Archive for category Research

Abstract

BACKGROUND:

Assessments of posteroanterior (PA) spinal stiffness using mobilization apparatuses have demonstrated an increase in PA spine stiffness during voluntary contraction of the lumbar extensor muscles; yet, little work has been done to this degree in symptomatic subjects.

OBJECTIVE:

To use a previously validated dynamic mechanical impedance procedure to quantify changes in PA dynamic spinal stiffness at rest and during lumbar isotonic extension tasks in patients with low back pain (LBP).

METHODS:

Thirteen patients with LBP underwent a dynamic spinal stiffness assessment in the prone-resting position and again during lumbar extensor efforts. Stiffness assessments were obtained using a handheld impulsive mechanical device equipped with an impedance head (load cell and accelerometer). PA manipulative thrusts (approximately 150 N, <5 milliseconds) were delivered to skin overlying the L3 left and right transverse processes (TPs) and to the L3 spinous process (SP) in a predefined order (left TP, SP, right TP) while patients were at rest and again during prone-lying lumbar isotonic extension tasks. Dynamic spinal stiffness characteristics were determined from force and acceleration measurements using the apparent mass (peak force/peak acceleration, kg). Apparent mass measurements for the resting and active lumbar isotonic task trials of each patient were compared using a 2-tailed, paired t test.

RESULTS:

A significant increase in the PA dynamic spinal stiffness was noted for thrusts over the SP (apparent mass [17.0%], P=.0004) during isotonic trunk extension tasks compared with prone resting, but no statistically significant changes in apparent mass were noted for the same measures over the TPs.

CONCLUSIONS:

These findings add support to the significance of the trunk musculature and spinal posture in providing increased spinal stability.


J Manipulative Physiol Ther. 2004 May;27(4):229-37. [PMID:15148461]

Author information: Colloca CJ, Keller TS. Department of Kinesiology, Atizona State University, Tempe, AZ, USA.


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Abstract:

Over the past decade, mechanical adjusting devices (MAD’s) 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 MAD’s the CAS established a committee in 2001 to review the literature on MAD. The committee evaluated the literature on the efficacy, 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 first in a series of two -the background and the methods utilized by the MAD committee’s activities are described, as well as the results for the review of the literature on efficacy. Of the 21 articles related to efficacy, five were identified as Class 1 evidence; 4 were identified as Class 2 evidence; and 12 were identified as Class 3. Overall, the committee reached consensus that the MAD procedures using the Activator were as effective as manual (HVLA) procedures in producing clinical benefit and biological change. A minority report was also written, arguing that there was not enough evidence to support or refute the efficacy of MAD’s.


J Can Chiropr Assoc. 2004 Mar;48(1):74-108. [PMID:17549220]

Author information: Taylor SH, Arnold ND, Biggs L, Colloca CJ, Mierau DR, Symons BP, Triano JJ.


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Abstract

OBJECTIVE:

To simultaneously quantify vertebral motions and neuromuscular and spinal nerve root responses to mechanical force, manually assisted, short-lever spinal manipulative thrusts.

METHODS:

Four patients underwent lumbar laminarthrectomy to decompress the central spinal canal and neuroforamina, as clinically indicated. Prior to decompression, finely threaded, 1.8-mm diameter intraosseous pins were rigidly fixed to the lumbar spinous process (L1 or L3) using fluoroscopic guidance, and a high-frequency, low-noise, 10-g, triaxial accelerometer was mounted to the pin. Following decompression, 4 needle electromyographic (nEMG) electrodes were inserted into the multifidus musculature adjacent to the pin mount bilaterally, and 2 bipolar platinum electrodes were cradled around the left and right S1 spinal nerve roots. With the spine exposed, spinal manipulative thrusts were delivered internally to the lumbosacral spinous processes and facet joints and externally by contacting the skin overlying the respective spinal landmarks using 2 force settings ( approximately 30 N, < 5 milliseconds (ms); approximately 150 N, < 5 ms) and 2 force vectors (posteroanterior and superior; posteroanterior and inferior).

RESULTS:

Spinal manipulative thrusts resulted in positive electromyographic (EMG) and compound action potential (CAP) responses that were typically characterized by a single voltage potential change lasting several milliseconds in duration. However, multiple EMG and CAP discharges were observed in numerous cases. The temporal relationship between the initiation of the mechanical thrust and the neurophysiologic response to internal and external spinal manipulative therapy (SMT) thrusts ranged from 2.4 to 18.1 ms and 2.4 to 28.6 ms for EMG and CAP responses, respectively. Neurophysiologic responses varied substantially between patients.

CONCLUSIONS:

Vertebral motions and resulting spinal nerve root and neuromuscular reflex responses appear to be temporally related to the applied force during SMT. These findings suggest that intersegmental motions produced by spinal manipulation may play a prominent role in eliciting physiologic responses.


J Manipulative Physiol Ther. 2003 Nov-Dec;26(9):579-91. [PMID:14673407]

Author information: Colloca CJ, Keller TS, Gunzburg R. State of the Art Chiropractic Center, Pheonix, AZ, USA.

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Abstract

OBJECTIVE:

To quantify in vivo spinal motions and coupling patterns occurring in human subjects in response to mechanical force, manually assisted, short-lever spinal manipulative thrusts (SMTs) applied to varying vertebral contact points and utilizing various excursion (force) settings.

METHODS:

Triaxial accelerometers were attached to intraosseous pins rigidly fixed to the L1, L3, or L4 lumbar spinous process of 4 patients (2 male, 2 female) undergoing lumbar decompressive surgery. Lumbar spine acceleration responses were recorded during the application of 14 externally applied posteroanterior (PA) impulsive SMTs (4 force settings and 3 contact points) in each of the 4 subjects. Displacement time responses in the PA, axial (AX), and medial-lateral (ML) axes were obtained, as were intervertebral (L3-4) motion responses in 1 subject. Statistical analysis of the effects of facet joint (FJ) contact point and force magnitude on peak-to-peak displacements was performed. Motion coupling between the 3 coordinate axes of the vertebrae was examined using a least squares linear regression.

RESULTS:

SMT forces ranged from 30 N (lowest setting) to 150 N (maximum setting). Peak-to-peak ML, PA, and AX vertebral displacements increased significantly with increasing applied force. For thrusts delivered over the FJs, pronounced coupling was observed between all axes (AX-ML, AX-PA, PA-ML) (linear regression, R(2) = 0.35-0.52, P <.001), whereas only the AX and PA axes showed a significant degree of coupling for thrusts delivered to the spinous processes (SPs) (linear regression, R(2) = 0.82, P <.001). The ML and PA motion responses were significantly (P <.05) greater than the AX response for all SMT force settings. PA vertebral displacements decreased significantly (P <.05) when the FJ contact point was caudal to the pin compared with FJ contact cranial to the pin. FJ contact at the level of the pin produced significantly greater ML vertebral displacements in comparison with contact above and below the pin. SMTs over the spinous processes produced significantly (P <.05) greater PA and AX displacements in comparison with ML displacements. The combined ML, PA, and AX peak-to-peak displacements for the 4 force settings and 2 contact points ranged from 0.15 to 0.66 mm, 0.15 to 0.81 mm, and 0.07 to 0.45 mm, respectively. Intervertebral motions were of similar amplitude as the vertebral motions.

CONCLUSIONS:

In vivo kinematic measurements of the lumbar spine during the application of SMTs over the FJs and SPs corroborate previous spinous process measurements in human subjects. Our findings demonstrate that PA, ML, and AX spinal motions are coupled and dependent on applied force and contact point.


J Manipulative Physiol Ther. 2003 Nov-Dec;26(9):567-78. [PMID:14673406]

Author information: Keller TS, Colloca CJ, Gunzburg R. Department of Mechanical Engineering, University of Vermont, Burlington, USA.

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Abstract

OBJECTIVE:

To discuss 2 patients with Ehlers-Danlos syndrome seeking chiropractic evaluation and management of their disabling musculoskeletal pain and associated disorders.

CLINICAL FEATURES:

Two disabled patients diagnosed with Ehlers-Danlos syndrome had spinal pain, including neck and back pain, headache, and extremity pain. Commonalities among these 2 cases included abnormal spinal curvatures (kyphosis and scoliosis), joint hypermobility, and tissue fragility. One patient had postsurgical thoracolumbar spinal fusion (T11-sacrum) for scoliosis and osteoporosis. The other patient had moderate anterior head translation.

INTERVENTION AND OUTCOME:

Both patients were treated with mechanical force and manually assisted spinal adjustments delivered to various spinal segments and extremities utilizing an Activator II Adjusting Instrument and Activator Methods Chiropractic Technique. Patients were also given postural advice, stabilization exercises, and postural corrective exercises, as indicated in Chiropractic BioPhysics Technique protocols. Both patients were able to reduce pain and anti-inflammatory medication usage in association with chiropractic care. Significant improvement in self-reported pain and disability as measured by visual analog score, Oswestry Low-Back Disability Index, and Neck Pain Disability Index were reported, and objective improvements in physical examination and spinal alignment were also observed following chiropractic care. Despite these improvements, work disability status remained unchanged in both patients.

CONCLUSION:

Chiropractic care may be of benefit to some patients with connective tissue disorders, including Ehlers-Danlos syndrome. Low-force chiropractic adjusting techniques may be a preferred technique of choice in patients with tissue fragility, offering clinicians a viable alternative to traditional chiropractic care in attempting to minimize risks and/or side effects associated with spinal manipulation. Psychosocial issues, including patient desire to return to work, were important factors in work disability status and perceived outcome.


J Manipulative Physiol Ther. 2003 Sep;26(7):448-59. [PMID:12975632]

Author information: Colloca CJ, Polkinghorn BS. State of the Art Chiropractic Center, PC, 11011 S. 48th Street, Suite 205, Phoenix, AZ 85044, USA.

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Abstract

OBJECTIVE:

To determine if there was a basis for the treatment of temporomandibular disease (TMD) using the chiropractic protocol developed by Activator Methods, International.

SETTING:

Private, solo practice of an Activator advanced proficiency rated chiropractor with 15 years experience.

DESIGN:

Prospective case series.

PARTICIPANTS:

Nine adult volunteers with articular TMD recruited from the practice of the treating clinician. Main outcome measures Change from baseline to follow-up of Visual Analog Scale (VAS) for temporomandibular joint (TMJ) pain and maximum active mouth opening without pain.

INTERVENTIONS:

Full spine and TMJ adjusting in accordance with the advanced protocol of Activator Methods, International. Participants were typically seen 3 times per week for 2 weeks and according to individual progress thereafter for 6 more weeks.

RESULTS:

Eight participants completed outcome assessments. The median VAS decrease was 45 mm (range 21-71); all experienced improvement. The median increase of mouth opening was 9 mm (range 1-15); all showed improvement.

CONCLUSION:

The results of this prospective case series indicated that the TMD symptoms of these participants improved following a course of treatment using the Activator Methods, International protocol. Consequently, further investigation of this type of chiropractic treatment for patients with the articular type of TMD is warranted.


J Manipulative Physiol Ther. 2003 Sep;26(7):421-5. [PMID:12975628]

Author information: DeVocht JW, Long CR, Zeitler DL, Schaeffer W.  Palmer Center for Chiropractic Research, 741 Brady Street, Davenport, Iowa 52803, USA.

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Abstract

OBJECTIVE:

To examine radiological changes of the lateral cervical curve in patients who received chiropractic care after motor vehicle collisions.

DESIGN:

A retrospective case series. Thirteen patients who had received chiropractic care after motor vehicle collisions were selected from a northeastern Washington chiropractic office. Patients had a lateral cervical radiograph taken prior to the initiation of chiropractic treatment and a comparative lateral cervical radiograph subsequent to a period of care. Cases were included if they met the previously stated criteria and if the radiographs were of sufficient quality to determine the lateral cervical curve from C2-C7.

RESULTS:

Adjustments rendered using an Activator Adjusting Instrument. Eleven of the subjects were also instructed to perform stretching exercises. Compared to the initial lateral cervical radiograph, the comparative radiographs demonstrated a mean increase in cervical lordosis between C2 and C7 of 6.4 degrees (SD = 8.2). The standard error estimate of the population was 2.3 degrees, with a 95% confidence interval of 1.4 degrees to 11.4 degrees.

CONCLUSION:

There was a mean increase in the cervical lordosis of 6.4 degrees (SD = 8.2). The standard error estimate of the population was 2.3 degrees, with a 95% confidence interval of 1.4 degrees to 11.4 degrees. We were not able to determine the individual effects of adjustment, stretching, and natural progression of the condition. The results suggest that further study of this phenomenon should be undertaken.


J Manipulative Physiol Ther. 2003 Jul-Aug;26(6):352-5. [PMID:12902963]

Author information: Coleman RR, Hagen JO, Troyanovich SJ, Plaugher G. Adjunct Research Faculty, Life Chiropractic College West, Othello, Wash, USA.

 

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Abstract

BACKGROUND:

Assessments of spinal stiffness have become more popular in recent years as a noninvasive objective biomechanical means to evaluate the human spine. Studies investigating posteroanterior (PA) forces in spinal stiffness assessment have shown relationships to spinal level, body type, and lumbar extensor muscle activity. Such measures may be important determinants to discriminate between patients with low back pain (LBP) and asymptomatic subjects.

OBJECTIVE:

To determine the relationships between dynamic PA spinal stiffness and radiographic measures of lower lumbar disk height and disk degeneration.

METHODS:

L4 and L5 posterior disk height (PDH), vertebral body height (PVH), anterior disk height (ADH), and vertebral body height (AVH) were obtained from digitized plain film anteroposterior (AP) and lateral radiographs of 18 symptomatic LBP patients presenting to a chiropractic office (8 female patients and 10 male patients, aged 15-69 years, mean 44.3, SD 15.4 years). Disk degeneration (DD) and facet arthrosis (FA) were qualitatively assessed from the films by an independent examiner. Anterior disk height ratios (ADHR = ADH/AVH) and posterior disk height ratios (PDHR = PDH/PVH) were calculated from the disk height measurements and were compared to L4 and L5 posteroanterior spinal stiffness obtained using a previously validated mechanical impedance stiffness assessment procedure.

RESULTS:

One third of the subjects were found to have radiographic evidence of mild or moderate DD and approximately two thirds of the subjects showed signs of mild or moderate FA. The L4 and L5 anterior disk height and posterior disk height were approximately one half and one fifth of the respective vertebral body heights, and the PA stiffness was greater at L4 than at L5. Male subjects had a greater ADHR than female subjects, but female subjects had a greater L4 and L5 PA stiffness in comparison to male subjects; however, these differences were not statistically significant. Posteroanterior L5 vertebral stiffness was found to be significantly correlated to the L5 PDHR.

CONCLUSIONS:

Computations of spinal input impedance are relatively simple to perform, can provide a noninvasive measure of the dynamic mechanical behavior of the spine, appear to have potential to discriminate pathologic changes to the spine, and warrant further study on a larger sample of normal subjects and patients.


J Manipulative Physiol Ther. 2003 May;26(4):233-41. [PMID:12750657]

Author information: Colloca CJ, Keller TS, Peterson TK, Seltzer DE. New York Chiropractic College, Seneca Falls, NY, USA.

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Abstract

In a previous article, the author reported on the recommendations gathered from student projects between 1996 and 1999 investigating their preferences for including certain chiropractic Name technique systems into the curriculum at the Canadian Memorial Chiropractic College (CMCC). These results were found to be congruent with the professional treatment technique used by Canadian chiropractors. This article reports on the data obtained during the 2000 and 2001 academic years, comparing these results to those previously gathered. In addition, because of the implementation of a new curriculum during this time period, there was unique opportunity to observe whether or not student perceptions differed between those students in the `old’ curricular program, and those students in the `new’ curricular program. The results gathered indicate that students in both curricular programs show an interest in learning Thompson Terminal Point, Activator Methods, Gonstead, and Active Release Therapy techniques in the core curriculum, as an elective, or during continuing educational programs provided by the college. Students continue to show less interest in learning CranioSacral Therapy, SacroOccipital Technique, Logan Basic, Applied Kinesiology and Chiropractic BioPhysics. Over time, student interest has moved away from Palmer HIO and other upper cervical techniques, and students show a declining interest in being offered instruction in either Network Spinal Analysis or Torque Release Techniques. Since these findings reflect the practice activities of Canadian chiropractors they may have implications not only towards pedagogical decision-making processes at CMCC, but they may also influence professional standards of care.


J Can Chiropr Assoc. 2002 Dec; 46(4): 241–256. [PMC2505021]

Author information:Brain J Gleberzon. Canadian Memorial Chiropractic College, 1900 Bayview Avenue, Toronto, Ontario, Canada M4G 3E6.


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Abstract

Purpose:

A review of the Activator Methods chiropractic technique (AMCT) and Activator adjusting instrument (AAI) is presented. History and development of the technique and its evidence basis and safety issues are discussed.

Method:

Activator history and associated body of research literature on both the technique and the instrument are critically reviewed. Included are basic science research in biomechanics, neurophysiology, and clinical research in AMCT analysis reliability, case studies, prospective cohorts, randomized group clinical outcomes, and comparisons to hands-only treatments.

Summary:

AMCT and the AAI represent a system and mode of delivery based on rational and empirical evidence that continues to be informed by an active and growing body of clinical research. In comparison to other techniques, AMCT appears equivalent to various hands-on approaches, but with less physical demand on the doctor of chiropractic. As with all spinal manipulative and other therapies, risks of adverse effects exist, but appear to be minimized due to force and velocity characteristics of the AAI. Needs for future research directions are also discussed.


Top Clin Chiropr 2002; 9(3): 30–43.

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


 

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