Archive for category Research

Abstract

OBJECTIVE:

The goal of this study was to compare the variation of manipulative forces produced by instruments and a manual technique.

METHODS:

Four operators (2 experts and 2 novices) used 4 different mechanical instruments to apply force to a uniaxial load cell. A different group of 2 expert and 2 novice operators used a traditional manual technique to apply force to a sensor mat. Two primary outcome variables were obtained from each sensor system: peak-to-peak force magnitude (N) and peak-to-peak force duration (millisecond). Multiple analyses were performed to determine the absolute differences and variation in each variable.

RESULTS:

Force-producing instrumentation exhibited less variation in absolute force and force duration compared to manual techniques. However, the same instrument in the hands of different operators often produced significantly different values of absolute force and force duration. Although absolute values of force magnitude generally differed between operators, intraoperator variation was equal for instruments and the manual technique. Conversely, for force duration, significant differences in interoperator variability were observed for the manual technique and for one of the instruments.

CONCLUSIONS:

Force-producing instruments reduce absolute variation in force magnitude and duration. However, this reduction does not eliminate significant differences in absolute force parameters observed to occur between some operators using the same instrument. Given these observations, claims of instrument superiority that do not account for interoperator variability should be considered with caution.


J Manipulative Physiol Ther. 2006 Oct;29(8):611-8. [PMID:17045094]

Author information: Kawchuk GN, Prasad NG, McLeod RC, Liddle T, Li T, Zhu Q. University of Alberta, Edmonton, Canada.

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Abstract

OBJECTIVE:

The aim of this study was to quantify and compare the 3-dimensional intersegmental motion responses produced by 3 commonly used chiropractic adjusting instruments.

METHODS:

Six adolescent Merino sheep were examined at the Institute for Medical and Veterinary Science, Adelaide, Australia. In all animals, triaxial accelerometers were attached to intraosseous pins rigidly fixed to the L1 and L2 spinous processes under fluoroscopic guidance. Three handheld mechanical force chiropractic adjusting instruments (Chiropractic Adjusting Tool [CAT], Activator Adjusting Instrument IV [Activator IV], and the Impulse Adjusting Instrument [Impulse]) were used to randomly apply posteroanterior (PA) spinal manipulative thrusts to the spinous process of T12. Three force settings (low, medium, and high) and a fourth setting (Activator IV only) were applied in a randomized repeated measures design. Acceleration responses in adjacent segments (L1 and L2) were recorded at 5 kHz. The multiaxial intersegmental (L1-L2) acceleration and displacement response at each force setting was computed and compared among the 3 devices using a repeated measures analysis of variance (alpha = .05).

RESULTS:

For all devices, intersegmental motion responses were greatest for axial, followed by PA and medial-lateral (ML) measurement axes for the data examined. Displacements ranged from 0.11 mm (ML axis, Activator IV low setting) to 1.76 mm (PA axis, Impulse high setting). Compared with the mechanical (spring) adjusting instruments (CAT, Activator IV), the electromechanical Impulse produced the most linear increase in both force and intersegmental motion response and resulted in the greatest acceleration and displacement responses (high setting). Significantly larger magnitude intersegmental motion responses were observed for Activator IV vs CAT at the medium and high settings (P < .05). Significantly larger-magnitude PA intersegmental acceleration and displacement responses were consistently observed for Impulse compared with Activator IV and CAT for the high force setting (P < .05).

CONCLUSIONS:

Larger-magnitude, 3D intersegmental displacement and acceleration responses were observed for spinal manipulative thrusts delivered with Impulse at most force settings and always at the high force setting. Our results indicate that the force-time characteristics of impulsive-type adjusting instruments significantly affects spinal motion and suggests that instruments can and should be tuned to provide optimal force delivery.


J Manipulative Physiol Ther. 2006 Jul-Aug;29(6):425-36. [PMID:16904488]

Author information: Keller TS, Colloca CJ, Moore RJ, Gunzburg R, Harrison DE, Harrison DD. Musculoskeletal Research Foundation, Florida Orthopaedic Institute, Temple Terrace, Fla., USA.

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Summary

This paper provides an account of a survey of chiropractors registered with the British Chiropractic Association that was designed to examine use of the Activator as a therapeutic instrument, and opinions related to its use. The survey was mailed to a sample population of 300 chiropractors and achieved a response rate of 82%. Of the chiropractors who responded to the survey and were included in data analysis, 82% reported that they used an Activator adjusting instrument, but only 2% of these stated that they typically used it as their primary method of treatment. The survey suggested that Activator I was the most frequently used form of the instrument. Cervical pain was the most frequently identified condition for whIch the activator was used. The vast majority of responders believed that the Activator was a useful therapeutic instrument in chiropractic practice (81%), and that it offered a safe treatment option (84%). Viewed in the context of other surveys of activator usage, this work adds to a body of literature which suggests an increase In Activator usage among chiropractors practicing in the United Kingdom since the early 1990’s. This being the case, it is appropriate that issues of effectiveness and safety in relation to Activator therapy are given due consideration in future research.


 

Clinical Chiropractic Volume 9, Issue 2, June 2006, Pages 70–75.
Author information: Dicken T. Reada, Francis J.H. Wilsonb, Hugh A. Gemmell. Anglo-European College of Chiropractic, 13-15 Parkwood Road, Bournemouth, Dorset, BH5 2DF, UK.

 

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Abstract

Clinical reports and research studies have documented the behavior of chronic low back and neck pain patients. A few hypotheses have attempted to explain these varied clinical and research findings. A new hypothesis, based upon the concept that subfailure injuries of ligaments (spinal ligaments, disc annulus and facet capsules) may cause chronic back pain due to muscle control dysfunction, is presented. The hypothesis has the following sequential steps. Single trauma or cumulative microtrauma causes subfailure injuries of the ligaments and embedded mechanoreceptors. The injured mechanoreceptors generate corrupted transducer signals, which lead to corrupted muscle response pattern produced by the neuromuscular control unit. Muscle coordination and individual muscle force characteristics, i.e. onset, magnitude, and shut-off, are disrupted. This results in abnormal stresses and strains in the ligaments, mechanoreceptors and muscles, and excessive loading of the facet joints. Due to inherently poor healing of spinal ligaments, accelerated degeneration of disc and facet joints may occur. The abnormal conditions may persist, and, over time, may lead to chronic back pain via inflammation of neural tissues. The hypothesis explains many of the clinical observations and research findings about the back pain patients. The hypothesis may help in a better understanding of chronic low back and neck pain patients, and in improved clinical management.


Eur Spine J. 2006 May;15(5):668-76. Epub 2005 Jul 27. [PMID:16047209]

Author information: Panjabi MM. Biomechanics Research Laboratory, Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, CT 06520-8071, USA.


Free PMC Article

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Abstract

OBJECTIVE:

To document potential mediating effects of the Activator-assisted spinal manipulative therapy (ASMT) on pain and hyperalgesia after acute intervertebral foramen (IVF) inflammation.

METHODS:

The IVF inflammation was mimicked by in vivo delivery of inflammatory soup directly into the L5 IVF in adult male Sprague-Dawley rats. Thermal hyperalgesia and mechanical allodynia were determined by the shortened latency of foot withdrawal to radiant heat and von Frey filament stimulation to the hind paw, respectively. Intracellular recordings were obtained in vitro from L5 dorsal root ganglion (DRG) somata. DRG inflammation was examined by observation of the appearance and hematoxylin and eosin staining. ASMT was applied to the spinous process of L4, L5, and L6. A series of 10 adjustments were initiated 24 hours after surgery and subsequently applied daily for 7 consecutive days and every other day during the second week.

RESULTS:

(1) ASMT applied on L5, L6, or L5 and L6 spinous process significantly reduced the severity and duration of thermal and mechanical hyperalgesia produced by the IVF inflammation. However, ASMT applied on L4 did not affect the response in rats with IVF inflammation or the controls; (2) electrophysiological studies showed that hyperexcitability of the DRG neurons produced by IVF inflammation was significantly reduced by ASMT; (3) pathological studies showed that manifestations of the DRG inflammation, such as the increased vascularization and satellitosis, were significantly reduced 2 to 3 weeks after ASMT.

CONCLUSIONS:

These studies show that ASMT can significantly reduce the severity and shorten the duration of pain and hyperalgesia caused by lumbar IVF inflammation. This effect may result from ASMT-induced faster elimination of the inflammation and recovery of excitability of the inflamed DRG neurons by improving blood and nutrition supplement to the DRG within the affected IVF. Manipulation of a specific spinal segment may play an important role in optimizing recovery from lesions involving IVF inflammation.


J Manipulative Physiol Ther. 2006 Jan;29(1):5-13. [PMID:16396724]

Author information: Song XJ, Gan Q, Cao JL, Wang ZB, Rupert RL. Department of Neurobiology, Parker College Research Institute, Dallas, TX 75229, USA.

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Abstract

OBJECTIVE:

To describe the chiropractic management of a 30-year-old woman with temporomandibular joint (TMJ) pain and to discuss the general etiology and management of TMJ conditions.

CLINICAL FEATURES:

The patient suffered from daily unremitting jaw pain for 7 years, which was the apparent sequela of a series of 8 root canals on the same tooth. Pain radiated from her TMJ into her shoulder and was accompanied by headache, tinnitus, decreased hearing, and a feeling of congestion in her right ear. Symptoms were not reduced by medication or other dental treatments.

OUTCOME AND INTERVENTION:

The patient underwent a series of chiropractic treatments using the instrument and protocol of Activator Methods, International. During the first 5 months, her VAS rating of jaw pain decreased from 60 (on a scale of 0 to 100) to 9, her ability to eat solid foods increased, headache intensity and frequency diminished, and her maximum mouth opening without pain measurement increased from 22 to 28 mm. Overall, 20 months of chiropractic treatment along with 2 concurrent months of massage therapy yielded slow but continual progress that finally resulted in total resolution of all symptoms except some fullness of the right cheek.

CONCLUSION:

Use of the Activator Methods protocol of chiropractic treatment was beneficial for this patient and merits further study in similar cases.


Altern Ther Health Med. 2005 Nov-Dec;11(6):70-3. [PMID:16320863]

Author information: DeVocht JW, Schaeffer W, Lawrence DJ. Palmer Center for Chiropiractic Research, Davenport, Iowa, USA.

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Abstract

Objective:

To examine the effect of spinal manipulation  on electromyographic (EMG) activity in areas of localized tight muscle  bundles of the low back.

Methods:

Surface EMG activity was collected from 16  participants in 2 chiropractic offices during the 5 to 10 minutes of the  treatment protocol. Electrodes were placed over the 2 sites of greatest  paraspinal muscle tension as determined by manual palpation. Spinal  manipulation was administered to 8 participants using Activator  protocol; the other 8 were treated using Diversified protocol.

Results:

Electromyographic activity decreased by at least  25% after treatment in 24 of the 31 sites that were monitored. There  was less than 25% change at 3 sites and more than 25% increase at 4  sites. Multiple distinct increases and decreases were observed in many  data plots.

Conclusions:

The results of this study indicate that  manipulation induces a virtually immediate change, usually a reduction,  in resting EMG levels in at least some patients with low back pain and  tight paraspinal muscle bundles. In some cases, EMG activity increased  during the treatment protocol and then usually, but not always,  decreased to a level lower than the pretreatment level.


J Manipulative Physiol Ther. 2005 Sep;28(7):465-71. [PMID:16182019]

Author information: DeVocht JW, Pickar JG, Wilder DG. Palmer Center for Chiropractic Research, Davenport, Iowa 52803, USA.

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Abstract

OBJECTIVE:

To investigate the effect of instrument-delivered compared with traditional manual-delivered thrust chiropractic adjustments in the treatment of sacroiliac joint syndrome.

METHODS:

Prospective, randomized, comparative clinical trial. Sixty patients with sacroiliac syndrome were randomized into two groups of 30 subjects. Each subject received 4 chiropractic adjustments over a 2-week period and was evaluated at 1-week follow-up. One group received side-posture, high-velocity, low-amplitude chiropractic adjustments; the other group received mechanical-force, manually-assisted chiropractic adjustments using an Activator Adjusting Instrument (Activator Methods International, Ltd, Phoenix, Ariz).

RESULTS:

No significant differences between groups were noted at the initial consultation for any of the outcome variables. Statistically significant improvements were observed in both groups from the first to third, third to fifth, and first to fifth consultations for improvements (P < .001) in mean numerical pain rating scale 101 (group 1, 49.1-23.4; group 2, 48.9-22.5), revised Oswestry Low Back Pain Disability Questionnaire (group 1, 37.4-18.5; group 2, 36.6-15.1), orthopedic rating score (group 1, 7.6-0.6; group 2, 7.5-0.8), and algometry measures (group 1, 4.8-6.5; group 2, 5.0-6.8) for first to last visit for both groups.

CONCLUSIONS:

The results indicate that a short regimen of either mechanical-force, manually-assisted or high-velocity, low-amplitude chiropractic adjustments were associated with a beneficial effect of a reduction in pain and disability in patients diagnosed with sacroiliac joint syndrome. Neither mechanical-force, manually-assisted nor high-velocity, low-amplitude adjustments were found to be more effective than the other in the treatment of this patient population.


J Manipulative Physiol Ther. 2005 Sep;28(7):493-501. [PMID:16182023]

Author information: Shearar KA, Colloca CJ, White HL. Chiropractic Department, Durban Institute of Technology, Durban, South Africa.

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Abstract

OBJECTIVE:

To provide an historical overview, description, synthesis, and critique of the Activator Adjusting Instrument (AAI) and Activator Methods Chiropractic Technique of clinical assessment.

METHODS:

Online resources were searched including Index to Chiropractic Literature, EBSCO Online, MANTIS, CHIROLARS, CINAHL, eJournals, Ovid, MDConsult, Lane Catalog, SU Catalog, and Pubmed. Relevant peer-reviewed studies, commentaries, and reviews were selected. Studies fell into 2 major content areas: instrument adjusting and the analysis system for therapy application. Studies were categorized by research content type: biomechanical, neurophysiological, and clinical. Each study was reviewed in terms of contribution to knowledge and critiqued with regard to quality.

DISCUSSION:

More than 100 studies related to the AAI and the technique were found, including studies on the instrument’s mechanical effects, and a few studies on clinical efficacy. With regard to the analysis, there is evidence for good reliability on prone leg-length assessment, but to date, there is only 1 study evaluating the Activator Methods Chiropractic Technique analysis.

CONCLUSION:

A body of basic science and clinical research has been generated on the AAI since its first peer-reviewed publication in 1986. The Activator analysis may be a clinically useful tool, but its ultimate scientific validation requires testing using sophisticated research models in the areas of neurophysiology, biomechanics, and statistical analysis.

J Manipulative Physiol Ther. 2005 Feb;28(2):e1-e20. [PMID:15800504]

Author information: Fuhr AW, Menke JM. Activator Methods International, Ltd, Phoenix, AZ, USA.


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Abstract:

Over the past decade, mechanical adjusting devices (MADs) were a major source of debate within the Chiropractors’ Association of Saskatchewan (CAS). Since Saskatchewan was the only jurisdiction in North America to prohibit the use of MADs, the CAS established a committee in 2001 to review the literature on MADs. The committee evaluated the efficacy, of literature on safety, and uses of moving stylus instruments within chiropractic practice, and the educational requirements for chiropractic practice. Following the rating criteria for the evaluation of evidence, as outlined in the Clinical Guidelines for Chiropractic Practice in Canada (1994), the committee reviewed 55 articles – all of which pertained to the Activator. Of the 55 articles, 13 were eliminated from the final study. Of the 42 remaining articles, 6 were rated as class 1 evidence; 11 were rated as class 2 evidence and 25 were rated as class 3 evidence.

In this article – the second in a series of two – we review the results of uses and usage, safety and educational requirements. Of the 30 articles designated under the category of usage, 3 were rated as Class 1 evidence; 9 studies were classified as Class 2 evidence and 18 were rated as Class 3 evidence. Overall the committee reached consensus that in clinical practice, there is broad application of these procedures. A minority report was written arguing that the reviewer was unable to reach a conclusion about the use of the Activator Instrument other than it is used as a clinical and research tool.

Of the 16 studies that dealt either explicitly or implicitly with safety, 4 were Class 1 evidence; 3 were Class 2 evidence and 9 were Class 3 evidence. Overall the committee reached consensus that the evidence supports that the Activator instrument is safe and has no more relative risk than do manual HVLA procedures. A minority report was written arguing that there is no evidence either to support or refute the view that MAD is safe. Of the 5 studies that dealt with educational requirements, all were Class 3 evidence. Overall the committee reached consensus that there was no evidence in the literature with respect to educational requirements to form any conclusions. A minority report was written offering opinion that there is evidence with respect to educational requirements.


J Can Chiropr Assoc. 2004 Jun; 48(2): 152–161. [PMC1840040]

Author information: Shane H Taylor, DC, Chairman, Nicole D Arnold, BSc, DC, Lesley Biggs, PhD, Christopher J Colloca, BS, DC, Dale R Mierau, DC, FCCS, MSc, Bruce P Symons, BSc, MSc, DC, and John J Triano, DC, PhD, FCCS.

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