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C J Colloca

Publications and source records attributed to C J Colloca.

15 recordsLinked to original sources
PubMed2001

Electromyographic reflex responses to mechanical force, manually assisted spinal manipulative therapy.

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.

Adolescent↗
PubMed2001

A pilot randomized clinical trial on the relative effect of instrumental (MFMA) versus manual (HVLA) manipulation in the treatment of cervical spine dysfunction.

OBJECTIVE: To determine the relative effect of instrument-delivered thrust cervical manipulations in comparison with traditional manual-delivered thrust cervical manipulations in the treatment of cervical spine dysfunction. DESIGN: Prospective, randomized, comparative clinical trial. SETTING: Outpatient chiropractic clinic, Technikon Natal, South Africa. PATIENTS: Thirty patients diagnosed with neck pain and restricted cervical spine range of motion without complicating pathosis for at least 1 month were included in the study. INTERVENTIONS: The patients were randomized into 2 groups. Those in one group received mechanical force, manually assisted (MFMA) manipulation to the cervical spine, delivered by means of a hand-held instrument (Activator II Adjusting Instrument). Those in the other group received specific contact high-velocity, low-amplitude (HVLA) manipulation consisting of standard Diversified rotary/lateral break techniques to the cervical spine. Each group received only the specific therapeutic intervention, no other treatment modalities or interventions (including medication) being used, until asymptomatic status was achieved or a maximum of 8 treatments had been received. MAIN OUTCOME MEASURES: Both treatment groups were assessed through use of subjective (Numerical Pain Rating Scale 101, McGill Short-Form Pain Questionnaire, and Neck Disability Index) and objective (goniometer cervical range of motion) measurement parameters at specific intervals during the treatment period and at 1-month follow-up. The data were assessed through use of 2-tailed nonparametric paired and unpaired analysis, descriptive statistics, and power analysis of the data. RESULTS: The results indicate that both treatment methods had a positive effect on the subjective and objective clinical outcome measures, no significant difference being observed between the 2 groups (P < .025). The subjective data from all 3 questionnaires showed statistically significant changes from initial to final consultations as well as from initial consultation to 1-month follow-up (P < .025). The objective range of motion measures showed statistically significant changes in the MFMA group for left and right rotation and left and right lateral flexion from initial consultation to final consultations and for right rotation and right lateral flexion from initial consultation to 1-month follow-up. The HVLA group showed only the change in left rotation from initial to final consultations and from initial consultation to 1-month follow-up to be statistically significant. CONCLUSIONS: The results of this clinical trial indicate that both instrumental (MFMA) manipulation and manual (HVLA) manipulation have beneficial effects associated with reducing pain and disability and improving cervical range of motion in this patient population. A randomized, controlled clinical trial in a similar patient base with a larger sample size is necessary to verify the clinical relevance of these findings.

Adult↗
PubMed2001

Stiffness and neuromuscular reflex response of the human spine to posteroanterior manipulative thrusts in patients with low back pain.

BACKGROUND: 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 in discriminating between patients who are asymptomatic and those who have low back pain. However, little objective evidence is available concerning variations in PA stiffness and their clinical significance. Moreover, although several studies have assessed only load input in relation to stiffness, a more complete assessment based on dynamic stiffness measurements (force/velocity) and concomitant neuromuscular response may offer more information concerning mechanical properties of the low back. OBJECTIVE: To determine the stiffness and neuromuscular characteristics of the symptomatic low back. STUDY DESIGN: This study is a prospective clinical study investigating the in vivo mechanical and muscular behavior of human lumbar spinal segments to high loading rate PA manipulative thrusts in research subjects with low back pain (LBP). METHODS: Twelve men and 10 women, aged 15 to 73 years (mean age of 42.8 +/- 17.5 years) underwent physical examination and completed outcome assessment instruments, including Visual Analog Scale, Oswestry Low Back Disability Index, and SF-36 health status questionnaires. Clinical categorization was made on the basis of symptom frequency and LBP history. A hand-held spinal manipulation device, equipped with a preload control frame and impedance head, was used to deliver high-rate (<0.1 millisecond) PA manipulative thrusts (190 N) to several common spinal landmarks, including the ilium, sacral base, and L5, L4, L2, T12, and T8 spinous and transverse processes. Surface, linear-enveloped, electromyographic (sEMG) recordings were obtained from electrodes (8 leads) located over the L3 and L5 paraspinal musculature to monitor the bilateral neuromuscular activity of the erector spinae group during the PA thrusts. Maximal-effort isometric trunk extensions were performed by the research subjects before and immediately after the testing protocol to normalize sEMG data. The accelerance or stiffness index (peak acceleration/peak force, kg-1) and composite sEMG neuromuscular reflex response were calculated for each of the thrusts. RESULTS: Posteroanterior stiffness obtained at the sacroiliac joints, transverse processes, or spinous processes was not different for subjects grouped according to LBP chronicity. However, in those with frequent or constant LBP symptoms, there was a significantly increased spinous process (SP) stiffness index (7.0 kg-1) (P <.05) in comparison with SP stiffness index (6.5 kg-1) of subjects with only occasional or no LBP symptoms. Subjects with frequent or constant LBP symptoms also reported significantly greater scores on the visual analog scale (P =.001), Oswestry (P =.001), and perceived health status (P =.03) assessments. The average SP stiffness index was 6.6% greater (P <.05) and 19.1% greater (P <.001) than the average sacroiliac stiffness index and average transverse process stiffness index, respectively. CONCLUSIONS: This study is the first to assess erector spinae neuromuscular reflex responses simultaneously during spinal stiffness examination. This study demonstrated increased spinal stiffness index and positive neuromuscular reflex responses in subjects with frequent or constant LBP as compared with those reporting intermittent or no LBP.

Adolescent↗
PubMed2000

Neurophysiologic response to intraoperative lumbosacral spinal manipulation.

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.

Action Potentials↗
PubMed2000

In vivo transient vibration assessment of the normal human thoracolumbar spine.

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.

Adult↗
PubMed1999

Validation of the force and frequency characteristics of the activator adjusting instrument: effectiveness as a mechanical impedance measurement tool.

OBJECTIVE: To determine the dynamic force-time and force-frequency characteristics of the Activator Adjusting Instrument and to validate its effectiveness as a mechanical impedance measurement device; in addition, to refine or optimize the force-frequency characteristics of the Activator Adjusting Instrument to provide enhanced dynamic structural measurement reliability and accuracy. METHODS: An idealized test structure consisting of a rectangular steel beam with a static stiffness similar to that of the human thoracolumbar spine was used for validation of a method to determine the dynamic mechanical response of the spine. The Activator Adjusting Instrument equipped with a load cell and accelerometer was used to measure forces and accelerations during mechanical excitation of the steel beam. Driving point and transfer mechanical impedance and resonant frequency of the beam were determined by use of a frequency spectrum analysis for different force settings, stylus masses, and stylus tips. Results were compared with beam theory and transfer impedance measurements obtained by use of a commercial electronic PCB impact hammer. RESULTS: The Activator Adjusting Instrument imparted a very complex dynamic impact comprising an initial high force (116 to 140 N), short duration pulse (<0.1 ms) followed by several lower force (30 to 100 N), longer duration impulses (1 to 5 ms). The force profile was highly reproducible in terms of the peak impulse forces delivered to the beam structure (<8% variance). Spectrum analysis of the Activator Adjusting Instrument impulse indicated that the Activator Adjusting Instrument has a variable force spectrum and delivers its peak energy at a frequency of 20 Hz. Added masses and different durometer stylus tips had very little influence on the Activator Adjusting Instrument force spectrum. The resonant frequency of the beam was accurately predicted by both the Activator Adjusting Instrument and electronic PCB impact hammer, but variations in the magnitude of the driving point impedance at the resonant frequency were high (67%) compared with the transfer impedance measurements obtained with the electronic PCB impact hammer, which had a more uniform force spectrum and was more repeatable (<10% variation). The addition of a preload-control frame to the Activator Adjusting Instrument improved the characteristics of the force frequency spectrum and repeatability of the driving point impedance measurements. CONCLUSION: These findings indicate that the Activator Adjusting Instrument combined with an integral load cell and accelerometer was able to obtain an accurate description of a steel beam with readily identifiable geometric and dynamic mechanical properties. These findings support the rationale for using the device to assess the dynamic mechanical behavior of the vertebral column. Such information would be useful for SMT and may ultimately be used to evaluate the [corrected] biomechanical effectiveness of various manipulative, surgical, and rehabilitative spinal procedures.

Acceleration↗
PubMed1997

Evaluation of the assumptions used to derive an ideal normal cervical spine model.

OBJECTIVES: To evaluate the accuracy of anatomical assumptions made to derive a geometrical, ideal, normal model of the upright, static, sagittal cervical spine, to make comparisons with other spinal models and to discuss the implications of a normal cervical model. BACKGROUND: Anatomical assumptions were made based on observations to assist in the development of a computerized geometrical model of the ideal upright, static, sagittal cervical spine. These assumptions address the magnitudes of the contribution made by the vertebral bodies and intervertebral discs to the overall magnitude and geometric shape of the cervical lordosis. STUDY DESIGN: (a) Data were collected from 400 lordotic lateral cervical radiographs and compared with the predictions of a geometric normal cervical lordotic model. Angels of intersecting tangent lines, drawn at posterior vertebral body margins, were measured at each disc space and between C2 and C7. Height-to-length ratios and an anterior weight-bearing distance were measured. (b) LITERATURE REVIEWs were obtained through Medline and Chirolars. RESULTS: (a) Modeling: the 400 sample subjects varied from the geometric model by approximately 5%. Subgroup averages, from partitioning the C2-C7 angle into 5 degrees intervals, were less than 8% in error to model predictions. (b) LITERATURE REVIEW: lordosis is the normal configuration for the cervical spine and many chiropractic empirical models are similar. CONCLUSIONS: The anatomical assumptions used to derive our normal geometric model of the cervical lordosis seem to be supported by the average values and literature reviewed. Two typical geometric configurations of the cervical spine were identified as a normal circular lordotic arc of 34 degrees and an ideal normal of 42 degrees. LITERATURE REVIEWed establishes cervical lordosis as a desirable clinical outcome of care.

Cervical Vertebrae↗
PubMed1996

Torque: an appraisal of misuse of terminology in chiropractic literature and technique.

OBJECTIVE: To assess the use of the term "torque" in the chiropractic literature and to analyze its usage in chiropractic technique procedures. DATA SOURCES, STUDY SELECTION AND DATA EXTRACTION: Articles were retrieved through literature searches of several indexing services [(MEDLINE, Index to Chiropractic Literature, Chiropractic Research Archives Collection (CRAC) and Chiropractic Literature Analysis and Retrieval System (ChiroLARS)] and hand searches in the technique section of a chiropractic college library. From textbooks, key terms included: Torque, Torsion, Biomechanics, Physics, Chiropractic, Nomenclature and Manipulation. For MEDLINE: Torque, Chiropractic Methods, Manipulation-Spinal Methods, Biomechanics, Nomenclature and Chiropractic Terminology. Texts and papers that discussed the word "torque" were reviewed for their association with the thrust of a spinal adjustment. Inferences of "torque" and its application were included to represent the present-day usage of the term in chiropractic. CONCLUSIONS: We believe that the term torque is misused in chiropractic literature. This misuse has been perpetuated in chiropractic college courses, student clinic examinations and state and national board examinations. We strongly suggest that references to the term torque that are not biomechanically correct must be removed from all such sources.

Chiropractic↗
PubMedDate not supplied

Chiropractic treatment of coccygodynia via instrumental adjusting procedures using activator methods chiropractic technique.

OBJECTIVE: To discuss a case of coccygodynia that responded favorably to conservative chiropractic adjusting procedures with the Activator Methods Chiropractic Technique (AMCT) and the Activator II Adjusting Instrument (AAI II). CLINICAL FEATURES: A 29-year-old woman had unremitting coccygeal pain of 3 weeks' duration. The problem began after she had moved heavy boxes while at work. The pain was characterized by a continual dull ache in the coccygeal region, accompanied by intermittent sharp pain, particularly upon sitting or rising from a seated position. She had been taking self-prescribed over-the-counter analgesics (aspirin and ibuprofen) for 3 weeks without obtaining relief. INTERVENTION AND OUTCOME: Treatment consisted of mechanical force, manually assisted, short-lever (MFMA) chiropractic adjusting procedures to the coccygeal area, primarily the sacrococcygeal ligament. The AAI II was used to deliver the adjustment according to diagnostic and treatment protocol specified for AMCT. The patient experienced first treatment. CONCLUSION: Chiropractic coccygeal manipulation may be effectively delivered via instrumental adjustment in certain cases of coccygodynia. The use of an AAI II in administering the coccygeal adjustment has the benefit of being a gentle, noninvasive procedure, as well as being comfortably tolerated by the patient. This method of coccygeal adjustment may bear consideration in certain cases of coccygodynia.

Adult↗
PubMedDate not supplied

Mechanical force spinal manipulation increases trunk muscle strength assessed by electromyography: a comparative clinical trial.

OBJECTIVE: The objective of this study was to determine whether mechanical force, manually-assisted (MFMA) spinal manipulative therapy (SMT) affects paraspinal muscle strength as assessed through use of surface electromyography (sEMG). DESIGN: Prospective clinical trial comparing sEMG output in 1 active treatment group and 2 control groups. SETTING: Outpatient chiropractic clinic, Phoenix, AZ. SUBJECTS: Forty subjects with low back pain (LBP) participated in the study. Twenty patients with LBP (9 females and 11 males with a mean age of 35 years and 51 years, respectively) and 20 age- and sex-matched sham-SMT/control LBP subjects (10 females and 10 males with a mean age of 40 years and 52 years, respectively) were assessed. METHODS: Twenty consecutive patients with LBP (SMT treatment group) performed maximum voluntary contraction (MVC) isometric trunk extensions while lying prone on a treatment table. Surface, linear-enveloped sEMG was recorded from the erector spinae musculature at L3 and L5 during a trunk extension procedure. Patients were then assessed through use of the Activator Methods Chiropractic Technique protocol, during which time they were treated through use of MFMA SMT. The MFMA SMT treatment was followed by a dynamic stiffness and algometry assessment, after which a second or post-MVC isometric trunk extension and sEMG assessment were performed. Another 20 consecutive subjects with LBP were assigned to one of two other groups, a sham-SMT group and a control group. The sham-SMT group underwent the same experimental protocol with the exception that the subjects received a sham-MFMA SMT and dynamic stiffness assessment. The control group subjects received no SMT treatment, stiffness assessment, or algometry assessment intervention. Within-group analysis of MVC sEMG output (pre-SMT vs post-SMT sEMG output) and across-group analysis of MVC sEMG output ratio (post-SMT sEMG/pre-SMT sEMG output) during MVC was performed through use of a paired observations t test (POTT) and a robust analysis of variance (RANOVA), respectively. MAIN OUTCOME MEASURES: Surface, linear-enveloped EMG recordings during isometric MVC trunk extension were used as the primary outcome measure. RESULTS: Nineteen of the 20 patients in the SMT treatment group showed a positive increase in sEMG output during MVC (range, -9.7% to 66.8%) after the active MFMA SMT treatment and stiffness assessment. The SMT treatment group showed a significant (POTT, P < 0.001) increase in erector spinae muscle sEMG output (21% increase in comparison with pre-SMT levels) during MVC isometric trunk extension trials. There were no significant changes in pre-SMT vs post-SMT MVC sEMG output for the sham-SMT (5.8% increase) and control (3.9% increase) groups. Moreover, the sEMG output ratio of the SMT treatment group was significantly greater (robust analysis of variance, P = 0.05) than either that of the sham-SMT group or that of the control group. CONCLUSIONS: The results of this preliminary clinical trial demonstrated that MFMA SMT results in a significant increase in sEMG erector spinae isometric MVC muscle output. These findings indicate that altered muscle function may be a potential short-term therapeutic effect of MFMA SMT, and they form a basis for a randomized, controlled clinical trial to further investigate acute and long-term changes in low back function.

Adult↗
PubMedDate not supplied

Treatment of symptomatic lumbar disc herniation using activator methods chiropractic technique.

OBJECTIVE: To describe a case of symptomatic lumbar disc herniation, successfully treated via chiropractic intervention using Activator Methods Chiropractic Technique. CLINICAL FEATURES: A 26-yr-old man suffered from a chronic multisymptom complex composed of low back pain, left groin pain, left leg pain, left foot drop and associated muscle weakness with atrophy. The symptoms had persisted for more than 2 yr after an athletic injury. Magnetic resonance imaging evaluation revealed a 6-mm focal central disc protrusion with accompanying deformation of the thecal sac, consistent with the presenting symptoms. Lumbar spinal surgery had been recommended to the patient as the appropriate medical management for optimal outcome. INTERVENTION AND OUTCOME: The patient elected to pursue chiropractic treatment in an effort to resolve his condition via conservative management. Chiropractic intervention consisted of mechanical-force, manually assisted short-lever adjusting procedures, rendered via an Activator Adjusting Instrument (AAI). The patient responded favorably and his multisymptom complex resolved within 90 days of treatment. No residuals or recurrences were noted at examination over 1 yr later. CONCLUSION: This report suggests that chiropractic treatment of lumbar disc disorders may be effectively implemented, in certain cases, via mechanical-force, manually assisted adjusting procedures using an AAI. We speculate that the use of an AAI, combined with Activator methods, may provide definitive benefits over side-posture manipulation of the lumbar spine in treatment of resistive disc lesions, because of the lack of torsional stress imposed upon the disc during instrumental spinal adjustment. Further study should be made in this regard to determine the safest and most effective method to treat lumbar disc lesions in a chiropractic setting.

Adult↗