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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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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.
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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.
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Choi G, Giuliano D, Tibbles A, Howarth SJ, Tran S, Lee J, Funabashi M. Investigating force-time characteristics of prone thoracic SMT and self-reported patient outcome measures: a feasibility study. Chiropr Man Therap 2023; 31:19. [PMID: 37420257 DOI: 10.1186/s12998-023-00491-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 06/13/2023] [Indexed: 07/09/2023] Open
Abstract
BACKGROUND Spinal manipulative therapy (SMT) is commonly used to treat musculoskeletal conditions, including thoracic spine pain. Applying patient-specific force-time characteristics are believed to be important to improve SMT's effectiveness. Investigating SMT as part of a multimodal approach is fundamental to account for the complexity of chiropractic clinical practice. Therefore, pragmatic investigations balancing minimal disruptions to the clinical encounter at the same time as ensuring a robust data quality with rigorous protocols are needed. Consequently, preliminary studies are required to assess the study protocol, quality of data recorded and the sustainability of such investigation. Therefore, this study examined the feasibility of investigating SMT force-time characteristics and clinical outcome measures in a clinical setting. METHODS In this mixed-methods study, providers recorded thoracic SMT force-time characteristics delivered to patients with thoracic spinal pain during regular clinical encounters. Self-reported clinical outcomes of pain, stiffness, comfort during the SMT (using an electronic visual analogue scale), and global rating of change scale were measured before and after each SMT application. Feasibility was quantitatively assessed for participant recruitment, data collection and data quality. Qualitative data assessed participants' perceptions on the impact of data collection on patient management and clinical flow. RESULTS Twelve providers (58% female, 27.3 ± 5.0 years old) and twelve patients (58% female, 37.2 ± 14.0 years old) participated in the study. Enrolment rate was greater than 40%, data collection rate was 49% and erroneous data was less than 5%. Participant acceptance was good with both providers and patients reporting positive experience with the study. CONCLUSIONS Recording SMT force-time characteristics and self-reported clinical outcome measures during a clinical encounter may be feasible with specific modification to the current protocol. The study protocol did not negatively impact patient management. Specific strategies to optimize the data collection protocol for the development of a large clinical database are being developed.
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Affiliation(s)
- Grand Choi
- Canadian Memorial Chiropractic College, 6100 Leslie St, Toronto, ON, M2H 3J1, Canada
| | - Dominic Giuliano
- Canadian Memorial Chiropractic College, 6100 Leslie St, Toronto, ON, M2H 3J1, Canada
| | - Anthony Tibbles
- Canadian Memorial Chiropractic College, 6100 Leslie St, Toronto, ON, M2H 3J1, Canada
| | - Samuel J Howarth
- Canadian Memorial Chiropractic College, 6100 Leslie St, Toronto, ON, M2H 3J1, Canada
| | - Steve Tran
- Canadian Memorial Chiropractic College, 6100 Leslie St, Toronto, ON, M2H 3J1, Canada
| | - Joyce Lee
- Canadian Memorial Chiropractic College, 6100 Leslie St, Toronto, ON, M2H 3J1, Canada
| | - Martha Funabashi
- Canadian Memorial Chiropractic College, 6100 Leslie St, Toronto, ON, M2H 3J1, Canada.
- Université du Québec à Trois-Rivières, 3351, boulevard des Forges, Trois-Rivières, QC, G9A 5H7, Canada.
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Funabashi M, Gorrell LM, Pohlman KA, Bergna A, Heneghan NR. Definition and classification for adverse events following spinal and peripheral joint manipulation and mobilization: A scoping review. PLoS One 2022; 17:e0270671. [PMID: 35839253 PMCID: PMC9286262 DOI: 10.1371/journal.pone.0270671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 06/14/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction
Spinal and peripheral joint manipulation and mobilization are interventions used by many healthcare providers to manage musculoskeletal conditions. Although there are many reports of adverse events (or undesirable outcomes) following such interventions, there is no common definition for an adverse event or clarity on any severity classification. This impedes advances of patient safety initiatives and practice. This scoping review mapped the evidence of adverse event definitions and classification systems following spinal and peripheral joint manipulation and mobilization for musculoskeletal conditions in adults.
Methods
An electronic search of the following databases was performed from inception to February 2021: MEDLINE, EMBASE, CINAHL, Scopus, AMED, ICL, PEDro, Cochrane Library, Open Grey and Open Theses and Dissertations. Studies including adults (18 to 65 years old) with a musculoskeletal condition receiving spinal or peripheral joint manipulation or mobilization and providing an adverse event definition and/or classification were included. All study designs of peer-reviewed publications were considered. Data from included studies were charted using a standardized data extraction form and synthesised using narrative analysis.
Results
From 8248 identified studies, 98 were included in the final synthesis. A direct definition for an adverse event and/or classification system was provided in 69 studies, while 29 provided an indirect definition and/or classification system. The most common descriptors to define an adverse event were causality, symptom severity, onset and duration. Twenty-three studies that provided a classification system described only the end anchors (e.g., mild/minor and/or serious) of the classification while 26 described multiple categories (e.g., moderate, severe).
Conclusion
A vast array of terms, definition and classification systems were identified. There is no one common definition or classification for adverse events following spinal and peripheral joint manipulation and mobilization. Findings support the urgent need for consensus on the terms, definition and classification system for adverse events related to these interventions.
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Affiliation(s)
- Martha Funabashi
- Division of Research and Innovation, Canadian Memorial Chiropractic College, Toronto, ON, Canada
- Department of Chiropractic, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
- * E-mail:
| | - Lindsay M. Gorrell
- Department of Chiropractic Medicine, Integrative Spinal Research Group, University of Zürich and University Hospital Balgrist, Zürich, Switzerland
| | | | - Andrea Bergna
- Research Department, SOMA Istituto Osteopatia Milano, Milan, Italy
- AISO-Associazione Italiana Scuole di Osteopatia, Pescara, Italy
| | - Nicola R. Heneghan
- School of Sport, Exercise & Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
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Pasquier M, Young JJ, Lardon A, Descarreaux M. Factors Associated With Clinical Responses to Spinal Manipulation in Patients With Non-specific Thoracic Back Pain: A Prospective Cohort Study. FRONTIERS IN PAIN RESEARCH 2022; 2:742119. [PMID: 35295527 PMCID: PMC8915706 DOI: 10.3389/fpain.2021.742119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 11/23/2021] [Indexed: 12/29/2022] Open
Abstract
Introduction: The management of musculoskeletal disorders is complex and requires a multidisciplinary approach. Manual therapies, such as spinal manipulative therapy (SMT), are often recommended as an adjunct treatment and appear to have demonstrable effects on pain and short-term disability in several spinal conditions. However, no definitive mechanism that can explain these effects has been identified. Identifying relevant prognostic factors is therefore recommended for people with back pain. Objective: The main purpose of this study was to identify short-term candidate prognostic factors for clinically significant responses in pain, disability and global perceived change (GPC) following a spinal manipulation treatment in patients with non-specific thoracic back pain. Methods: Patients seeking care for thoracic spine pain were invited to participate in the study. Pain levels were recorded at baseline, post-intervention, and 1 week after a single session of SMT. Disability levels were collected at baseline and at 1-week follow-up. GPC was collected post-intervention and at 1-week follow-up. Biomechanical parameters of SMT, expectations for improvement in pain and disability, kinesiophobia, anxiety levels as well as perceived comfort of spinal manipulative therapy were assessed. Analysis: Differences in baseline characteristics were compared between patients categorized as responders or non-responders based on their pain level, disability level, and GPC at each measurement time point. Binary logistic regression was calculated if the statistical significance level of group comparisons (responder vs. non-responders) was equal to, or <0.2 for candidate prognostic factors. Results: 107 patients (62 females and 45 males) were recruited. Mean peak force averaged 450.8 N with a mean thrust duration of 134.9 ms. Post-intervention, comfort was associated with pain responder status (p < 0.05) and GPC responder status (p < 0.05), while expectation of disability improvement was associated with GPC responder status (p < 0.05). At follow-up, comfort and expectation of pain improvement were associated with responder GPC status (p < 0.05). No association was found between responder pain, disability or GPC status and biomechanical parameters of SMT at any time point. Discussion: No specific dosage of SMT was associated with short-term clinical responses to treatment. However, expectations of improvement and patient comfort during SMT were associated with a positive response to treatment.
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Affiliation(s)
- Mégane Pasquier
- Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
- Institut Franco-Européen de Chiropraxie, Toulouse, France
- *Correspondence: Mégane Pasquier
| | - James J. Young
- Center for Muscle and Joint Health Department, University of Southern Denmark, Odense, Denmark
- Department of Research, Canadian Memorial Chiropractic College, Toronto, ON, Canada
| | - Arnaud Lardon
- Institut Franco-Européen de Chiropraxie, Toulouse, France
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Martin Descarreaux
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
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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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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.
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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.
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Characteristics of Forces at the Clinician–Patient and Patient–Table Interfaces During Thoracic Spinal Manipulation in Asymptomatic Adults Are Consistent With Deformable Body Models. J Appl Biomech 2021; 38:39-46. [DOI: 10.1123/jab.2021-0255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 11/04/2021] [Accepted: 12/08/2021] [Indexed: 11/18/2022]
Abstract
Investigating all forces exerted on the patient’s body during high-velocity, low-amplitude spinal manipulative therapy (SMT) remains fundamental to elucidate how these may contribute to SMT’s effects. Previous conflicting findings preclude our understanding of the relationship between SMT forces acting at the clinician–patient and patient–table interfaces. This study aimed to quantify forces at the clinician–participant and participant–table interfaces during thoracic SMT in asymptnomatic adults. An experienced clinician provided a posterior to anterior SMT centered to T7 transverse processes using predetermined force–time characteristics to 40 asymptomatic volunteers (20 females; average age = 27.2 [4.9] y). Forces at the clinician–participant interface were recorded by triaxial load cells; whereas, forces at the participant–table interface were recorded by the force-sensing table technology. Preload force, total peak force, time to peak, and loading rate at each interface were analyzed descriptively. Total peak vertical forces at the clinician–participant interface averaged 532 (71) N while total peak forces at the participant–table interface averaged 658 (33) N. Forces at the participant–table interface were, on average, 1.27 (0.25) times larger than the ones at the clinician–participant interface. Larger forces at the participant–table interface compared with the ones at the clinician–participant interface during thoracic SMT are consistent with mathematical models developed to investigate thoracic impact simulating a dynamic force-deflection response.
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