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At least 199 records · Page 11Linked to original sources
PubMed2000

Spinal manipulation.

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Clinical Trials as Topic↗
PubMed2006

Measurement of in vivo lumbar intervertebral disc pressure during spinal manipulation: a feasibility study.

This paper presents the first reported measurements of lumbar intervertebral disc pressure in vivo during spinal manipulation. A pressure transducer was inserted into the nucleus pulposus of one normal-appearing lumbar disc in an asymptomatic adult volunteer. Pressures were recorded during several body positions and maneuvers, then during spinal manipulation, and lastly during a repetition of the preintervention body positions. Baseline pressures in the prone and side-lying positions measured 110 kPa and 150 kPa, respectively. During the manipulation, pressure rose to a peak of 890 kPa over 250 ms. Immediately following, pressures in the prone and side-lying positions measured 150 kPa and 165 kPa, respectively. These data do not support the hypotheses that manipulation can reduce a herniation by decreasing intradiscal pressure, or cause a herniation by raising pressure to failure levels. Further work may lead to a better understanding of this treatment method.

Adult↗
PubMedDate not supplied

Muscle testing response to provocative vertebral challenge and spinal manipulation: a randomized controlled trial of construct validity.

OBJECTIVE: To evaluate the relationship of muscle strength response to a provocative vertebral challenge and to spinal manipulation. DESIGN: Prospective double-blind randomized controlled trial: crossover and between subjects designs. SETTING: Laboratory: Center for Technique Research. PARTICIPANTS: Sixty-eight naive volunteers from the student body, staff and faculty of the college. INTERVENTIONS: Provocative vertebral challenge: standardized 4-5 kg force applied with a pressure algometer to the lateral aspects of the T3-12 spinous processes. INTERVENTION: manual high velocity low amplitude adjustment or switched-off activator sham. MAIN OUTCOME MEASURES: Piriformis muscle response was defined in two ways: reactivity (a decrease in muscle resistance, yes or nor, following a vertebral challenge); responsiveness (the cessation of reactivity following spinal manipulation). Relative response attributable to the maneuver (RRAM): the percent of an outcome attributable to the challenge or adjustment itself. RESULTS: Average RRAM = 16% reactivity to vertebral challenge; average RRAM = 0% responsiveness to spinal manipulation. Six to 10% of muscle tests were positive regardless of examiner, previous finding or intervention. CONCLUSIONS: For the population under investigation, muscle response appeared to be a random phenomenon unrelated to manipulable subluxation. In and of itself, muscle testing appears to be of questionable use for spinal screening and post-adjustive evaluation. Further research is indicated in more symptomatic populations, different regions of the spine, and using different indicator muscles.

Adult↗
PubMed1998

Spinal manipulation in the treatment of episodic tension-type headache: a randomized controlled trial.

CONTEXT: Episodic tension-type headache is common and is often treated using manual therapies. Few data exist for the efficacy of these interventions. OBJECTIVE: To determine the effects of spinal manipulation therapy on adults with episodic tension-type headache. DESIGN: Randomized controlled trial lasting 19 weeks. SETTING: Outpatient facility of a National Health Service-funded chiropractic research institution in Denmark. PARTICIPANTS: Volunteer sample of 26 men and 49 women aged 20 to 59 years who met the diagnostic criteria for episodic tension-type headache as defined by the International Headache Society. INTERVENTION: Participants were randomized into 2 groups, 1 receiving soft tissue therapy and spinal manipulation (the manipulation group), and the other receiving soft tissue therapy and a placebo laser treatment (the control group). All participants received 8 treatments over 4 weeks; all treatments were performed by the same chiropractor. MAIN OUTCOME MEASURES: Daily hours of headache, pain intensity per episode, and daily analgesic use, as recorded in diaries. RESULTS: Based on intent-to-treat analysis, no significant differences between the manipulation and control groups were observed in any of the 3 outcome measures. However, by week 7, each group experienced significant reductions in mean daily headache hours (manipulation group, reduction from 2.8 to 1.5 hours; control group, reduction from 3.4 to 1.9 hours) and mean number of analgesics per day (manipulation group, reduction from 0.66 to 0.38; control group, reduction from 0.82 to 0.59). These changes were maintained through the observation period. Headache pain intensity was unchanged for the duration of the trial. CONCLUSION: As an isolated intervention, spinal manipulation does not seem to have a positive effect on episodic tension-type headache.

Adult↗
PubMed2006

A perspective for considering the risks and benefits of spinal manipulation in patients with low back pain.

The purpose of this study was to determine if patients who do not receive manipulation for their low back pain (LBP) are at an increased risk for worsening disability compared to patients receiving an exercise intervention without manipulation. One hundred and thirty-one consecutive patients with LBP were randomly assigned to receive manipulation and an exercise intervention (n = 70) or an exercise intervention without manipulation (n = 61). Patients were classified as to whether they had experienced a worsening in disability upon follow-up. Relative risk and number needed to treat (NNT) statistics and associated 95% confidence intervals (CI) were calculated. Patients who completed the exercise intervention without manipulation were eight (95% CI: 1.1, 63.5) times more likely to experience a worsening in disability than patients who received manipulation. The NNT with manipulation to prevent one additional patient from experiencing a worsening in disability was 9.9 (95% CI: 4.9, 65.3) and 4 weeks with manipulation was 11.6 (95% CI: 5.2, 219.2). The results of this study offer an additional perspective for considering the risks and benefits of spinal manipulation and help to inform the integration of current evidence for spinal manipulation into healthcare policy.

Adult↗
PubMed2004

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↗
PubMed2005

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↗