinician-patient interface. The factors explaining this force amplification remains unclear. OBJECTIVE To determine the difference between the force applied to a cadaveric specimen's thoracic spine and the resulting force measured by a force-sensing table, as well as to evaluate the relationship between this difference and both the SMT force-time characteristics and the specimens' characteristics. METHODS Twenty-five SMTs with different force-time profiles were delivered by an apparatus at the T7 vertebra of nine human cadaveric specimens lying prone on a treatment table equipped with a force plate. The difference between the force applied by the apparatus and the resulting force measured by the force plate was calculated in absolute force (Fdiff) and as the percentage of the applied force (Fdiff%). Kinematics markers were inserted into T6 to T8 spinous and transverse processes to evaluate vertebral displacements during the SMT thrusts. Mixed-effects linear models were run to evaluate the variance in Fdiff and Fdiff% explained by SMT characteristics (peak force, thrust duration and force application rate), T6 to T8 relative and total displacements, and specimens' characteristics (BMI, height, weight, kyphosis angle, thoracic thickness). RESULTS Sixty percent of the trials showed lower force measured at the force plate than the one applied at T7. Fdiff¸ was significantly predicted (R2marginal = 0.54) by peak force, thrust duration, thoracic thickness and T6-T7 relative displacement in the z-axis (postero-anterior). Fdiff% was significantly predicted (R2marginal = 0.56) by force application rate, thoracic thickness and total T6 displacements. For both dependant variables, thoracic thickness showed the highest R2marginal out of all predictors. CONCLUSION Difference in force between the clinician-patient and the patient-table interfaces is influenced by SMT force-time characteristics and by thoracic thickness. How these differences in force are associated with vertebral displacements remains unclear. Although further studies are needed, clinicians should consider thorax thickness as a possible modulator of forces being transmitted through it during prone SMT procedures.
Collapse
Affiliation(s)
- Jérémie Mikhail
- Department of Chiropractic, Université du Québec à Trois-Rivières, 3351 Boul. des Forges, Trois-Rivières, QC, G8Z 4M3, Canada
- Research Group on Neuromusculoskeletal Disorders, Université du Québec à Trois-Rivières, 3351 Boul. des Forges, Trois-Rivières, QC, G8Z 4M3, Canada
| | - Martha Funabashi
- Department of Chiropractic, Université du Québec à Trois-Rivières, 3351 Boul. des Forges, Trois-Rivières, QC, G8Z 4M3, Canada
- Canadian Memorial Chiropractic College, 6100 Leslie St, North York, ON, M2H 3J1, Canada
| | - Stéphane Sobczak
- Research Group on Neuromusculoskeletal Disorders, Université du Québec à Trois-Rivières, 3351 Boul. des Forges, Trois-Rivières, QC, G8Z 4M3, Canada
- Department of Anatomy, Université du Québec à Trois-Rivières, 3351 Boul. des Forges, Trois-Rivières, QC, G8Z 4M3, Canada
- Research Chair in Functional Anatomy, Université du Québec à Trois-Rivières, 3351 Boul. des Forges, QC, G8Z 4M3, Trois-Rivières, Canada
| | - Martin Descarreaux
- Research Group on Neuromusculoskeletal Disorders, Université du Québec à Trois-Rivières, 3351 Boul. des Forges, Trois-Rivières, QC, G8Z 4M3, Canada
- Department of Human Kinetics, Université du Québec à Trois-Rivières, 3351 Boul. des Forges, Trois-Rivières, QC, G8Z 4M3, Canada
| | - Isabelle Pagé
- Department of Chiropractic, Université du Québec à Trois-Rivières, 3351 Boul. des Forges, Trois-Rivières, QC, G8Z 4M3, Canada.
- Research Group on Neuromusculoskeletal Disorders, Université du Québec à Trois-Rivières, 3351 Boul. des Forges, Trois-Rivières, QC, G8Z 4M3, 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), 525 Boul. Wilfrid-Hamel, Québec City, QC, G1M 2S8, Canada.
| |
Collapse
|
2
|
Funabashi M, Son J, Pecora CG, Tran S, Lee J, Howarth SJ, Kawchuk G, de Luca K. Characterization of thoracic spinal manipulation and mobilization forces in older adults. Clin Biomech (Bristol, Avon) 2021; 89:105450. [PMID: 34450432 DOI: 10.1016/j.clinbiomech.2021.105450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 07/13/2021] [Accepted: 08/11/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Spinal mobilization and spinal manipulation are common interventions used by manual therapists to treat musculoskeletal conditions in older adults. Their force-time characteristics applied to older adults' thoracic spine are important considerations for effectiveness and safety but remain unknown. This study aimed to describe the force-time characteristics of posterior-to-anterior spinal mobilization and manipulation delivered to older adults' thoracic spine. METHODS Twenty-one older adults (≥65 years) with no thoracic pain received posterior-to-anterior thoracic spinal mobilization and/or manipulation with the force characteristics a chiropractor deemed appropriate. Six-degree-of-freedom load cells and an instrumented treatment table recorded the force characteristics of both interventions at the clinician-participant and participant-table interfaces, respectively. Preload force, total peak force, time to peak and loading rate were analyzed descriptively. FINDINGS Based on data from 18 adults (56% female; average: 70 years old), mean resultant spinal mobilization forces at the clinician-participant interface were: 220 ± 51 N during preload, 323 ± 67 N total peak force, and 312 ± 38 ms time to peak. At the participant-table interface, mobilization forces were 201 ± 50 N during preload, 296 ± 63 N total peak force, and 308 ± 44 ms time to peak. Mean resultant spinal manipulation forces at the clinician-participant interface were: 260 ± 41 N during preload, 470 ± 46 N total peak force, and 165 ± 28 ms time to peak. At the participant table interface, spinal manipulation forces were 236 ± 47 N during preload, 463 ± 57 N total peak force, and 169 ± 28 ms time to peak. INTERPRETATION Results suggest older adults experience unique, but comparable force-time characteristics during spinal mobilization and manipulation delivered to their thoracic spine compared to the ones delivered to younger adults described in the literature.
Collapse
Affiliation(s)
- Martha Funabashi
- Division of Research and Innovation, Canadian Memorial Chiropractic College, 6100 Leslie St., Toronto, ON M2H 3J1, Canada; Department of Chiropractic, Université du Québec à Trois-Rivières, 3351 boulevard des Forges, Trois-Rivières, QC G9A 5H7, Canada.
| | - James Son
- Division of Research and Innovation, Canadian Memorial Chiropractic College, 6100 Leslie St., Toronto, ON M2H 3J1, Canada.
| | - Cosma Gary Pecora
- Division of Research and Innovation, Canadian Memorial Chiropractic College, 6100 Leslie St., Toronto, ON M2H 3J1, Canada.
| | - Steve Tran
- Division of Research and Innovation, Canadian Memorial Chiropractic College, 6100 Leslie St., Toronto, ON M2H 3J1, Canada.
| | - Joyce Lee
- Division of Research and Innovation, Canadian Memorial Chiropractic College, 6100 Leslie St., Toronto, ON M2H 3J1, Canada.
| | - Samuel J Howarth
- Division of Research and Innovation, Canadian Memorial Chiropractic College, 6100 Leslie St., Toronto, ON M2H 3J1, Canada.
| | - Gregory Kawchuk
- Department of Physical Therapy, University of Alberta, 8205 114 St, 3-48 Corbett Hall, Edmonton, AB T6G 2G4, Canada.
| | - Katie de Luca
- Department of Chiropractic, Macquarie University, Balaclava Road, North Ryde, Sydney, NSW 2109, Australia.
| |
Collapse
|
3
|
Butts R, Legaspi O, Nocera-Mekel A, Dunning J. Physical therapy treatment of a pediatric patient with symptoms consistent with a spinal cord injury without radiographic abnormality: A retrospective case report. J Bodyw Mov Ther 2021; 27:455-463. [PMID: 34391271 DOI: 10.1016/j.jbmt.2021.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 12/22/2020] [Accepted: 01/13/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND A spinal cord injury without radiographic abnormality (SCIWORA) is a relatively uncommon event that occurs in children following cervical trauma primarily due to sports-related injuries or physical abuse. CASE DESCRIPTION This case report describes an 11-year-old wrestler that developed signs and symptoms consistent with a SCIWORA following neck trauma during competition. Despite all diagnostic tests being inconclusive, the patient demonstrated increased cervical, thoracic, and lumbar paraspinal tone along with pain, loss of sensation, loss of mobility, and weakness of the lower extremities. As a result, the patient was confined to a wheelchair and required maximum assistance to transfer and ambulate with a walker. The patient was referred to physical therapy nine days after the traumatic event, where he received interferential current with moist heat, myofascial release of paraspinal muscles, functional exercise, gait training, and spinal manipulative therapy targeting the cervical, thoracic, and lumbar vertebrae. OUTCOME After 13 physical therapy treatments over 5-weeks, the patient was able to ambulate independently and perform all activities of daily living without pain or functional limitation. The following case report outlines this patient's successful journey toward recovery. CONCLUSION This case report suggests that spinal manipulative therapy may be a safe and effective intervention when used within a multi-modal treatment strategy for patients with signs and symptoms consistent with SCIWORA. Moreover, spinal manipulative therapy may be considered a beneficial treatment in some pediatric patients. However, this report describes a single patient, and further research is required on the use of spinal manipulation in this patient population.
Collapse
Affiliation(s)
- Raymond Butts
- Research Physical Therapy Specialists, Columbia, SC, USA; American Academy of Manipulative Therapy, Montgomery, AL, USA.
| | | | | | - James Dunning
- American Academy of Manipulative Therapy, Montgomery, AL, USA; Montgomery Osteopractic Physiotherapy and Acupuncture Clinic, Montgomery, AL, USA
| |
Collapse
|