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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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Mercier MA, Rousseau P, Funabashi M, Descarreaux M, Pagé I. Devices Used to Measure Force-Time Characteristics of Spinal Manipulations and Mobilizations: A Mixed-Methods Scoping Review on Metrologic Properties and Factors Influencing Use. FRONTIERS IN PAIN RESEARCH 2021; 2:755877. [PMID: 35295511 PMCID: PMC8915691 DOI: 10.3389/fpain.2021.755877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 10/06/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Spinal manipulations (SMT) and mobilizations (MOB) are interventions commonly performed by many health care providers to manage musculoskeletal conditions. The clinical effects of these interventions are believed to be, at least in part, associated with their force-time characteristics. Numerous devices have been developed to measure the force-time characteristics of these modalities. The use of a device may be facilitated or limited by different factors such as its metrologic properties.Objectives: This mixed-method scoping review aimed to characterize the metrologic properties of devices used to measure SMT/MOB force-time characteristics and to determine which factors may facilitate or limit the use of such devices within the context of research, education and clinical practice.Methods: This study followed the Joanna Briggs Institute's framework. The literature search strategy included four concepts: (1) devices, (2) measurement of SMT or MOB force-time characteristics on humans, (3) factors facilitating or limiting the use of devices, and (4) metrologic properties. Two reviewers independently reviewed titles, abstracts and full articles to determine inclusion. To be included, studies had to report on a device metrologic property (e.g., reliability, accuracy) and/or discuss factors that may facilitate or limit the use of the device within the context of research, education or clinical practice. Metrologic properties were extracted per device. Limiting and facilitating factors were extracted and themes were identified.Results: From the 8,998 studies initially retrieved, 46 studies were finally included. Ten devices measuring SMT/MOB force-time characteristics at the clinician-patient interface and six measuring them at patient-table interfaces were identified. Between zero and eight metrologic properties were reported per device: measurement error (defined as validity, accuracy, fidelity, or calibration), reliability/repeatability, coupling/crosstalk effect, linearity/correlation, sensitivity, variability, drift, and calibration. From the results, five themes related to the facilitating and limiting factors were developed: user-friendliness and versatility, metrologic/intrinsic properties, cost and durability, technique application, and feedback.Conclusion: Various devices are available to measure SMT/MOB force-time characteristics. Metrologic properties were reported for most devices, but terminology standardization is lacking. The usefulness of a device in a particular context should be determined considering the metrologic properties as well as other potential facilitating and limiting factors.
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Affiliation(s)
- Marie-Andrée Mercier
- Chiropractic Department, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Philippe Rousseau
- Chiropractic Department, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Martha Funabashi
- Chiropractic Department, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
- Canadian Memorial Chiropractic College, Toronto, ON, Canada
| | - Martin Descarreaux
- Human Kinetics Department, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Isabelle Pagé
- Chiropractic Department, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Québec, QC, Canada
- *Correspondence: Isabelle Pagé
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Joo S, Kim J, Lee Y, Song C. The Biomechanical Analysis of Magnitude and Direction of Force by Different Techniques of Thoracic Spinal Manipulation. BIOMED RESEARCH INTERNATIONAL 2020; 2020:8928071. [PMID: 32775447 PMCID: PMC7399734 DOI: 10.1155/2020/8928071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 06/10/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Spinal manipulation (SM) has been widely recognized and used with success in health care fields for spinal joint dysfunction and pain. SM is a procedure that involves small amplitude manipulative thrusts performed with speed. These forces are complex three-dimensional (3-D) forces delivered to create forces and moments at the joint of interest to cause joint movements. The aim of this study was to conduct a 3-dimensional analysis of the magnitude and direction of the forces transmitted in 2 techniques of thoracic spinal manipulation (TSM). Materials/Methods. Thirty-two healthy participants were recruited from the university community. The physical therapist performed TSM using anterior (A) to posterior (P) and P to A techniques once at each of T3, T7, and T12 spinal levels. The magnitude and direction of the forces transmitted during TSM were sensed by the force plates, and the camera system monitored vertebral motion by tracking motion markers. RESULTS There were no significant differences on the x-axis while there were significant differences on the y-axis between the measured spinal levels in the P to A technique. There were significant differences found at preload force maximum, preload force minimum, and peak force between T3 and T12 and between T7 and T12 and at peak base force between T7 and T12 on the z-axis. In the A to P technique, there were significant differences in the change of force in measured spinal levels at different axes. CONCLUSION These study findings can help therapists better understand the mechanism of TSM and enhance the clinical usefulness of TSM.
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Affiliation(s)
- Sunghee Joo
- Department of Physical Therapy, College of Health Science, Sahmyook University, Republic of Korea
| | - Junghyun Kim
- Department of Physical Therapy, College of Health Science, Sahmyook University, Republic of Korea
| | - Yongwoo Lee
- Department of Physical Therapy, College of Health Science, Sahmyook University, Republic of Korea
| | - Changho Song
- Department of Physical Therapy, College of Health Science, Sahmyook University, Republic of Korea
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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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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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Bell S, D'Angelo K, Kawchuk GN, Triano JJ, Howarth SJ. Procedure Selection and Patient Positioning Influence Spine Kinematics During High-Velocity, Low-Amplitude Spinal Manipulation Applied to the Low Back. J Manipulative Physiol Ther 2017; 40:147-155. [PMID: 28196632 DOI: 10.1016/j.jmpt.2016.10.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 10/11/2016] [Accepted: 10/17/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVES This investigation compared indirect 3-dimensional angular kinematics (position, velocity, and acceleration) of the lumbar spine for 2 different high-velocity, low-amplitude (HVLA) spinal manipulation procedures (lumbar spinous pull or push), and altered initial patient lower limb posture. METHODS Twenty-four participants underwent 6 HVLA procedures directed toward the presumed L4 vertebra, reflecting each combination of 2 variants of a spinal manipulation application technique (spinous pull and push) and 3 initial hip flexion angles (0°, 45°, and 90°) applied using a right lateral recumbent patient position. All contact forces and moments between the patient and the external environment, as well as 3-dimensional kinematics of the patient's pelvis and thorax, were recorded. Lumbar spine angular positions, velocities, and accelerations were analyzed within the preload and impulse stages of each HVLA trial. RESULTS Lumbar spine left axial rotation was greater for the pull HVLA. The pull HVLA also generated a greater maximum (leftward) and lower minimum (rightward) axial rotation velocity and deceleration and greater leftward and rightward lateral bend velocities, acceleration, and deceleration components. Not flexing the hip produced the greatest amount of extension, as well as the lowest axial rotation and maximum axial rotation acceleration during the impulse. CONCLUSIONS This investigation provides basic kinematic information for clinicians to understand the similarities and differences between 2 HVLA side-lying manipulations in the lumbar spine. Use of these findings and novel technology can drive future research initiatives that can both affect clinical decision making and influence teaching environments surrounding spinal manipulative therapy skill acquisition.
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Affiliation(s)
- Spencer Bell
- Department of Graduate Education and Research Programs, Canadian Memorial Chiropractic College, Toronto, ON, Canada
| | - Kevin D'Angelo
- Department of Graduate Education and Research Programs, Canadian Memorial Chiropractic College, Toronto, ON, Canada
| | - Gregory N Kawchuk
- Department of Physical Therapy, University of Alberta, Alberta, BC, Canada
| | - John J Triano
- Department of Graduate Education and Research Programs, Canadian Memorial Chiropractic College, Toronto, ON, Canada
| | - Samuel J Howarth
- Department of Graduate Education and Research Programs, Canadian Memorial Chiropractic College, Toronto, ON, Canada.
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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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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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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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