Archive for category Activator IV

Abstract

OBJECTIVE:

The purpose of this study was to investigate the effects of instrument-assisted spinal manipulative therapy (SMT) targeted to the low-back region on changes in pressure pain thresholds (PPTs) and basal electromyographic activity (BEA) in asymptomatic participants.

METHODS:

A repeated-measures, single-blind, randomized trial was conducted on 30 participants, 19 men and 11 women (mean age, 24.5±3.9 years), without a current history of low-back pain. Each participant attended all 2 treatment group sessions and received instrument-assisted SMT or a sham manipulation procedure. Instrument-assisted SMT was administered using the Activator Method protocol. Bilateral PPT levels over L5-S1 zygapophyseal joints, L5 dermatome, and first dorsal interossei in the hand and bilateral BEA of low back and neck region were assessed pre- and posttreatment by an assessor blinded to the treatment allocation of the participant. A 3-way analysis of variance with time (pre-post) and side (ipslateral, contralateral to the intervention) as within-group variable and intervention (manipulation or sham) as between-group variable was used to evaluate changes in PPT. A paired sample t test was used to analyze the differences between pre- and posttreatment in BEA.

RESULTS:

The group vs time interaction was statistically significant for PPT irrespective of the site tested or the side treated. Participants receiving the instrument-assisted SMT experienced greater improvement in PPT when compared with the control group. Paired sample t tests for BEA only show an immediate decrease in BEA of the paraspinal muscle on the pelvic deficiency side of the low-back region.

CONCLUSIONS:

The application of instrument-assisted SMT resulted in an immediate and widespread hypoalgesic effect with local muscle relaxation in asymptomatic participants. It is hypothesized that therapeutic mechanisms, either segmental or central, may be involved in the therapeutic effects of instrument-assisted SMT.


J Manipulative Physiol Ther. 2012 Jul;35(6):437-45. [PMID:22902139]

Author information: Yu X, Wang X, Zhang J, Wang Y. Department of Physical Medicine and Rehabilitation, Renji Hospital, Jiaotong University, School of Medicine, Shanghai, China.


ClinicalTrials.gov Identifier: NCT01469533

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Abstract

OBJECTIVE:

The purpose of this study was to evaluate the mechanical allodynia in animals after immobilization and chiropractic manipulation using the Activator instrument (Activator Methods International, Phoenix, Ariz) through the Von Frey test in an animal model that had its hind limb immobilized as a form to induce mechanical allodynia.

METHOD:

Eighteen adult male Wistar rats were used and divided into 3 groups: control group (C) (n = 6) that was not immobilized; immobilized group (I) (n = 6) that had its right hind limb immobilized; immobilized and adjusted group (IAA) (n = 6) that had its right hind limb immobilized and received chiropractic manipulation after. The mechanical allodynia was induced through the right hind limb immobilization. At the end of the immobilization period, the first Von Frey test was performed, and after that, 6 chiropractic manipulations on the tibial tubercle were made using the Activator instrument. After the manipulation period, Von Frey test was performed again.

RESULTS:

It was observed that after the immobilization period, groups I and IAA had an exacerbation of mechanical allodynia when compared with group C (P < .001) and that after the manipulation, group IAA had a reversion of these values (P < .001), whereas group I kept a low pain threshold when compared with group C (P < .001).

CONCLUSION:

This study demonstrates that immobilization during 4 weeks was sufficient to promote mechanical allodynia. Considering the chiropractic manipulation using the Activator instrument, it was observed that group IAA had decreased levels of mechanical allodynia, obtaining similar values to group C.


J Manipulative Physiol Ther. 2012 Jan;35(1):18-25. [PMID:22054875]

Author information: Trierweiler J, Göttert DN, Gehlen G. Academic of Chiropractic from the University Feevale, Laboratory of Comparative Histophysiology, ICS, University Feevale, Novo Hamburgo, RS, Brazil.

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Objective: Several studies have reported the effects of various specific cervical chiropractic adjustments on blood pressure(1-5) and pulse rate.(1-3) However, those studies have been criticized due to small sample size and various methodological concerns. The purpose of this randomized controlled trial (RCT) was to measure the effects of specific cervical (C3 to Occiput [“C0”]) chiropractic adjustments on blood pressure (BP) and pulse rate (PR) in a larger sample size of both normotensive and hypertensive humans.

 

Methods: After IRB approval, Informed Consent was  obtained and 331 human subjects who met the inclusion  criteria were randomly assigned to one of three groups:  Control (N=108; no treatment, no placebo); Placebo Treatment (N=117; sham adjustment with inactive device); or Active Treatment (N=106; adjustment with active device). Subjects were seated in a relaxing climate-controlled room for a minimum of 15 minutes prior to obtaining a baseline blood pressure (BP) (systolic and diastolic) and pulse rate (PR) measurement with an electronic oscillometric BP monitor. The subjects were then moved to chairs stationed according to the study group in which they were assigned. Subjects had another BP and PR measured (“anxiety” BP and PR measurements) after being called upon for active treatment, placebo treatment, or no treatment at all. Active treatment involved the use of the Activator IV(6) adjusting instrument to correct subluxations detected according to the Activator Methods Chiropractic Technique for cervical vertebrae C3 to C0. Placebo treatment was performed with an Activator II8 adjusting instrument in the “off” position which mimics all aspects of the treatment that is administered when in the “on” position but no manipulative force is delivered. Following active treatment (or placebo treatment or no treatment), subjects had their BP and PR measured once again.

 

Results: Subjects ranged in age from 18 to 85 years old (mean age = 52) and 64% of them were female. Systolic and diastolic BP decreased significantly (p<0.0001) in the active treatment group, whereas no significant changes occurred in the placebo treatment and control groups. Similarly, PR decreased significantly (p<0.0001) in the active treatment group, whereas no significant changes occurred in the placebo treatment and control groups.

 

Discussion: Similar smaller studies, utilizing various chiropractic adjusting techniques, served as the foundation for this larger and important RCT. The results of this RCT indicate, with strong statistical significance, that specific cervical (C3 to C0) chiropractic adjustments decrease systolic and diastolic BP, as well as PR.

 

Conclusion: This significant and important RCT demonstrates that specific cervical chiropractic adjustments decrease BP and PR. In follow-up to this RCT, a longitudinal pilot study of both normotensive and hypertensive subjects is currently in progress by the authors to determine how long a decrease in BP and PR is sustained following specific cervical chiropractic adjustments. Given the worldwide burden of hypertension and its adverse effects on health, further studies on the effects of chiropractic adjustments on BP and PR are warranted.


Fourth Place Research Prize at the 11th WFC Biennial Congress in Rio de Janiero, Brazil.

Author information: Steven Roffers, Laura Huber, David Morris, Anquonette Stiles, Derek Barton, Therese House

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Abstract

OBJECTIVE:

Inflammatory markers interleukin-6 (IL-6) and C-reactive protein (CRP) have not been evaluated in response to a short course of lumbar spinal manipulation. The purpose of this study is to observe the responses of inflammatory markers (IL-6 and CRP) after a series of 9 chiropractic spinal manipulations.

METHODS:

Twenty-one participants were assigned to a treatment or a control group. Only the treatment group received 9 chiropractic interventions. Pre- and postintervention measures were recorded for blood samples for detection of proinflammatory cytokines IL-6 and CRP.

RESULTS:

Mediators of inflammation (IL-6 and high-sensitivity CRP) were modified by the intervention received in the treatment group, and the effect size demonstrated a tendency toward the control group values.

CONCLUSION:

A total of 9 chiropractic lower back manipulations caused the mediators of inflammation to present a normalization response in individuals suffering from chronic low back pain.


J Chiropr Med. 2010 Sep;9(3):107-14. [PMID:22027032]

Author information: Roy RA, Boucher JP, Comtois AS.  Département de Kinanthropologie, Université du Québec à Montréal, Montréal, Québec, Canada.


Free PMC Article

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Abstract

OBJECTIVE:

This is an observational prospective cohort study to explore the treatment effect of mechanical vs manual manipulation for acute low back pain.

METHODS:

Ninety-two patients with a history of acute low back pain were recruited from 3 private chiropractic offices, 2 of which used manual lumbar manipulation and 1 used mechanical instrument manipulation (Activator) as their primary modes of treatment. The chiropractors used their “treatment-as-usual” protocols for a maximum of 8 visits or 4 weeks, whichever occurred first. Primary outcome measures were changes in Numeric Pain Rating Scale (NPRS) and Oswestry Disability Index (ODI) scores from baseline to 4 weeks. The linear regression models were adjusted for baseline NPRS and ODI scores, age, and treatment expectancy.

RESULTS:

Comparison of baseline characteristics did not show any significant differences between the groups except for age (38.4 vs 49.7 years, P < .001) and treatment expectancy (5.7 vs 6.3, P = .003). Linear regression revealed significantly lower NPRS scores in the manual manipulation group at 4 weeks (beta = -1.2; 95% confidence interval, -2.1 to -.28) but no significant difference in ODI scores between the 2 groups at 4 weeks (beta = 1.5; 95% confidence interval, -8.3 to 2.4). Treatment expectancy, but not age, was found to have a significant main effect on both NPRS and ODI scores at 4 weeks. Exploratory analysis of the clinical patterns of care between the clinicians revealed significant differences in treatment frequency, duration, modality, and radiograph use between the 2 cohorts.

CONCLUSIONS:

This study highlights the challenges inherent with conducting research that allows for “treatment as usual.” The data and experience derived from this investigational study will be used to design a future randomized clinical trial in which tighter controls will be imposed on the treatment protocol.


J Manipulative Physiol Ther. 2010 Mar-Apr;33(3):193-200. [PMID:20350672]

Author information: Schneider MJ, Brach J, Irrgang JJ, Abbott KV, Wisniewski SR, Delitto A. School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA 15241, USA.


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Abstract

Objective:

To describe the results obtained in three women with breech presentations (In-Utero Constraint) who experienced a turning of the fetus using the Activator Adjusting Instrument (AAI) in conjunction with the Webster’s Protocol.

Clinical Features:

Three women presented to the author’s office specifically for reduction of In Utero Constraint and were found to have subluxations consistent with the Webster analysis and protocol. Interventions and

Outcomes:

Webster’s Technique was administered with the sacral component completed using the Activator adjusting instrument. Each fetus successfully turned within 4 visits. Of the three, two went on to have normal vaginal deliveries while one developed other complications during delivery and required an emergency C-section.

Conclusion:

The Activator Adjusting Instrument was used successfully in these cases to reduce the posterior sacral subluxation component of the Webster In-Utero Constraint Technique.


Journal of Pediatric, Maternal & Family Health – Chiropractic ~ Volume 2010 ~ Issue 1 ~ Pages 18-21

Author information: Drew Rubin, BS, DC, CCSP, DACCP. Private Practice of Chiropractic, Smyrna, GA. Adjunct Faculty, Life University, Marietta, GA.


Full Text Article

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Abstract

BACKGROUND:

The purpose of this study was to examine heart rate variability (HRV) in the presence or the absence of pain in the lower back, while receiving one chiropractic treatment at L5 from either a manually assisted mechanical force (Activator) or a traditional diversified technique spinal manipulation.

METHODS:

A total of 51 participants were randomly assigned to a control (n = 11), 2 treatment, or 2 sham groups (n = 10 per group). Participants underwent an 8-minute acclimatizing period. The HRV tachygram (RR interval) data were recorded directly into a Suunto watch (model T6; FitzWright Company Ltd, Langley, British Columbia, Canada). We analyzed the 5-minute pretreatment and posttreatment intervals. The spectral analysis of the tachygram was performed with Kubios software.

RESULTS:

All groups decreased in value except the control group that reacted in the opposite direction, when comparing the pretests and posttests for the high-frequency component. The very low frequency increased in all groups except the control group. The low frequency decreased in all groups except the sham pain-free group. The low frequency-high frequency ratio decreased in the treatment pain group by 0.46 and in the sham pain-free group by 0.26. The low frequency-high frequency ratio increase was 0.13 for the sham pain group, 0.04 for the control group, and 0.34 for the treatment pain-free group. The mean RR increased by 11.89 milliseconds in the sham pain-free group, 18.65 milliseconds in the treatment pain group, and 13.14 milliseconds in the control group. The mean RR decreased in the treatment pain-free group by 1.75 milliseconds and by 0.01 milliseconds in the sham pain group.

CONCLUSION:

Adjusting the lumbar vertebrae affected the lumbar parasympathetic nervous system output for this group of participants. Adaptation in the parasympathetic output, reflected by changes in high frequency, low frequency, and very low frequency, may be independent of type of adjustment. Therefore, the group differences found in the modulation of the HRV would seem to be related to the presence or absence of pain. The autonomic nervous system response may be specific and sensitive to its effectors organ.


J Manipulative Physiol Ther. 2009 May;32(4):277-86. [PMID:19447264]

Author information: Roy RA, Boucher JP, Comtois AS. Université du Québec à Montréal, Département de Kinanthropologie, CP 8888, Succursale Centre-Ville, Montréal, Québec, Canada.

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Summary

Background:

Trigger points are a common cause of severe and  disabling pain in chiropractic practice. While trigger points may be  found in any skeletal muscle the majority are found in the upper  trapezius. Relatively few studies have investigated non-invasive  treatments for upper trapezius trigger points. Common manual therapy  treatments utilized for upper trapezius trigger points in chiropractic  include manual pressure and myofascial release. The purpose of this  study was to compare the effect of a single treatment of ischaemic  compression and activator trigger point therapy on active upper  trapezius trigger points.

Methods:

Fifty-two subjects with active upper trapezius  trigger points met the participation criteria and were randomised to an  ischaemic compression or activator trigger point therapy group. The  primary outcome measure was Patient Global Impression of Change.  Secondary outcome measures were an 11-point numerical rating scale for  change in pain, and change in pressure pain threshold using an algometer  for trigger point sensitivity. While the treating clinician and  subjects were not masked to treatment assignment, the examiner was blind  to treatment assignment until data analyses were completed. An  independent t-test was used to compare the groups at baseline on the  continuous variables. The Mann—Whitney U-test was used to compare the  groups at baseline on the non-continuous variables. Relative risk ratios  of improvement for the primary and secondary outcome measures were  calculated with 95% confidence intervals for clinical significance.

Results:

Seventy volunteers were screened  with 25 subjects randomised to the ischaemic compression group and 27 to  the activator trigger point therapy group. There was no significant  difference between the groups in any of the baseline variables. On the  primary outcome measure both groups improved (78% of those in the  activator group and 72% in the ischaemic compression group). Relative  risk for improvement of 1.00 suggested that those treated with the  Activator instrument were no more likely to improve than those treated  with ischaemic compression (95% CI = 0.73—1.37). For the secondary  outcome measure of pain reduction 41% of those treated with the  Activator instrument improved compared to 36% of those in the ischaemic  compression group. Those treated with the Activator instrument were 13%  more likely to improve than those treated with ischaemic compression.  However this relative risk of 1.13 in favour of the activator group was  not significant (95% CI = 0.57— 2.26). For the secondary outcome of  reduction in trigger point sensitivity 32% of those in the ischaemic  compression group improved compared to 30% in the activator group. Those  treated with ischaemic compression were 8% more likely to improve;  however, the relative risk of 1.08 was not significant (95% CI =  0.48—2.44). As risk of improvement on the outcome measures between the  groups was not significantly different, number needed to treat was not  calculated.

Conclusion:

Based on the primary outcome  measure the results suggest that both ischaemic compression and  Activator trigger point therapy have an equal immediate clinically  important effect on upper trapezius trigger point pain.


Clin Chiropr. (2008) 11(4):175-181.

Author information: Gemmel H, Allen A. Anglo-European College of Chiropractic, 13-15 Parkwood Road, Bournemouth, BH5 2DF, United Kingdom.

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Abstract

OBJECTIVE:

Digitized infrared segmental thermometry (DIST) is a tool used for measuring cutaneous temperature (CT). This project ascertains the effect of a manually assisted mechanical force producing a chiropractic adjustment in the lumbar spine after the Activator Methods Chiropractic Technique on CT during 2 different time recording periods (TRPs).

METHODS:

Sixty-six healthy subjects (36 women and 30 men) without acute low back conditions or symptoms were recruited. Subjects were randomly divided into 2 groups based on the length of the acclimatization period (8 or 30 minutes; TRP(8) and TRP(30), respectively). In turn, each recording period group was divided into 3 subgroups (n = 11 per subgroup): treatment, sham, and control subgroups. Bilateral DIST was conducted at L-4 (TRP(30)) and L-5 (TRP(8)) using infrared cameras (Subluxation Station Insight 7000; Chiropractic Leadership Alliance, Mahwah, NJ).

RESULTS:

Before treatment (t(-0.5)), the TRP(8) CT was significantly different between the ipsilateral and the contralateral sides for all subgroups. At 10 minutes (t(10)) after intervention, CT increased significantly (P < .05) for the treatment group but not for the sham and control groups. In contrast, there were no significant differences in the TRP(30) CT before treatment between the ipsilateral and the contralateral sides; but at t(10), CT was significantly (P < .05) greater for all 3 subgroups compared with preintervention CT.

CONCLUSION:

Contacting the skin with the instrument with (treatment group TRP(30)) or without (sham group TRP(30)) a thrust with a sustained pressure stronger than the loading principle taught in the Activator Methods Chiropractic Technique protocol or a thrust respecting the standard loading principle (treatment group TRP(8)) of the instrument produced a CT cooling immediately after the adjustment. Furthermore, we observed that when contacting the skin with the instrument with a thrust respecting the standard loading principle (treatment group TRP(8)) of the instrument, it produced a secondary cooling at t(5) followed by a rewarming at t(10). Finally, contacting the skin with the instrument without a thrust and respecting the standard loading principle (sham TRP(8)) of the instrument did not produce a CT change.


J Manipulative Physiol Ther. 2008 Mar;31(3):230-6. [PMID:18394501]

Author information: Roy RA, Boucher JP, Comtois AS. Private Practice, LaSalle, Québec, Canada.

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Abstract

Objective:

To determine the immediate effect of activator trigger point therapy (ATrPT) and myofascial band therapy (MBT) compared to sham ultrasound (SUS) on non-specific neck pain, cervical lateral flexion and pain pressure threshold of upper trapezius trigger points.

Design:

Randomised, placebo-controlled clinical trial.

Setting:

Anglo-European College of Chiropractic (AECC) in Bournemouth, England.

Subjects:

Forty-five subjects between 18 and 55 years of age with non-specific neck pain of at least 4 on an 11-point numerical rating scale (NRS), an upper trapezius trigger point (TrP) and decreased cervical lateral flexion to the opposite side of the active upper trapezius TrP were recruited from the AECC student body.

Methods:

The subjects were randomly assigned to one of three treatment groups: activator trigger point therapy, myofascial band therapy or sham ultrasound (control group). Neck pain level was determined using a numerical rating scale, degree of lateral flexion (LF) was determined using a cervical range of motion (CROM) goniometer and pain pressure thresholds (PPT) were measured with a pain pressure algometer. All subjects attended one treatment session and outcome measures were repeated within 5 min after treatment.

Results:

A one-way ANOVA indicated there was no statistically significant difference between the groups at baseline in age, pain level, lateral cervical flexion or pain pressure threshold ( p > 0.05). For the primary outcome measure of pain reduction the odds of a patient improving with activator trigger point therapy was 7 times higher than a patient treated with myofascial band therapy or sham ultrasound (95% CI:1.23—45.03). The number needed to treat (NNT) with activator trigger point therapy for one patient to improve was 3 (95% CI: 1.4—10.6).

Conclusion:

Activator trigger point therapy appears to be more effective than myofascial band therapy or sham ultrasound in treating patients with non-specific neck pain and upper trapezius trigger points.


Clin Chiropr. (2008) 11(1):23-29.

Author information: Blikstad A, Gemmell H. Anglo-European College of Chiropractic, 13-15 Parkwood Road, Bournemouth BH5 2DF, UK.

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