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Abstract

OBJECTIVE:

The purpose of this study was to determine how the preload that precedes a high-velocity, low-amplitude spinal manipulation (HVLA-SM) affects muscle spindle input from lumbar paraspinal muscles both during and after the HVLA-SM.

METHODS:

Primary afferent activity from muscle spindles in lumbar paraspinal muscles were recorded from the L6 dorsal root in anesthetized cats. High-velocity, low-amplitude spinal manipulation of the L6 vertebra was preceded either by no preload or systematic changes in the preload magnitude, duration, and the presence or absence of a downward incisural point. Immediate effects of preload on muscle spindle responses to the HVLA-SM were determined by comparing mean instantaneous discharge frequencies (MIF) during the HVLA-SM’s thrust phase with baseline. Longer lasting effects of preload on spindle responses to the HVLA-SM were determined by comparing MIF during slow ramp and hold movement of the L6 vertebra before and after the HVLA-SM.

RESULTS:

The smaller compared with the larger preload magnitude and the longer compared with the shorter preload duration significantly increased (P = .02 and P = .04, respectively) muscle spindle responses during the HVLA-SM thrust. The absence of preload had the greatest effect on the change in MIF. Interactions between preload magnitude, duration, and downward incisural point often produced statistically significant but arguably physiologically modest changes in the passive signaling properties of the muscle spindle after the manipulation.

CONCLUSION:

Because preload parameters in this animal model were shown to affect neural responses to an HVLA-SM, preload characteristics should be taken into consideration when judging this intervention’s therapeutic benefit in both clinical efficacy studies and in clinical practice.


J Manipulative Physiol Ther. 2014 Feb;37(2):68-78. [PMID:24387888]

Author information: Reed WR, Long CR, Kawchuk GN, Pickar JG.  Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, Iowa.


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Abstract

BACKGROUND:

Temporomandibular pain has multiple etiologies and a range of therapeutic options. In this pilot study, the authors assessed the feasibility of conducting a larger trial to evaluate chiropractic treatment of temporomandibular disorders (TMDs).

METHODS:

The authors assigned 80 participants randomly into one of the following four groups, all of which included a comprehensive self-care program: reversible interocclusal splint therapy (RIST), Activator Method Chiropractic Technique (AMCT) (Activator Methods International, Phoenix), sham AMCT and self-care only. They made assessments at baseline and at month 2 and month 6, including use of the Research Diagnostic Criteria for Temporomandibular Disorders.

RESULTS:

The authors screened 721 potential participants and enrolled 80 people; 52 participants completed the six-month assessment. The adjusted mean change in current pain over six months, as assessed on the 11-point numerical rating scale, was 2.0 (95 percent confidence interval, 1.1-3.0) for RIST, 1.7 (0.9-2.5) for self-care only, 1.5 (0.7-2.4) for AMCT and 1.6 (0.7-2.5) for sham AMCT. The authors also assessed bothersomeness and functionality.

CONCLUSIONS:

The authors found the study design and methodology to be manageable. They gained substantial knowledge to aid in conducting a larger study. AMCT, RIST and self-care should be evaluated in a future comparative effectiveness study.

PRACTICAL IMPLICATIONS:

This pilot study was a necessary step to prepare for a larger study that will provide clinicians with information that should be helpful when discussing treatment options for patients with TMD.


J Am Dent Assoc. 2013 Oct;144(10):1154-63. [PMID:24080932]

Author information: DeVocht JW, Goertz CM, Hondras MA, Long CR, Schaeffer W, Thomann L, Spector M, Stanford CM. Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, Iowa.

ClinicalTrials.gov Identifier: NCT01021306


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Abstract

BACKGROUND:

With the development of increasing evidence for the use of manipulation in the management of musculoskeletal conditions, there is growing interest in identifying the appropriate indications for care. Recently, attempts have been made to develop clinical prediction rules, however the validity of these clinical prediction rules remains unclear and their impact on care delivery has yet to be established. The current study was designed to evaluate the literature on the validity and reliability of the more common methods used by doctors of chiropractic to inform the choice of the site at which to apply spinal manipulation.

METHODS:

Structured searches were conducted in Medline, PubMed, CINAHL and ICL, supported by hand searches of archives, to identify studies of the diagnostic reliability and validity of common methods used to identify the site of treatment application. To be included, studies were to present original data from studies of human subjects and be designed to address the region or location of care delivery. Only English language manuscripts from peer-reviewed journals were included. The quality of evidence was ranked using QUADAS for validity and QAREL for reliability, as appropriate. Data were extracted and synthesized, and were evaluated in terms of strength of evidence and the degree to which the evidence was favourable for clinical use of the method under investigation.

RESULTS:

A total of 2594 titles were screened from which 201 articles met all inclusion criteria. The spectrum of manuscript quality was quite broad, as was the degree to which the evidence favoured clinical application of the diagnostic methods reviewed. The most convincing favourable evidence was for methods which confirmed or provoked pain at a specific spinal segmental level or region. There was also high quality evidence supporting the use, with limitations, of static and motion palpation, and measures of leg length inequality. Evidence of mixed quality supported the use, with limitations, of postural evaluation. The evidence was unclear on the applicability of measures of stiffness and the use of spinal x-rays. The evidence was of mixed quality, but unfavourable for the use of manual muscle testing, skin conductance, surface electromyography and skin temperature measurement.

CONCLUSIONS:

A considerable range of methods is in use for determining where in the spine to administer spinal manipulation. The currently published evidence falls across a spectrum ranging from strongly favourable to strongly unfavourable in regard to using these methods. In general, the stronger and more favourable evidence is for those procedures which take a direct measure of the presumptive site of care- methods involving pain provocation upon palpation or localized tissue examination. Procedures which involve some indirect assessment for identifying the manipulable lesion of the spine-such as skin conductance or thermography-tend not to be supported by the available evidence.


Chiropr Man Therap. 2013 Oct 21;21(1):36. [PMID:24499598]

Author information: Triano JJ, Budgell B, Bagnulo A, Roffey B, Bergmann T, Cooperstein R, Gleberzon B, Good C, Perron J, Tepe R. Canadian Memorial Chiropractic College, 6100 Leslie St,, Toronto, Ontario, Canada.


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Reference: Dennis M. Richards…Chiropractic Journal of Australia March 1994 (Mar); 24(1): pp.28-32

Abstract: Activator Methods chiropractic technique (AMCT) was developed by Warren Lee, DC and Arlan Fuhr, DC. In the evolution of AMCT, Lee and Fuhr drew on elements of several other techniques, including Logan Basic, Van Rumpt, Truscott and Derefield, and developed innovation equipment, such as the Activator adjusting instrument (AAI) and an adjusting table designed specifically for AMCT. Based on oral history interviews, this paper records the early lives of Lee and Fuhr, their entries into chiropractic, influences on their personalities, the development of their technique and the seminars which presented it to the chiropractic profession.

Key Words: (MeSH): chiropractic , history; historical article. (other): history of chiropractic

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Abstract

OBJECTIVE:

Mechanical characteristics of high-velocity, low-amplitude spinal manipulations (HVLA-SMs) can vary. Sustained changes in peripheral neuronal signaling due to altered load transmission to a sensory receptor’s local mechanical environment are often considered a mechanism contributing to the therapeutic effects of spinal manipulation. The purpose of this study was to determine whether variation in an HVLA-SM’s thrust amplitude and duration alters the neural responsiveness of lumbar muscle spindles to either vertebral movement or position.

METHODS:

Anesthetized cats (n = 112) received L6 HVLA-SMs delivered to the spinous process. Cats were divided into 6 cohorts depending upon the peak thrust force (25%, 55%, 85% body weight) or thrust displacement (1, 2, 3 mm) they received. Cats in each cohort received 8 thrust durations (0-250 milliseconds). Afferent discharge from 112 spindles was recorded in response to ramp and hold vertebral movement before and after the manipulation. Changes in mean instantaneous frequency (∆MIF) during the baseline period preceding the ramps (∆MIFresting), during ramp movement (∆MIFmovement), and with the vertebra held in the new position (∆MIFposition) were compared.

RESULTS:

Thrust duration had a small but statistically significant effect on ∆MIFresting at all 6 thrust amplitudes compared with control (0-millisecond thrust duration). The lowest amplitude thrust displacement (1 mm) increased ∆MIFresting at all thrust durations. For all the other thrust displacements and forces, the direction of change in ∆MIFresting was not consistent, and the pattern of change was not systematically related to thrust duration. Regardless of thrust force, displacement, or duration, ∆MIFmovement and ∆MIFposition were not significantly different from control.

CONCLUSION:

Relatively low-amplitude thrust displacements applied during an HVLA-SM produced sustained increases in the resting discharge of paraspinal muscle spindles regardless of the duration over which the thrust was applied. However, regardless of the HVLA-SM’s thrust amplitude or duration, the responsiveness of paraspinal muscle spindles to vertebral movement and to a new vertebral position was not affected.


J Manipulative Physiol Ther. 2013 Feb;36(2):68-77. [PMID:23499141]

Author information: Cao DY, Reed WR, Long CR, Kawchuk GN, Pickar JG. Palmer Center for Chiropractic Research, Davenport, IA 52803, USA.


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Abstract

OBJECTIVE:

The purpose of this study was to evaluate the effects of chiropractic manipulative treatment on paraspinal cutaneous temperature (PCT) for subjects with chronic low back pain and compare these PCT findings to subjects without chronic low back pain.

METHODS:

Two groups were created, a symptomatic treatment group (subjects with chronic low back pain, n = 11, 7 males, 4 females) and an asymptomatic, nontreatment group (asymptomatic subjects, n = 10, 6 males, 4 females). Outcomes included the modified Oswestry questionnaire and PCT measurements in the prone position after an 8-minute acclimation period. The treatment group received 9 chiropractic spinal instrument-based manipulative treatments over 2 weeks. Reevaluation was done 2 weeks after the initial evaluation for both groups.

RESULTS:

The preintervention Oswestry results (29.8% ± 11.8%) for the treatment group were higher than the asymptomatic group (10.2% ± 10.6%). The postintervention Oswestry results for the treatment group were 14.20 % ± 11.5%. The resulting Cohen’s effect size of the spinal manipulation on the Oswestry evaluation is 0.58. The preintervention PCT showed higher temperature for the nontreatment group compared with the treatment group. Comparing the levels associated with low back pain, the nontreatment group PCT was stable, varying from 0.01°C to 0.02°C, whereas the treatment group PCT varied from 0.10°C to 0.18°C. The treatment group postintervention PCT showed an increase in temperature after the 9 visits; however, this did not reach the values of the asymptomatic group.

CONCLUSION:

The PCT readings for subjects with chronic low back pain were lower than the asymptomatic, nontreatment group. The PCT temperature of the treatment group increased after 9 treatments.


J Manipulative Physiol Ther. 2013 Jan;36(1):44-50. [PMID:23380213]

Author information: Roy RA, Boucher JP, Comtois AS. Department of Kinanthropology, Université du Québec à Montréal, C.P. 8888, Succursale Centre-Ville, Montréal, Québec, Canada.

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Abstract

OBJECTIVE:

The purpose of this article is to report the response of chiropractic care of a geriatric veteran with degenerative disk disease and diffuse idiopathic skeletal hyperostosis.

CLINICAL FEATURES:

A 74-year-old man presented with low back pain (LBP) and loss of feeling in his lower extremities for 3 months. The LBP was of insidious onset with a 10/10 pain rating on the numeric pain scale (NPS) and history of degenerative disk disease and diffuse idiopathic skeletal hypertrophy. Oswestry questionnaire was 44% and health status questionnaire was 52%, which were below average for his age. The patient presented with antalgia and severe difficulty with ambulation and thus used a walker.

INTERVENTION AND OUTCOME:

Chiropractic care included Activator Methods protocol. Two weeks into treatment, he reported no back pain; and after 4 treatments, he was able to walk with a cane instead of a walker. The NPS decreased from a 10/10 to a 0/10, and his Revised Oswestry score decreased from 44/100 to 13.3/100. His Health Status Questionnaire score increased 25 points to 77/100, bringing him from below average for his age to above average for his age. Follow-up with the patient at approximately 1 year and 9 months showed an Oswestry score of 10/100 and a Health Status Questionnaire score of 67/100, still above average for his age.

CONCLUSION:

The findings in this case study showed that Activator-assisted spinal manipulative therapy had positive subjective and objective results for LBP and ambulation in a geriatric veteran with degenerative disk disease and diffuse idiopathic skeletal hyperostosis.


J Chiropr Med. 2012 Dec;11(4):293-9. [PMID:23843763]

Author information: Roberts JA, Wolfe TM. Chiropractor, Private Practice, HealthQuest Chiropractic, Farmington, ME.


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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 conduct a systematic review of the literature investigating clinical outcomes involving the use of the Activator Adjusting Instrument (AAI) or Activator Methods Chiropractic Technique (AMCT).

Methods:

A literature synthesis was performed on the available research and electronic databases, along with hand-searching of journals and reference tracking for any studies that investigated the AAI in terms of clinical effectiveness. Studies that met the inclusion criteria were evaluated using an instrument that assessed their methodological quality.

Results:

Eight articles met the inclusion criteria.  Overall, the AAI provided comparable clinically meaningful benefits to patients when compared to high-velocity, low-amplitude (HVLA) manual manipulation or trigger point therapy for patients with acute and chronic spinal pain, temporomandibular joint (TMJ) dysfunction and trigger points of the trapezius muscles.

Conclusion:

This systematic review of 8 clinical trials involving the use of the AAI found reported benefits to patients with a spinal pain and trigger points, although the clinical trials reviewed suffered from many methodological limitations, including small sample size, relatively brief follow-up period and lack of control or sham treatment groups.


J Can Chiropr Assoc. 2012 Mar; 56(1): 49–57. [PMCID: PMC3280118]

Author information: Tiffany Huggins, BA(Hons), BEd, DC, Ana Luburic Boras, BA, DC, Brian J. Gleberzon, DC, MHSc, Mara Popescu, BA, DC, Lianna A. Bahry, BKin, DC. Department of Chiropractic Therapeutics, CMCC, 6100 Leslie St. Toronto, Ontario, M2H 3J1.


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Abstract

OBJECTIVE:

The purpose of this report is to describe the response of a geriatric patient with low back pain and a history of leukemia, multiple compression fractures, osteoporosis, and degenerative joint disease using Activator chiropractic technique.

CASE REPORT:

An 83-year-old man who is the primary caretaker for his disabled wife had low back pain after lifting her into a truck. The patient had a history of leukemia, multiple compression fractures, osteoporosis, and degenerative joint disease. His Revised Oswestry Low Back Pain Disability Questionnaire was 26%, with a 10/10 pain rating at its worst on the Numeric Pain Scale. The patient presented with a left head tilt, right high shoulder, and right high ilium with anterior translation and flexion of the torso and spasm and tenderness from the lower thoracic spine to lumbar spine.

INTERVENTION AND OUTCOME:

The patient was cared for using Activator Methods protocol. After 8 treatments, the patient was stable and remained stable for 4 months without spasm or tenderness in his spine. His Revised Oswestry score dropped to 6%, with a 4/10 Numeric Pain Scale pain rating when at its worst; and the patient reported being able to take care of his wife.

CONCLUSION:

The findings of this case suggest that Activator-assisted spinal manipulative therapy had a positive effect on low back pain and function in an elderly patient with a complex clinical history.


J Manipulative Physiol Ther. 2013 Feb;36(2):68-77. doi: 10.1016/j.jmpt.2013.01.004. [PMID: 22942837] Author information: Roberts JA, Wolfe TM. Doctor of Chiropractic, HealthQuest Chiropractic, Farmington, ME 04938.


 

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