Spinal manipulation reduces pain and hyperalgesia after lumbar intervertebral foramen inflammation in the rat.
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Animals↗
Biomedical subjects
Christopher J Colloca
Publications and source records attributed to Christopher J Colloca.
Muscular contributions to dynamic dorsoventral lumbar spine stiffness.
Spinal musculature plays a major role in spine stability, but its importance to spinal stiffness is poorly understood. We studied the effects of graded trunk muscle stimulation on the in vivo dynamic dorsoventral (DV) lumbar spine stiffness of 15 adolescent Merino sheep. Constant voltage supramaximal electrical stimulation was administered to the L3-L4 interspinous space of the multifidus muscles using four stimulation frequencies (2.5, 5, 10, and 20 Hz). Dynamic stiffness was quantified at rest and during muscle stimulation using a computer-controlled testing apparatus that applied variable frequency (0.46-19.7 Hz) oscillatory DV forces (13-N preload to 48-N peak) to the L3 spinous process of the prone-lying sheep. Five mechanical excitation trials were randomly performed, including four muscle stimulation trials and an unstimulated or resting trial. The secant stiffness (k (y) = DV force/L3 displacement, kN/m) and loss angle (phase angle, deg) were determined at 44 discrete mechanical excitation frequencies. Results indicated that the dynamic stiffness varied 3.7-fold over the range of mechanical excitation frequencies examined (minimum resting k (y) = 3.86 +/- 0.38 N/mm at 4.0 Hz; maximum k (y) = 14.1 +/- 9.95 N/mm at 19.7 Hz). Twenty hertz muscle stimulation resulted in a sustained supramaximal contraction that significantly (P < 0.05) increased k (y) up to twofold compared to rest (mechanical excitation at 3.6 Hz). Compared to rest, k (y) during the 20 Hz muscle stimulation was significantly increased for 34 of 44 mechanical excitation frequencies (mean increase = 55.1%, P < 0.05), but was most marked between 2.55 and 4.91 Hz (mean increase = 87.5%, P < 0.05). For lower frequency, sub-maximal muscle stimulation, there was a graded change in k (y), which was significantly increased for 32/44 mechanical excitation frequencies (mean increase = 40.4%, 10 Hz stimulus), 23/44 mechanical excitation frequencies (mean increase = 10.5%, 5 Hz stimulus), and 11/44 mechanical excitation frequencies (mean increase = 4.16%, 2.5 Hz stimulus) when compared to rest. These results indicate that the dynamic mechanical behavior of the ovine spine is modulated by muscle stimulation, and suggests that muscle contraction plays an important role in stabilizing the lumbar spine.
Animals↗
Increased multiaxial lumbar motion responses during multiple-impulse mechanical force manually assisted spinal manipulation.
BACKGROUND: Spinal manipulation has been found to create demonstrable segmental and intersegmental spinal motions thought to be biomechanically related to its mechanisms. In the case of impulsive-type instrument device comparisons, significant differences in the force-time characteristics and concomitant motion responses of spinal manipulative instruments have been reported, but studies investigating the response to multiple thrusts (multiple impulse trains) have not been conducted. The purpose of this study was to determine multi-axial segmental and intersegmental motion responses of ovine lumbar vertebrae to single impulse and multiple impulse spinal manipulative thrusts (SMTs). METHODS: Fifteen adolescent Merino sheep were examined. Tri-axial accelerometers were attached to intraosseous pins rigidly fixed to the L1 and L2 lumbar spinous processes under fluoroscopic guidance while the animals were anesthetized. A hand-held electromechanical chiropractic adjusting instrument (Impulse) was used to apply single and repeated force impulses (13 total over a 2.5 second time interval) at three different force settings (low, medium, and high) along the posteroanterior axis of the T12 spinous process. Axial (AX), posteroanterior (PA), and medial-lateral (ML) acceleration responses in adjacent segments (L1, L2) were recorded at a rate of 5000 samples per second. Peak-peak segmental accelerations (L1, L2) and intersegmental acceleration transfer (L1-L2) for each axis and each force setting were computed from the acceleration-time recordings. The initial acceleration response for a single thrust and the maximum acceleration response observed during the 12 multiple impulse trains were compared using a paired observations t-test (POTT, alpha = .05). RESULTS: Segmental and intersegmental acceleration responses mirrored the peak force magnitude produced by the Impulse Adjusting Instrument. Accelerations were greatest for AX and PA measurement axes. Compared to the initial impulse acceleration response, subsequent multiple SMT impulses were found to produce significantly greater (3% to 25%, P < 0.005) AX, PA and ML segmental and intersegmental acceleration responses. Increases in segmental motion responses were greatest for the low force setting (18%-26%), followed by the medium (5%-26%) and high (3%-26%) settings. Adjacent segment (L1) motion responses were maximized following the application of several multiple SMT impulses. CONCLUSION: Knowledge of the vertebral motion responses produced by impulse-type, instrument-based adjusting instruments provide biomechanical benchmarks that support the clinical rationale for patient treatment. Our results indicate that impulse-type adjusting instruments that deliver multiple impulse SMTs significantly increase multi-axial spinal motion.
Journal Article↗
Radiographic pseudoscoliosis in healthy male subjects following voluntary lateral translation (side glide) of the thoracic spine.
OBJECTIVE: To determine projected Cobb angles associated with trunk list (side shift) posture, hypothesizing that the side shift "scoliotic" curvature would be similar to true scoliotic curvature in the early stages. DESIGN: Anteroposterior (AP) radiographs of volunteers in neutral, in left, and right lateral translations of the thoracic cage (trunk list) were digitized. SETTING: Computer laboratory. PARTICIPANTS: Fifteen healthy male volunteers. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Cobb and Risser-Ferguson angles determined from digitizing vertebral body corners from T12 to L5 on 51 AP lumbar radiographs. RESULTS: Using the horizontal displacement of T12 from S1, subjects could translate an average of 54.0 mm to the left and 52.5 mm to the right. The average digitized Cobb T12-L5 angle produced for the 30 translated postures was 16 degrees. Angles ranged from 2.6 degrees to 27.0 degrees. Risser-Ferguson angles averaged 10 degrees between T12 and L5. Statistical correlations were found between Cobb L1-5 and translation to the left (P=.015), Cobb T12-L5 and translation to the right (P=.024), Risser-Ferguson angle and translation to the left (P=.021), and the lumbosacral angle to the right and trunk translation to the right (P=.027). CONCLUSIONS: During lateral translation of the thorax (trunk list), coupled lumbar lateral flexion resulted in the appearance of a pseudoscoliosis on AP radiographs. For this trunk list posture, Cobb angles are considerable (16 degrees ) and increase as the magnitude of trunk translation increases. Differentiating true structural scoliosis from this pseudoscoliosis would be clinically important. The small coupled axial rotation in trunk list is in contrast to the considerable degree of axial rotation observed in structural idiopathic scoliosis.
Adult↗
Spinal manipulation force and duration affect vertebral movement and neuromuscular responses.
BACKGROUND: Previous study in human subjects has documented biomechanical and neurophysiological responses to impulsive spinal manipulative thrusts, but very little is known about the neuromechanical effects of varying thrust force-time profiles. METHODS: Ten adolescent Merino sheep were anesthetized and posteroanterior mechanical thrusts were applied to the L3 spinous process using a computer-controlled, mechanical testing apparatus. Three variable pulse durations (10, 100, 200 ms, force = 80 N) and three variable force amplitudes (20, 40, 60 N, pulse duration = 100 ms) were examined for their effect on lumbar motion response (L3 displacement, L1, L2 acceleration) and normalized multifidus electromyographic response (L3, L4) using a repeated measures analysis of variance. FINDINGS: Increasing L3 posteroanterior force amplitude resulted in a fourfold linear increase in L3 posteroanterior vertebral displacement (p < 0.001) and adjacent segment (L1, L2) posteroanterior acceleration response (p < 0.001). L3 displacement was linearly correlated (p < 0.001) to the acceleration response over the 20-80 N force range (100 ms). At constant force, 10 ms thrusts resulted in nearly fivefold lower L3 displacements and significantly increased segmental (L2) acceleration responses compared to the 100 ms (19%, p = 0.005) and 200 ms (16%, p = 0.023) thrusts. Normalized electromyographic responses increased linearly with increasing force amplitude at higher amplitudes and were appreciably affected by mechanical excitation pulse duration. INTERPRETATION: Changes in the biomechanical and neuromuscular response of the ovine lumbar spine were observed in response to changes in the force-time characteristics of the spinal manipulative thrusts and may be an underlying mechanism in related clinical outcomes.
Animals↗
Dynamic dorsoventral stiffness assessment of the ovine lumbar spine.
Posteroanterior spinal stiffness assessments are common in the evaluating patients with low back pain. The purpose of this study was to determine the effects of mechanical excitation frequency on dynamic lumbar spine stiffness. A computer-controlled voice coil actuator equipped with a load cell and LVDT was used to deliver an oscillatory dorsoventral (DV) mechanical force to the L3 spinous process of 15 adolescent Merino sheep. DV forces (48 N peak, approximately 10% body weight) were randomly applied at periodic excitation frequencies of 2.0, 6.0, 11.7 and a 0.5-19.7 Hz sweep. Force and displacement were recorded over a 13-22 s time interval. The in vivo DV stiffness of the ovine spine was frequency dependent and varied 3.7-fold over the 0.5-19.7 Hz mechanical excitation frequency range. Minimum and maximum DV stiffness (force/displacement) were 3.86+/-0.38 and 14.1+/-9.95 N/mm at 4.0 and 19.7 Hz, respectively. Stiffness values based on the swept-sine measurements were not significantly different from corresponding periodic oscillations (2.0 and 6.0 Hz). The mean coefficient of variation in the swept-sine DV dynamic stiffness assessment method was 15%, which was similar to the periodic oscillation method (10-16%). The results indicate that changes in mechanical excitation frequency and animal body mass modulate DV spinal stiffness.
Animals↗
A randomized clinical trial of manual versus mechanical force manipulation in the treatment of sacroiliac joint syndrome.
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.
Adolescent↗
The biomechanical and clinical significance of the lumbar erector spinae flexion-relaxation phenomenon: a review of literature.
OBJECTIVES: The aim of this study was to review the biomedical literature to ascertain the biomechanical and clinical significance of the lumbar erector spinae flexion-relaxation phenomenon (FRP). DATA SOURCES: Index Medicus via PubMed, the Noble Science Library's e-journal archives, and the Manual Alternative and Natural Therapy Index System databases were searched using the same search terms. DISCUSSION: The presence of the FRP during trunk flexion represents myoelectric silence consistent with increased load sharing of the posterior discoligamentous passive structures. Passive contributions from erector spinae stretching during the flexion posture and active contributions from other muscles (quadratus lumborum and deep erector spinae among others) further assist in load sharing in the trunk flexion posture. A number of studies have shown differences in the FRP between patients with chronic low back pain and healthy individuals, and the reliability of the assessment. Persistent activation of the lumbar erector spinae musculature among patients with back pain may represent the body's attempt to stabilize injured or diseased spinal structures via reflexogenic ligamentomuscular activation thereby protecting them from further injury and avoiding pain. CONCLUSIONS: The myoelectric silencing of the erector spinae muscles in the trunk flexion posture is indicative of increased load sharing on passive structures, which tissues have been found to fail under excessive loading conditions and shown to be a source of low back pain. The studies that show differences in the presence of the FRP among patients and control subjects are encouraging for this type of clinical assessment and suggest that assessment of the FRP is a valuable objective clinical tool to aid in the diagnosis and treatment of patients with low back pain.
Biomechanical Phenomena↗
A non-randomized clinical control trial of Harrison mirror image methods for correcting trunk list (lateral translations of the thoracic cage) in patients with chronic low back pain.
Spinal trunk list is a common occurrence in clinical practice, but few conservative methods of spinal rehabilitation have been reported. This study is a non-randomized clinical control trial of 63 consecutive retrospective subjects undergoing spinal rehabilitation and 23 prospective volunteer controls. All subjects presented with lateral thoracic-cage-translation posture (trunk list) and chronic low back pain. Initial and follow-up numerical pain rating scales (NRS) and AP lumbar radiographs were obtained after a mean of 11.5 weeks of care (average of 36 visits) for the treatment group and after a mean of 37.5 weeks for the control group. The radiographs were digitized and analyzed for a horizontal displacement of T12 from the second sacral tubercle, verticality of the lumbar spine at the sacral base, and any dextro/levo angle at mid-lumbar spine. Treatment subjects received the Harrison mirror image postural correction methods, which included an opposite trunk-list exercise and a new method of opposite trunk-list traction. Control subjects did not receive spinal rehabilitation therapy, but rather self-managed their back pain. For the treatment group, there were statistically significant improvements (approximately 50%) in all radiographic measurements and a decrease in pain intensity (NRS: 3.0 to 0.8). For the control group, no significant radiographic and NRS differences were found, except in trunk-list displacement of T12 to S1, worsened by 2.4 mm. Mirror image (opposite posture) postural corrective exercises and a new method of trunk-list traction resulted in 50% reduction in trunk list and were associated with nearly resolved pain intensity in this patient population. The findings warrant further study in the conservative treatment of chronic low back pain and spinal disorders.
Adult↗
Anterior thoracic posture increases thoracolumbar disc loading.
In the absence of external forces, the largest contributor to intervertebral disc (IVD) loads and stresses is trunk muscular activity. The relationship between trunk posture, spine geometry, extensor muscle activity, and the loads and stresses acting on the IVD is not well understood. The objective of this study was to characterize changes in thoracolumbar disc loads and extensor muscle forces following anterior translation of the thoracic spine in the upright posture. Vertebral body geometries (C2 to S1) and the location of the femoral head and acetabulum centroids were obtained by digitizing lateral, full-spine radiographs of 13 men and five women volunteers without previous history of back pain. Two standing, lateral, full-spine radiographic views were obtained for each subject: a neutral-posture lateral radiograph and a radiograph during anterior translation of the thorax relative to the pelvis (while keeping T1 aligned over T12). Extensor muscle loads, and compression and shear stresses acting on the IVDs, were calculated for each posture using a previously validated biomechanical model. Comparing vertebral centroids for the neutral posture to the anterior posture, subjects were able to anterior translate +101.5 mm+/-33.0 mm (C7-hip axis), +81.5 mm+/-39.2 mm (C7-S1) (vertebral centroid of C7 compared with a vertical line through the vertebral centroid of S1), and +58.9 mm+/-19.1 mm (T12-S1). In the anterior translated posture, disc loads and stresses were significantly increased for all levels below T9. Increases in IVD compressive loads and shear loads, and the corresponding stresses, were most marked at the L5-S1 level and L3-L4 level, respectively. The extensor muscle loads required to maintain static equilibrium in the upright posture increased from 147.2 N (mean, neutral posture) to 667.1 N (mean, translated posture) at L5-S1. Compressive loads on the anterior and posterior L5-S1 disc nearly doubled in the anterior translated posture. Anterior translation of the thorax resulted in significantly increased loads and stresses acting on the thoracolumbar spine. This posture is common in lumbar spinal disorders and could contribute to lumbar disc pathologies, progression of L5-S1 spondylolisthesis deformities, and poor outcomes after lumbar spine surgery. In conclusion, anterior trunk translation in the standing subject increases extensor muscle activity and loads and stresses acting on the intervertebral disc in the lower thoracic and lumbar regions.
Biomechanical Phenomena↗
Active trunk extensor contributions to dynamic posteroanterior lumbar spinal stiffness.
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.
Adult↗
Biomechanical and neurophysiological responses to spinal manipulation in patients with lumbar radiculopathy.
OBJECTIVE: The purpose of this study was to quantify in vivo vertebral motions and neurophysiological responses during spinal manipulation. METHODS: Nine patients undergoing lumbar decompression surgery participated in this study. Spinal manipulative thrusts (SMTs) ( approximately 5 ms; 30 N [Sham], 88 N, 117 N, and 150 N [max]) were administered to lumbar spine facet joints (FJs) and spinous processes (SPs) adjacent to an intraosseous pin with an attached triaxial accelerometer and bipolar electrodes cradled around the S1 spinal nerve roots. Peak baseline amplitude compound action potential (CAP) response and peak-peak amplitude axial (AX), posterior-anterior (PA), and medial-lateral (ML) acceleration time and displacement time responses were computed for each SMT. Within-subject statistical analyses of the effects of contact point and force magnitude on vertebral displacements and CAP responses were performed. RESULTS: SMTs (>/= 88 N) resulted in significantly greater peak-to-peak ML, PA, and AX vertebral displacements compared with sham thrusts (P <.002). SMTs delivered to the FJs resulted in approximately 3-fold greater ML motions compared with SPs (P <.001). SMTs over the SPs resulted in significantly greater AX displacements compared with SMTs applied to the FJs (P <.05). Seventy-five percent of SMTs resulted in positive CAP responses with a mean latency of 12.0 ms. Collectively, the magnitude of the CAP responses was significantly greater for max setting SMTs compared with sham (P <.01). CONCLUSIONS: Impulsive SMTs in human subjects were found to stimulate spinal nerve root responses that were temporally related to the onset of vertebral motion. Further work, including examination of the frequency and force duration dependency of SMT, is necessary to elucidate the clinical relevance of enhanced or absent CAP responses in patients.
Adult↗
Prediction of osteoporotic spinal deformity.
STUDY DESIGN: A biomechanical model was developed from full-spine lateral radiographs to predict osteoporotic spinal deformity in elderly subjects. OBJECTIVE: To investigate the biomechanics of age-related spinal deformity and concomitant height loss associated with vertebral osteoporosis. SUMMARY OF BACKGROUND DATA: Vertebral bone loss and disc degeneration associated with aging causes bone and disc structures to weaken and deform as a result of gravity and postural stresses. METHODS: An anatomically accurate sagittal-plane, upright-posture biomechanical model of the anterior spinal column (C2-S1) was created by digitizing lateral full-spine radiographs of 20 human subjects with a mean height of 176.8 cm and a mean body weight of 76.6 kg. Body weight loads were applied to the model, after which intervertebral disc and vertebral body forces and deformation were computed and the new spine geometry was calculated. The strength and stiffness of the vertebral bodies were reduced according to an osteopenic aging model and modulus reduction algorithm, respectively. RESULTS: The most osteopenic model (L3 F(ult) = 750 N) produced gross deformities of the spine, including anterior wedge-like fracture deformities at T7 and T8. In this model, increases in thoracic kyphosis and decreases in vertebral body height resulted in a 25.2% decrease in spinal height (C2-S1), an 8.6% decrease in total body height, and a 15.1-cm anterior translation of the C2 spine segment centroid. The resulting deformity qualitatively resembled deformities observed in elderly individuals with osteoporotic compression fractures. CONCLUSIONS: These predictions suggest that postural forces are responsible for initiation of osteoporotic spinal deformity in elderly subjects. Vertebral deformities are exacerbated by anterior translation of the upper spinal column, which increases compressive loads in the thoracolumbar region of the spine.
Age Factors↗
Comparison of dynamic posteroanterior spinal stiffness to plain film radiographic images of lumbar disk height.
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.
Adolescent↗
Chiropractic management of Ehlers-Danlos syndrome: a report of two cases.
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.
Adult↗
Repeatability over time of posture, radiograph positioning, and radiograph line drawing: an analysis of six control groups.
BACKGROUND: There is debate concerning the repeatability of posture over time, radiograph positioning repeatability, and radiograph line drawing reliability. These ideas seem to negate the use of before-and-after spinal radiographic imaging to detect and correct vertebral subluxations. OBJECTIVE: To review the results of control groups in 6 clinical control trials with before-and-after radiographic measurements taken days, weeks, months, or years apart to accept or reject the hypothesis that radiographic analysis procedures are not repeatable, reliable, or reproducible. DATA SOURCES: Six published control groups from original data. Other data were obtained from searches on MEDLINE, CHIROLARS, MANTIS, and CINAHL on radiographic reliability, posture, and positioning. RESULTS: Comparison of initial and follow-up radiographic data for 6 control groups indicate that measured angles and distances between initial and follow-up radiograph measurements on lateral and anterior to posterior radiographs are not significantly different when utilizing Chiropractic Biophysics radiographic procedures. In 48 out of 50 measurements, the differences between initial and follow-up radiographs are less than 1.5 degrees and 2 mm. These measurements indicate that posture is repeatable, radiographic positioning is repeatable, and radiographic line drawing analysis for spinal displacement is highly reliable. The scientific literature on these topics also indicates the repeatability of posture, radiographic positioning, and radiographic line drawing. CONCLUSIONS: Posture, radiographic positioning, and radiographic line drawing are all very reliable/repeatable. When Chiropractic Biophysics standardized procedures are used, any pre-to-post alignment changes in treatment groups are a result of the treatment procedures applied. These results contradict common claims made by several researchers and clinicians in the indexed literature. Chiropractic radiologic education and publications should reflect the recent literature, provide more support for posture analysis, radiographic positioning, radiographic line drawing analyses, and applications of posture and radiographic procedures for measuring spinal displacement on plain radiographs.
Biomechanical Phenomena↗
Chiropractic management of chronic chest pain using mechanical force, manually assisted short-lever adjusting procedures.
OBJECTIVE: To discuss a case involving a patient with chronic chest pain, dyspnea, and anxiety. Although resistant to previous treatment regimens, the condition responded favorably to chiropractic manipulation of the costosternal articulations. CLINICAL FEATURES: A 49-year-old man had chronic chest pain, dyspnea, and anxiety for over 4 months. The severity of the condition gradually progressed to the point of precluding the patient's active employment and most physical activity. Prior efforts to treat the condition had met with failure. INTERVENTION AND OUTCOME: The patient received mechanical force, manually assisted short-lever chiropractic adjustment of the thoracic spine and, in particular, the costosternal articulations. Adjustments were by means of an Activator Adjusting Instrument II. The patient responded favorably to the intervention, obtaining prompt relief from his symptoms. Sustained chiropractic care rendered over a 14-week period resulted in complete resolution of the patient's previously chronic condition, with recovery maintained at 9-month follow-up. CONCLUSIONS: Certain types of chest pain may have their etiology in a subluxation complex involving the costosternal articulation. Although the possibility of myocardial involvement must be considered with all patients whose symptoms include chest pain, a musculoskeletal involvement, including costosternal subluxation complex, may be the underlying cause of the symptoms in certain patients. When this is the case, chiropractic adjustment may provide an effective mode of treatment. Further study in an academic research venue is merited to investigate the role that conservative chiropractic care can provide for patients with chest pain.
Anxiety↗
Force-deformation response of the lumbar spine: a sagittal plane model of posteroanterior manipulation and mobilization.
OBJECTIVE: To develop a mathematical model capable of describing the static and dynamic motion response of the lumbar spine to posteroanterior forces. DESIGN: Static, impulsive and oscillatory forces with varying thrust angles and offsets were applied to the model, and the resulting motion responses were compared to experimental data published for spinal mobilization and manipulation of prone-lying subjects. BACKGROUND: Methods are sought to improve understanding of the dynamic force-induced displacement response of the lumbar spine during spinal mobilization and manipulation treatment. METHODS: The thorax, pelvis and five lumbar vertebrae were represented as seven rigid structures and eight flexible joint structures. Flexible joint structures were modeled using spring and damper elements with three displacement degrees-of-freedom (posterior-anterior and axial displacement, and flexion-extension rotation). The resulting 21 degrees-of-freedom lumped parameter model was solved in modal space. RESULTS: The fundamental natural frequency of vibration was 5.24 Hz. Simulations performed using 100 N static and dynamic posteroanterior forces applied to the L3 vertebrae indicated that peak L3 segmental displacements were up to 2.40 mm (impulsive) and 8.23 mm (oscillatory at 2 Hz). Appreciable axial displacements (0.41 mm) and flexion-extension rotations (1.49 degrees ) were also observed for oscillatory forces at L3. The posteroanterior motion response of the lumbar vertebrae was relatively insensitive to both the thrust force angle and thrust force offset, but axial displacements and flexion-extension rotations showed a large change (2-fold or greater) for thrust angles greater than -5 degrees (caudal) in comparison to vertical thrusts. Intersegmental motion responses for static, impulsive and oscillatory loads were more comparable than their segmental counterparts. CONCLUSIONS: The model predicts lumbar segmental and inter-segmental motion responses to manipulative forces that are otherwise difficult to obtain experimentally. RELEVANCE: This study assists clinicians to understand the biomechanics of posteroanterior forces applied to the lumbar spine of prone-lying subjects. Of particular clinical relevance is the finding that greater spinal mobility is possible by targeting specific load-time histories.
Biomechanical Phenomena↗