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Abstract

OBJECTIVE:

The objective of this study was to quantify the mobility characteristics (dynamic stiffness and mechanical impedance) of the normal human thoracolumbar spine with a transient vibration analysis technique.

DESIGN:

This study is a prospective clinical investigation to obtain normative biomechanical data from the human male and female spine in vivo.

SETTING:

Musculoskeletal research laboratory, university setting.

SUBJECTS:

Twenty asymptomatic subjects (age range, 20-60 years) with no recent history of musculoskeletal complaints.

MAIN OUTCOME MEASURES:

Mechanical impedance, effective stiffness, and resonant frequency analyses were used to quantify the dynamic stiffness of the thoracolumbar spine in this subject population. Data were obtained from posteroanterior mechanical thrusts delivered with an activator adjusting instrument equipped with a load cell and accelerometer by means of a portable computer.

RESULTS:

In response to the activator adjusting instrument thrusts, the thoracolumbar spine typically exhibited an impedance minimum at frequencies ranging between 30 and 50 Hz. The maximum posteroanterior impedance and corresponding maximum effective stiffness of the thoracolumbar spine and sacrum was roughly 2 to 8 times greater than the magnitude of the impedance minimum. Statistically significant differences in mobility between male and female subjects were noted, particularly for frequencies corresponding to the maximum mobility (40 Hz) and minimum mobility (10-20 Hz, 70-80 Hz). For most subjects (both male and female), the lumbar region exhibited a higher impedance and stiffness (less mobility) when compared with the thoracic region.

CONCLUSIONS:

The posteroanterior mechanical behavior of the human thoracolumbar spine was found to be sensitive to mechanical stimulus frequency and showed significant region-specific and gender differences. In the frequency range of 30 to 50 Hz, the lumbar spine of this subject population is the least stiff and therefore has the greatest mobility. From a biomechanical point-of-view, the results of this study indicate that dynamic spinal manipulative therapy procedures will produce more spinal motion for a given force, particularly when the posteroanterior manipulative thrust is delivered in frequency ranges at or near the resonant frequency. In this regard, spinal manipulative therapy procedures designed to target the resonant frequency of the spine require less force application. Both magnitude and frequency content of manual and mechanical thrusting manipulations may be critical elements for therapeutic outcome.


J Manipulative Physiol Ther. 2000 Oct;23(8):521-30. [PMID:11050608]

Author information: Keller TS, Colloca CJ, Fuhr AW. Department of Mechanical Engineering, University of Vermont, Burlington, VT 05405, USA.

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Abstract

The stress-strain relationships of human spinal ligaments and  muscles indicate that the spinal musculature play a major role in spine  stability (1, 2). Low-loading rate, quasi-static assessments of  posteroanterior (PA) spinal stiffness have correlated increased PA spine  stiffness to voluntary contracture of the lumbar extensor muscles (3,  4), No study, however, has examined the contributions of lumbar extensor  muscle and high-loading rate dynamic PA spinal stiffness. The objective  of this study was to quantify PA dynamic spinal stiffness at rest and  during maximal voluntary contraction (MVC) efforts in patients with LBP.  Twenty-two consecutive patients with LBP underwent dynamic spinal  stiffness assessment in the prone resting position and during lumbar  extensor muscle MVC, A hand-held Activator Adjusting Instrument equipped  with an impedance head was used to deliver high-loading rate( < 0,1  msec) PA manipulative thrusts (450 N) to the L3 spinous process for  spinal stiffness assessment using a previously validated technique (5).  Surface, linear enveloped, electromyographic (sEMG) recordings were  obtained during the thrusts from electrodes (8 leads) located over the  L3 and L5 erector spinae and data was normalized to subject individual  MVC’s. The accelerance (peak acceleration/peak force, kg-1) or stiffness  index was calculated for each of the thrusts and compared for the  resting and active MVC trials using a 2-tailed, paired t-test. A  significantly increased spine stiffness index (8.36%) (P=0.012) was  found upon MVC trials compared to prone resting stiffness indices.  Lumbar spine extensor MVC contributes to increased PA lumbar spine  stiffness. These findings corroborate the findings of others and add  support to the significance of the trunk musculature in providing spinal  stability.


Reference: Christopher J. Colloca, D.C.1, Tony S. Keller, Ph.D. 2 Daryn E. Seltzer, D.C.3, Arlan w. Fuhr, D.C.1;  Muscular and Soft-Tissue Contributions of Dynamic Posteroanterior  Spinal Stiffness; Proceedings of the International Conference on Spinal Manipulation,  Bloomington, MN September 21-23,2000.


1 Postdoctoral & Related Professional Education  Department Faculty, Logan College of Chiropractic, St. Louis, MO, USA;  National Institute of Chiropractic Research, Phoenix, AZ, USA; Private  Practice of Chiropractic, Phoenix, AZ, USA. 2 Professor, Department of Mechanical Engineering  & Department of Orthopedics and Rehabilitation, The University of  Vermont, Burlington, VT, USA. 3 National Institute of Chiropractic Research, Phoenix, AZ, USA; Private Practice of Chiropractic, Phoenix, AZ, USA.

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ABSTRACT

The purpose of this study was to determine the neuromuscular  reflex responses of the erector spinae musculature to spinal  manipulative thrusts (SMTs) in patients with LBP. 20 (10 male/10 female,  mean age = 43 yrs.) consecutive LBP patients received MFMA SMTs  delivered to the transverse and spinous processes of T8, T12, L2, L4,  L5, and the sacral base and PSIS by means of an Activator Adjusting  Instrument (AAI) equipped with an impedance head. Surface, linear  enveloped, electromyographic (sEMG) recordings were obtained from  electrodes located bilaterally over the L5 and L3 erector spinae muscles  during each of the thrusts. Repeated pre. post isometric extension  strength tests were performed to normalize reflex data. 1600 sEMG  recordings were analyzed from 20 SMT treatments and comparisons were  made between segmental level, segmental contact point (spinous vs.  tranverse processes), and magnitude of the sEMG reflex response. SEMG  threshold was further assessed for correlation of patient self. reported  pain and disability, Consistent, but relatively localized sEMG reflex  responses occurred in response to the MFMA SMTs. 95 % of patients showed  a positive sEMG response to MFMA SMT, Patients with frequent to  constant LBP symptoms tended to have a more marked sEMG response in  comparison to patients with occasional to intermittent LBP. This is the  first study demonstrating neuromuscular reflex responses associated with  MFMA SMT in patients with LBP.


Reference: Christopher J. Colloca, D.C.1, Tony S. Keller, Ph.D. 2, Daryn E. Seltzer, D.C.3, Arlan W. Fuhr, D.C.1;  Lumbar Erector Spinae Reflex Responses to Mechanical Force, Manually-  Assisted Thoracolumbar and Sacroiliac Joint Manipulation in Patients  with Low Back Pain; Proceedings of the 2000 International Conference on Spinal  Manipulation, Bloomington, MN September 21-23,2000.


1 Postdoctoral & Related Professional Education  Department Faculty, Logan College of Chiropractic, St, Louis, MO, USA;  National Institute of Chiropractic Research, Phoenix, AZ, USA; Private  Practice of Chiropractic, Phoenix, AZ, USA. 2 Professor, Department of Mechanical Engineering  & Department of Orthopedics and Rehabilitation, The University of  Vermont, Burlington, VT, USA. 3 National Institute of Chiropractic Research, Phoenix, AZ, USA; Private Practice of Chiropractic, Phoenix, AZ, USA.

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Abstract

Assessments of spinal stiffness are becoming more  popular in recent years as a objective biomechanical means to evaluate  the human frame. 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 and asymptomatic subjects. However, little objective evidence is  available discerning variations in PA stiffness and its clinical  significance. No study has investigated the relationships of invivo PA  spinal stiffness to radiographic images. L5-S1 disc to body height  ratios were calculated from digitized plane film lateral radiographs of  eighteen symptomatic LBP patients (8 females and 10 males, 15-69 years,  mean 44.3 SD 15.4 years). Posterior disc height ratio (PDR) and anterior  disc height ratio (ADR) were compared to the L5 posterior-anterior  dynamic effective stiffness determined using a validated in vivo  mechanical impedance assessment procedure [1]. Dynamic effective  stiffness (N/m) was calculated from the impedance-frequency response  spectrum as the dynamic mechanical impedance (Force/Velocity, Ns/m) x  circular frequency (rad/sec). Dynamic effective stiffness (minl) at the  first resonance frequency (fminl)is reported. No correlation was noted  between minl and ADR at L5. However, minl was positively correlated to  the PDR at L5 {minl=232 x PDR + 32 (R=0.76)}. Dynamic spinal stiffness  assessments may provide additional biomechanical data that may be prove  to be of use to clinicians in the diagnosis of lumbar spinal disorders.


Reference: Christopher J. Colloca,DC; Tony S. Keller,PhD; Terry  K. Peterson,DC; Daryn E. Seltzer,DC; Arlan W. Fuhr,DC. Proceedings of the International  Conference on Spinal Manipulation , Sept 21-23,2000.

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Abstract BACKGROUND: Although the mechanisms of spinal manipulation are poorly understood, the clinical effects are thought to be related to mechanical, neurophysiologic, and reflexogenic processes. Animal studies have identified mechanosensitive afferents in animals, and clinical studies in human beings have measured neuromuscular responses to spinal manipulation. Few, if any, studies have identified the basic neurophysiologic […]

Fuhr Intraoperative

Abstract

BACKGROUND:

Although the mechanisms of spinal manipulation are poorly understood, the clinical effects are thought to be related to mechanical, neurophysiologic, and reflexogenic processes. Animal studies have identified mechanosensitive afferents in animals, and clinical studies in human beings have measured neuromuscular responses to spinal manipulation. Few, if any, studies have identified the basic neurophysiologic mechanisms of spinal manipulation in human beings or animals.

OBJECTIVES:

The purpose of this clinical investigation was to determine the feasibility of obtaining intraoperative neurophysiologic recordings and to quantify mixed-nerve root action potentials in response to lumbosacral spinal manipulation in a human subject undergoing lumbar spinal surgery.

METHODS:

An L4-L5 laminectomy was performed in a 62-year-old man. Short-duration (<0.1 ms) mechanical force, manually assisted spinal manipulative thrusts (150 N) were delivered to the lumbosacral spine with an Activator II Adjusting Instrument. With the spine exposed, spinal manipulative thrusts were delivered internally to the L5 mammillary process, L5-S1 joint, and the sacral base with various force vectors. This protocol was repeated by contacting the skin overlying respective anatomic landmarks. Mixed-nerve root recordings were obtained from gas-sterilized platinum bipolar hooked electrodes attached to the S1 nerve root at the level of the dorsal root ganglion during the spinal manipulative thrusts and during a 30-second baseline period during which no spinal manipulative thrusts were applied.

RESULTS:

During the active trials, mixed-nerve root action potentials were observed in response to both internal and external spinal manipulative thrusts. Differences in the amplitude and discharge frequency were noted in response to varying segmental contact points and force vectors, and similarities were noted for internally and externally applied spinal manipulative thrusts. Amplitudes of mixed-nerve root action potentials ranged from 200 to 2600 mV for internal thrusts and 800 to 3500 mV for external thrusts.

CONCLUSIONS:

Monitoring mixed-nerve root discharges in response to spinal manipulative thrusts in vivo in human subjects undergoing lumbar surgery is feasible. Neurophysiologic responses appeared sensitive to the contact point and applied force vector of the spinal manipulative thrust. Further study of the neurophysiologic mechanisms of spinal manipulation in humans and animals is needed to more precisely identify the mechanisms and neural pathways involved.


J Manipulative Physiol Ther. 2000 Sep;23(7):447-57. [PMID:11004648]

Author information: Colloca CJ, Keller TS, Gunzburg R, Vandeputte K, Fuhr AW. Postdoctoral and Related Professional Education Department Faculty, Logan College of Chiropractic, St. Louis, MO, USA.

 

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Abstract

Since its establishment in 1945, the Canadian Memorial Chiropractic College (CMCC) has predominately adhered to a Diversified model of chiropractic technique in the core curriculum; however, many students and graduates have voiced a desire for greater exposure to chiropractic techniques other than Diversified at CMCC. A course structure is presented that both exposes students to a plethora of different “Name techniques” and provides students with a forum to appraise them critically. The results of a student survey suggested that both of these learning objectives have been successfully met. In addition, an assignment was designed that enabled students to recommend which, if any, “Name techniques” should be included in the curriculum of the College. The recommendations from these assignments were compiled since the 1996/97 academic year. The results indicated an overwhelming demand for the inclusion of Thompson Terminal Point, Gonstead, Activator Methods, Palmer HIO and Active Release Therapy techniques either as part of the core curriculum or in an elective program. These recommendations parallel the practice activities of Canadian chiropractors.


J Can Chiropr Assoc. 2000 Sep; 44(3): 157–168. [PMCID: PMC2485519]

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


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Introduction:

A biomechanical analysis of the spine is  important for understanding its response to different loading  environments. Although substantial information exists on the dynamic  response of the spine in the axial direction, little is known about the  dynamic response to externally applied, posterior-anterior (PA) directed  forces Such as chiropractic manipulations, in this paper, a  5-degree-of-freedom (DOF), lumped equivalent model the lumbar spine is  developed. Model results are compared to quasi-static, oscillatory and  impulsive force measurements of vertebral motion associated with  mobilization [1], manual manipulation [2] and mechanical force,  manually-assisted (MFMA) adjustments [3].

 

Material and methods:

Five Degree-of Freedom Model A 5-DOF mass, massless-spring and damper model of the lumbar  spine is shown in Fig. 1. This model differs from that of a single-DOF  system in that it has 5 natural frequencies.

Modeling of this multi-DOF structure necessitates one governing  equation of motion for each DOF; in matrix form: [M]d2x/dt2+ [C]dx/dt +  [K]x = [F] (1) where [M] is the mass matrix, [C] is the damping matrix,  [K] is the stiffness matrix, [F] is the PA excitation force matrix, and  x = x(t) is the resulting displacement vector. Here we assume that the  system has zero mass coupling, in which case [M] is diagonal. [K] is  written in terms of the stiffness influence coefficients and is a band  matrix along the diagonal. The equations of motion are solved in modal  space using the eigensolution (i.e. the modal properties) of the  homogeneous equation of motion (free vibration without damping). The  eigenvectors (mode shapes) are then assembled into a mode shape matrix such that[M]= [I] and [K] =[frequencies 2], where {tr} denotes the transpose, [I] is the diagonal identity matrix. Given modal damping ratios for each mode shape i, the 5×5 damping

Using Matlab, the motion response of the spine was studied in  response to a 100 N static load, 100 N sinusoidal oscillation, and 100 N  impulsive force applied to each of the vertebral segments. The  following coefficients were used for the mass matrix (kg) and stiffness  (kN/m) matrix [3]: ml=m2=0.170, m3=m4=m5=0.114; kl=50, k2=40, k3=k4=30, k5=45; l,…5= 0.25 (25% of critical) resulting in damping coefficients CIJ ranging from 40-60 Ns/m.

Results:

The PA damped and undamped natural frequencies predicted by the model  were 44.6 Hz and 46. 1 Hz, respectively. Steady State Response The  steady state response to a PA sinusoidal oscillation, f= Foe is given by  the frequency response function; H(oo)=[K oo2M + iooC] (3)For PA  sinusoidal loading, the model-predicted natural frequency ranged from  39-47 Hz (Fig. 2). At resonance, segmental and inter-segmental P A  displacements were 7.1 mm and 1.7 mm, respectively, for PA thrusts on  L3. PA spine mobilization [1] and manual manipulation [2]  correspond to an oscillatory frequency of ~2 Hz. At 2 Hz segmental and  Inter-segmental displacements were predicted to be 4.0 mm (L3) and 1.5  mm (L3-L4), respectively.

 

Impulsive Force Response: The response to an initial displacement [X0] and velocity [V0] was derived by assuming a solution x = UeM for eq. (1): PA MFMA adjustments produce a damped sinusoidal-like  oscillation With a duration of ~5 ms (impulsive force). Hence, we used  the impulse-momentum principle to estimate V0 (1.84 m/s) for a damped  MFMA oscillation f=466e-1000sin(200(3.14)t). Model predicted L3 and  L3.L4 displacements were 1.25 mm and 0.89 mm, respectively, for PA  impulsive forces at L3.

 

Discussion and Conclusions:

The model predicted PA  oscillatory and impulsive resonant frequency of the lumbar spine Is  consistent with previous experimental findings [3]. Segmental  displacements were over 3-fold greater for manual and mobilization  therapies in comparison to MFMA therapy, but differences in  inter-segmental displacements were less remarkable for these three types  of spinal manipulation.

 


Reference: T.S. Keller and C. J. Colloca; Dynamic  Response of the Human Lumbar Spine: A 5 DOF Lumped Parameter Time and  Frequency Domain Model; Proceeding of the 2000 Meeting of the European Society of  Biomechanics, Dublin, Ireland, August 10-14.

References: [1] M. Lee and N.L. Svensson (1993) JMPT 16:  439-446. [2] I. Gal et al. (1997) JMPT 20: 30.40. [3] T.S. Keller, C.I.  Colloca, and A. W. Fuhr(1999) JMPT 22: 75-86.

Acknowledgements: National Institute of Chiropractic Research; Foundation for the Advancement of Chiropractic Education.

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Abstract:

Activator Methods Chiropractic Technique (AMCT) has based its methods on a systematic protocol developed to determine the functional short leg or the “pelvic deficient side” Relative changes in leg length must be observed accurately by the examiner in order to be certain that the diagnosis and correction of subluxation were effective. Research has been conducted in the past to evaluate interexaminer reliability of prone leg-length assessment, with findings that reliability can be fair to good. Motion palpation and misalignment palpation have been determined to have poor to moderate reproducibility. However, these remain the gold standard of analysis at chiropractic colleges. The objective of this study was to determine if the AMCT procedures for determining leg-length discrepancy could be taught effectively by observing for reproducibility between examiners in a student population.

METHODS:

In a chiropractic college technique classroom setting, prior to training in AMCT procedures, 80 student patients were instructed to lie in the prone extended position. Each was instructed to wear shoes with welts or surgical boots and to remain motionless throughout all evaluative procedures. A chiropractor rated at advanced proficiency in AMCT used leg-length analysis to evaluate each student patient for leg- length discrepancy. The procedure includes observation of the shoe welt in the prone extended position; cupping the lateral malleoli with the examiner’s palms; and a “6-point landing” which involves positioning the index and middle fingers of the examiner around the lateral malleoli and the thumbs on the patient’s heels. Each student patient was assessed to have a right short leg, a left short leg, or even leg lengths. The results were recorded by the examiner and concealed. Immediately following, 80 untrained student doctors evaluated each of the student patients based on their prior knowledge of leg-length analysis. Results for each were recorded on a ballot and concealed from the next student doctor in an envelope as they rotated to the next student patient until all 80 were evaluated. The envelopes and ballots were collected and the student doctors’ results were compared to the AMCT doctor. Approaching the end of the Basic AMCT course, the procedure above was repeated by both the AMCT doctor and the trained student doctors. The data were analyzed and interexaminer reliability was calculated based on the student doctors’ results compared to the AMCT doctor’s results pre- and post- training

RESULTS:

Pre-training analysis revealed an average of 69.9% between the students and the AMCT examiner in the 80 subjects, whereas post-training analysis revealed an average of 82.2% agreement. Overall improvement was found in 67% of the cases upon post-training analysis. Results were consistent in both pre- and post-training analysis in 14% of the cases and agreement declined in 19% of cases. Forty-three percent of students were in 100% agreement with the AMCT examiner after course training, compared to only 14% prior to course training. Sixty-six percent were at or above 80% agreement post-training, compared to 45% pre-training; 78% were at or above 70% agreement post-training, compared to 57% pre training; and only 10% were below 50% agreement after being trained in AMCT leg-length analysis, compared to 24% prior to being trained in AMCT leg checks.

DISCUSSION:

The data collected indicate that leg-length analysis utilizing the AMCT protocol can be effectively taught in order to generate reproducible results. When a standard procedure is utilized, the results of interexaminer reliability remain most consistent. Therefore if leg-length analysis is going to be used in practice, it should be recommended that AMCT leg checks be taught in chiropractic colleges to improve reliability in the field. Although leg-length evaluation is used only for functional deficiencies, there was no exclusion of student patients who have a structural short leg, as every student is a class participant. This inclusion may have skewed results. Students or doctors in training of leg-length analysis must be made aware of the need to evaluate for a structural short leg using Allis’ test, tape measure, or X-ray analysis of femur head heights during their initial examination. They should also know that patient history of childhood epiphyseal disease or fracture could indicate an existing structural problem. The reproducibility of AMCT is dependent on some variables, and in this particular study footwear was controlled. However, inappropriate tables and patient positioning could have resulted in lower reliability. It is standard with AMCT to utilize a hi-lo elevation table to eliminate active positioning; therefore, weight bearing distortions and postural asymmetries are preserved. This study does not address the validity or clinical significance of prone leg checks. Many field practitioners value leg-length assessment to determine pelvic obliquity, assuming abnormal loading results and affects spinal alignment.

CONCLUSION:

Pre-training analysis revealed an average of 69.6% agreement between the students and the AMCT examiner in the 80 subjects, whereas post-training analysis revealed an average of 82.2% agreement. Overall improvement was found in 67% of the cases upon post-training analysis. Results were consistent in both pre- and post-training analysis in 14% of cases and The AMCT leg check protocol appears to offer promise in consistency and interexaminer reliability. The results of this classroom study are encouraging and suggest that with further controlled studies, uniformity in leg-length analysis could be reached within the chiropractic profession.


Author information: Janeen Wallace, DC, New York Chiropractic College

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Abstract

STUDY DESIGN:

Surface electromyographic reflex responses associated with mechanical force, manually assisted (MFMA) spinal manipulative therapy were analyzed in this prospective clinical investigation of 20 consecutive patients with low back pain.

OBJECTIVES:

To characterize and determine the magnitude of electromyographic reflex responses in human paraspinal muscles during high loading rate mechanical force, manually assisted spinal manipulative therapy of the thoracolumbar spine and sacroiliac joints.

SUMMARY OF BACKGROUND DATA:

Spinal manipulative therapy has been investigated for its effectiveness in the treatment of patients with low back pain, but its physiologic mechanisms are not well understood. Noteworthy is the fact that spinal manipulative therapy has been demonstrated to produce consistent reflex responses in the back musculature; however, no study has examined the extent of reflex responses in patients with low back pain.

METHODS:

Twenty patients (10 male and 10 female, mean age 43.0 years) underwent standard physical examination on presentation to an outpatient chiropractic clinic. After repeated isometric trunk extension strength tests, short duration (<5 msec), localized posteroanterior manipulative thrusts were delivered to the sacroiliac joints, and L5, L4, L2, T12, and T8 spinous processes and transverse processes. Surface, linear-enveloped electromyographic (sEMG) recordings were obtained from electrodes located bilaterally over the L5 and L3 erector spinae musculature. Force-time and sEMG time histories were recorded simultaneously to quantify the association between spinal manipulative therapy mechanical and electromyographic response. A total of 1600 sEMG recordings were analyzed from 20 spinal manipulative therapy treatments, and comparisons were made between segmental level, segmental contact point (spinous vs. transverse processes), and magnitude of the reflex response (peak-peak [p-p] ratio and relative mean sEMG). Positive sEMG responses were defined as >2.5 p-p baseline sEMG output (>3.5% relative mean sEMG output). SEMG threshold was further assessed for correlation of patient self-reported pain and disability.

RESULTS:

Consistent, but relatively localized, reflex responses occurred in response to the localized, brief duration MFMA thrusts delivered to the thoracolumbar spine and SI joints. The time to peak tension (sEMG magnitude) ranged from 50 to 200 msec, and the reflex response times ranged from 2 to 4 msec, the latter consistent with intraspinal conduction times. Overall, the 20 treatments produced systematic and significantly different L5 and L3 sEMG responses, particularly for thrusts delivered to the lumbosacral spine. Thrusts applied over the transverse processes produced more positive sEMG responses (25.4%) in comparison with thrusts applied over the spinous processes (20.6%). Left side thrusts and right side thrusts over the transverse processes elicited positive contralateral L5 and L3 sEMG responses. When the data were examined across both treatment level and electrode site (L5 or L3, L or R), 95% of patients showed positive sEMG response to MFMA thrusts. Patients with frequent to constant low back pain symptoms tended to have a more marked sEMG response in comparison with patients with occasional to intermittent low back pain.

CONCLUSIONS:

This is the first study demonstrating neuromuscular reflex responses associated with MFMA spinal manipulative therapy in patients with low back pain. Noteworthy was the finding that such mechanical stimulation of both the paraspinal musculature (transverse processes) and spinous processes produced consistent, generally localized sEMG responses. Identification of neuromuscular characteristics, together with a comprehensive assessment of patient clinical status, may provide for clarification of the significance of spinal manipulative therapy in eliciting putative conservative therapeutic benefits in patients with pain of musculoskeletal origin.


 

Spine (Phila Pa 1976). 2001 May 15;26(10):1117-24. [PMID: 11413422]

Author information: Colloca CJ. Postdoctoral & Related Professional Education Department, Logan College of Chiropractic, St Louis, Missouri, USA.

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