Abstract
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) (∼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.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Manipulative & Physiological TherapeuticsAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Forces and relative vertebral movements during SMT to unembalmed post-rigor human cadavers.J Manipulative Physiol Ther. 1995; 18: 4-9
- Biomechanical characterization (fingerprinting) of five novel methods of cervical spine manipulation.J Manipulative Physiol Ther. 1993; 16: 573-577
- Forces exerted during spinal manipulative therapy.Spine. 1993; 18: 1206-1212
- Forces generated during spinal manipulative therapy of the cervical spine.J Manipulative Physiol Ther. 1992; 15: 275-278
- The mechanics of spinal manipulation.in: Herzog W. Clinical biomechanics of spinal manipulation. Churchill Livingstone, Philadelphia2000: 92-190
- Validation of the force and frequency characteristics of the activator adjusting instrument.J Manipulative Physiol Ther. 1999; 22: 75-86
- Stiffness and neuromuscular reflex response of the human spine to posteroanterior manipulative thrusts in patients with low back pain.J Manipulative Physiol Ther. 2001; 24: 489-500
- Experimental measurement of the force exerted during spinal manipulation using the Thompson technique.J Manipulative Physiol Ther. 1990; 13: 448-453
- Loads transmitted during lumbosacral spinal manipulative therapy.Spine. 1997; 22: 1955-1964
- Validation of displacement measurements obtained from ultrasonic images during indentation testing.Ultrasound Med Biol. 1998; 24: 105-111
- Ultrasonic indentation.J Manipulative Physiol Ther. 2001; 24: 149-156
- Evaluation of a new device for measuring responses to posteroanterior forces in a patient population, part 1.Phys Ther. 1996; 76: 158-165
- An investigation of the relationship between low back pain and lumbar posteroanterior stiffness.J Manipulative Physiol Ther. 1996; 19: 587-591
- The effects of high and low loading forces on measured values of lumbar stiffness.J Manipulative Physiol Ther. 1998; 21: 157-163
- The response of posteroanterior lumbar stiffness to repeated loading.Man Ther. 2002; 7: 19-25
- The diagnostic performance of vertebral displacement measurements derived from ultrasonic indentation in an in vivo model of degenerative disc disease.Spine. 2001; 26: 1348-1355
- Movements of vertebrae during manipulative thrusts to unembalmed human cadavers.J Manipulative Physiol Ther. 1997; 20: 30-40
- Measurements of vertebral translations using bone pins, surface markers and accelerometers.Clin Biomech. 1997; 12: 337-340
- Skin accelerometer displacement and relative bone movement of adjacent vertebrae in response to chiropractic percussion thrusts.J Manipulative Physiol Ther. 1989; 12: 26-37
- Accuracy of piezoelectric accelerometers measuring displacement of a spinal adjusting instrument.J Manipulative Physiol Ther. 1986; 9: 15-21
- Load-displacement-time characteristics of the spine under posteroanterior mobilization.Aust J Physiother. 1992; 38: 115-123
- Measurement and analysis of the in vivo posteroanterior impulse response of the human thoracolumbar spine.J Manipulative Physiol Ther. 1994; 17: 431-441
- A method for the intravital measurement of interspinous kinematics.J Biomech. 1992; 25: 451-456
- Neural elements in human cervical intervertebral discs.Spine. 1992; 17: 132-135
- Mechanoreceptors in intervertebral discs. Morphology, distribution, and neuropeptides.Spine. 1995; 20: 2645-2651
- The nature and distribution of the innervation of human supraspinal and interspinal ligaments.Spine. 1995; 20: 869-876
- Mechanoreceptor endings in human thoracic and lumbar facet joints.Spine. 1998; 23: 168-173
- Mechanoreceptor endings in human cervical facet joints.Spine. 1994; 19: 495-501
Cavanaugh JM, Ozaktay AC, Yamashita T, Avramov A, Getchell TV, King AI. Mechanisms of low back pain: a neurophysiologic and neuroanatomic study. Clin Orthop 1997;335:166-80
- Lumbar facet pain.J Biomech. 1996; 29: 1117-1129
- Neural mechanisms of lumbar pain.Spine. 1995; 20: 1804-1809
- Ligamento-muscular protective reflex in the lumbar spine of the feline.J Electromyogr Kinesiol. 1998; 8: 197-204
- The ligamento-muscular stabilizing system of the spine.Spine. 1998; 23: 2552-2562
- Biomechanics of increased exposure to lumbar injury caused by cyclic loading.Spine. 1999; 24: 2426-2434
- Biexponential recovery model of lumbar viscoelastic laxity and reflexive muscular activity after prolonged cyclic loading.Clin Biomech. 2000; 15: 167-175
- Interaction between the porcine lumbar intervertebral disc, zygapophysial joints, and paraspinal muscles.Spine. 1997; 22: 2834-2840
- Electromyographic response of the porcine multifidus musculature after nerve stimulation.Spine. 1995; 20: 2652-2658
- Responses of mechanosensitive afferents to manipulation of the lumbar facet in the cat.Spine. 1995; 20: 2379-2385
- Response of muscle proprioceptors to spinal manipulative-like loads in the anesthetized cat.J Manipulative Physiol Ther. 2001; 24: 2-11
- Neurophysiologic response to intraoperative lumbosacral spinal manipulation.J Manipulative Physiol Ther. 2000; 23: 447-457
Fuhr AW, Colloca CJ, Green JR, Keller TS. Activator methods chiropractic technique. St. Louis: Mosby;1997
- Mechanical force, manually assisted short lever chiropractic adjustment.J Manipulative Physiol Ther. 1992; 15: 309-317
- Spinous process osteotomies to facilitate lumbar decompressive surgery.Spine. 1999; 24: 62-66
- Electromyographic reflex response to mechanical force, manually-assisted spinal manipulative therapy.Spine. 2001; 26: 1117-1124
Colloca CJ, Keller TS, Gunzburg R. Neuromechanical characterization of in vivo lumbar spinal manipulation. Part II: neurophysiological response. J Manipulative Physiol Ther 2003;26:579-91
- Highlighting of intervertebral movements and variations of intradiskal pressure during lumbar spine manipulation.J Manipulative Physiol Ther. 2000; 23: 531-535
- Force-deformation response of the lumbar spine.Clin Biomech. 2002; 17: 185-196
- Ultrasonic quantification of osseous displacements resulting from skin surface indentation loading of bovine para-spinal tissue.Clin Biomech (Bristol, Avon). 2000; 15: 228-233
- Mechanical impedance of the human lower thoracic and lumbar spine exposed to in vivo posterior-anterior manipulative thrusts. The Royal College of Surgeons, Dublin2000: 171
- Effect of loading frequency on response of the spine to lumbar posteroanterior forces.J Manipulative Physiol Ther. 1993; 16: 439-446
- A preliminary investigation of the relationship between lumbar posteroanterior mobility and low back pain.J Manipulative Man Ther. 1993; 1: 22-25
- Correlations between joint and spinal mobility, spinal sagittal configuration, segmental mobility, segmental pain, symptoms and disabilities in female homecare personnel.Scand J Rehabil Med. 2000; 32: 124-133
- Comparison of dynamic posteroanterior spinal stiffness to plain film radiographic images of lumbar disc height.J Manipulative Physiol Ther. 2003; 26: 233-241
- Lumbar disc degeneration and sagittal flexibility.J Spinal Disord. 1996; 9: 418-424
Colloca CJ, Keller TS, Seltzer DE, Fuhr AW. Muscular and soft-tissue contributions of dynamic posteroanterior spinal stiffness. Proceedings of the 2000 International Conference on Spinal Manipulation. Bloomington, MN: 2000. p. 159-60
- The relationship between submaximal activity of the lumbar extensor muscles and lumbar posteroanterior stiffness.Phys Ther. 1999; 79: 278-285
- Muscular and kinematic behavior of the lumbar spine during flexion-extension.J Spinal Disord. 1998; 11: 163-174
- Sources of variation in spinal indentation testing.J Manipulative Physiol Ther. 2001; 24: 84-91
Shirley D, Hodges PQ, Eriksson AE, Gandevia SC. Spinal stiffness changes throughout the respiratory cycle. J Appl Physiol 2003;95:1467-75
- Posteroanterior stiffness in the lumbosacral spine. The correlation between adjacent vertebral levels.Spine. 1997; 22: 2724-2729
- Effect of direction of applied mobilization force on the posteroanterior response in the lumbar spine.J Manipulative Physiol Ther. 2001; 24: 71-78
- Effect of direction of applied mobilization force on the posteroanterior response in the lumbar spine.J Manipulative Physiol Ther. 2001; 24: 487-488
- Influence of load orientation on the posteroanterior stiffness of the lumbar spine.J Manipulative Physiol Ther. 1998; 21: 534-538
- Effect of position on the posteroanterior stiffness of the lumbar spine.Man Ther. 1998; 3: 21-26
- A model of spine, ribcage and pelvic responses to a specific lumbar manipulative force in relaxed subjects.J Biomech. 1995; 28: 1403-1408
- Theory of small vertebral motions.Clin Biomech. 2000; 15: 87-94
- A rigid body model of the dynamic posteroanterior motion response of the human lumbar spine.J Manipulative Physiol Ther. 2002; 25: 485-496
- Sacroiliac joint involvement in activation of the porcine spinal and gluteal musculature.J Spinal Disord. 1999; 12: 325-330
- Evaluation of motor function during thoracic and thoracolumbar spinal surgery based on motor-evoked potentials using train spinal stimulation.Spine. 1997; 22: 1385-1393
- Physiologic changes of nerve root during posterior lumbar discectomy.Spine. 1995; 20: 654-659
- Clinical and electrophysiologic characteristics of compressed lumbar nerve roots.Spine. 1997; 22: 2100-2105
- Monitoring of lumbosacral nerve roots during spinal instrumentation.Spine. 1993; 18: 2059-2062
- Epidural recording of nerve conduction studies and surgical findings in radiculopathy.Arch Phys Med Rehabil. 1994; 75: 17-24
- Electrophysiologic evidence for an intersegmental reflex pathway between lumbar paraspinal tissues.Spine. 2002; 27: E56-E63
- Sensorimotor control of the spine.J Electromyogr Kinesiol. 2002; 12: 219-234
- Reflex responses associated with activator treatment.J Manipulative Physiol Ther. 2000; 23: 155-159
- Mechanical force spinal manipulation increases trunk muscle strength assessed by electromyography.J Manipulative Physiol Ther. 2000; 23: 585-595
- Preliminary study of the effects of a placebo chiropractic treatment with sham adjustments.J Manipulative Physiol Ther. 1999; 22: 436-443
- Articular neurology, altered biomechanics, and subluxation pathology.in: Fuhr A.W. Colloca C.J. Green J.R. Keller T.S. Activator methods chiropractic technique. Mosby Year-Book, Inc, St. Louis1997: 19-64
- Articular neurology and manipulative therapy.in: Glasgow E. Twomey L. Scull E. Kleynhans A. Idczak R. Aspects of manipulative therapy. Churchill-Livingstone, New York1985: 72-77
- Electromyographic responses of back and limb muscles associated with spinal manipulative therapy.Spine. 1999; 24: 146-152
- Spinal reflex attenuation associated with spinal manipulation.Spine. 2000; 25: 2519-2525
- Comparison of effects of spinal manipulation and massage on motoneuron excitability.Electromyogr Clin Neurophysiol. 2001; 41: 97-106
- First prize-central motor excitability changes after spinal manipulation.J Manipulative Physiol Ther. 2002; 25: 1-9
Article info
Publication history
Received in revised form:
November 18,
2003
Received:
July 8,
2003
Identification
Copyright
© 2004 National University of Health Sciences. Published by Elsevier Inc. All rights reserved.
