Abstract
Objective
This study aimed to investigate stress distribution and disk displacement in healthy
and degenerated intervertebral disks during simulated lumbar rotation manipulation
(LRM) in the sitting and side-lying positions.
Methods
Three-dimensional (3D) finite element models of healthy, mildly degenerated and moderately
degenerated L4/5 spinal units were reconstructed. Lumbar rotation manipulation in
the sitting and side-lying positions were simulated, and alterations in stress distribution
and disk displacement in the lumbar disks were observed.
Results
The application of LRM in the sitting or side-lying position resulted in a similar
stress distribution in healthy, mildly degenerated, and moderately degenerated disks.
Stress was concentrated at the anterior right side of the annulus. In all disks, intradiskal
pressure (IDP) and maximum von Mises stress were higher during LRM in the sitting
position than during LRM in the side-lying position. During these manipulations, Intradiskal
pressure and stress in the annulus of moderately degenerated disks were higher than
in mildly degenerated disks. Displacement was most obvious in healthy disks.
Conclusions
Mildly and moderately degenerated lumbar disks were subject to higher stress during
LRM in the sitting position than during LRM in the side-lying position. Intradiskal
pressure and the maximum von Mises stress in the annulus of moderately degenerated
disks increased, suggesting the need for caution when treating patients with moderately
compromised disks. Although our results are in accordance with previously published
data, they are simulated and preliminary and do not necessarily replicate the clinical
condition.
Key Indexing Terms
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References
- Epidemiological features of chronic low back pain.Lancet. 1999; 354: 581-585
- Non-specific low back pain.Lancet. 2012; 379: 482-491
- Biomechancial quantification of pathologic manipulable spinal lesions: an in vivo ovine model of spondylolysis and intervertebral disc degeneration.J Manipulative Physiol Ther. 2012; 35: 354-366
- Musculoskeletal pain in the population.Schmerz. 2003; 17: 405-411
- Clinical practice guideline: chiropractic care for low back pain.J Manipulative Physiol Ther. 2016; 39: 1-22
- Efficacy of multidisciplinary treatment for patients with chronic low back pain: a prospective clinical study in 395 patients.J Clin Rheumatol. 2012; 18: 76-82
- The association between use of chiropractic care and costs of care among older Medicare patients with chronic low back pain and multiple comorbidities.J Manipulative Physiol Ther. 2016; 39: 63-75
- Cost analysis related to dose-response of spinal manipulative therapy for chronic low back pain: outcomes from a randomized controlled trial.J Manipulative Physiol Ther. 2014; 37: 300-311
- The effect of manipulation on the treating lumbar disc herniation.Chin Manipul Qigong Ther. 2007; 23: 22-24
- Application of manipulation for lumbar disc herniation: literature analysis in recent 10 years.Chin J Tissue Eng Res. 2014; 18: 7211-7216
- Effects of lumbar rotatory manipulation on changes of intrapressure of the lumbar disc and transposition of nerve roots.J Cervicodynia Lumbodynia. 2001; 22: 184-186
- Effect of different lumbar vertebrae pulling method on intradiscal pressure.J Trad Chin Orthop Traumatol. 2014; 26: 11-16
- A study on mechanism of manipulation used in lumbar disc herniation.Chin J Rehabil Med. 2001; 16: 8-10
- An observation on stress for lumbar manipulations.Chin J Rehabil Med. 2001; 16: 144-145
- Comparative study of simulated lumbar manipulation techniques using biomechanical and three-dimensional finite element models.Chin J Phys Rehabil Med. 2002; 24: 525-528
- The study on deformation and displacement of the lumbar during rotatory manipulation.Chin J Clin Anat. 2008; 26: 321-324
- Comparison of lumbar rotation manipulation in three lumbar flexion levels.J Cervicodynia Lumbodynia. 2008; 29: 24-26
- Li Song, Liu L, et al. Finite element analysis of the intervertebral disc during lumbar oblique-pulling manipulation.Chin J Clin Rehabil Tissue Eng Res. 2011; 15: 2335-2338
- The finite element analysis of stresses and displacements in discs undergoing two rotator manipulations.Guangdong Med J. 2010; 31: 992-994
- Finite element analysis of lumbar pelvic and proximal femur model with simulated lumbar rotatory manipulation.Chin J Orthop Trauma. 2012; 25: 582-586
- A three-dimensional finite element analysis of sacroiliac joint exerted simulating oblique-pulling manipulation.J Pract Med. 2014; 30: 2228-2230
- Factors influencing stresses in the lumbar spine after the insertion of intervertebral cages: finite element analysis.Eur Spine J. 2003; 12: 413-420
- Interlaminar shear stresses and laminae separation in a disc. Finite element analysis of the L3-L4 motion segment subjected to axial compressive loads.Spine. 1995; 20: 689-698
- The risk of disc prolapses with complex loading in different degrees of disc degeneration—a finite element analysis.Clin Biomech. 2007; 22: 988-998
- The mechanical response of the lumbar spine to different combinations of disc degenerative changes investigated using randomized poroelastic finite element models.Eur Spine J. 2011; 20: 563-571
- The effect of spinal rotator manipulation on lumbar disc herniation.Guid China Med. 2010; 8: 139-140
- Supine oblige pull method treatment of lumbar disc herniation standardized.Guid J Tradit Chin Med Pharm. 2012; 18: 1-3
- Study on dose-effect relationship of cracking sounds and largest manipulative force by lumbar rotated and localized manipulation.Chin J Clin Anat. 2004; 22: 658-660
- A study on manipulative forces during cracking sounds arising from lumbar oblique-pulling manipulation.Chin J Rehabil Med. 2008; 23: 202-204
- Stepwise reduction of functional spinal structures increase range of motion and change lordosis angle.J Biomech. 2007; 40: 271-280
- Mechanical behavior of the human lumbar and lumbosacral spine as shown by three-dimensional load-displacement curves.J Bone Joint Surg. 1994; 76: 413-424
- Mechanical properties of human lumbar spine motion segments. Part 1: Responses in flexion, extension, lateral bending, and torsion.J Biomech Eng. 1979; 101: 46-52
- The structural components of the intervertebral disc: a study of their contributions to the ability of the disc to withstand compressive forces.J Bone Joint Surg Am. 1974; 56: 675-687
- Modeling changes in intervertebral disc mechanics with degeneration.J Bone Joint Surg Am. 2006; 88: 36-40
- Influence of single-level lumbar degenerative disc disease on the behavior of the adjacent segments—a finite element model study.J Biomech. 2009; 42: 341-348
- The effect of degenerative morphological changes of the intervertebral disc on the lumbar spine biomechanics: a poroelastic finite element investigation.Comput Methods Biomech Biomed Engin. 2011; 14: 729-739
- Analysis of the influence of disc degeneration on the mechanical behaviour of a lumbar motion segment using the finite element method.J Biomech. 2006; 39: 2484-2490
- Validity and interobserver agreement of a new radiographic grading system for intervertebral disc degeneration: Part I. Lumbar spine.Eur Spine J. 2006; 15: 720-730
- Effects of resting modes on human lumbar spines with different levels of degenerated intervertebral discs: a finite element investigation.BMC Musculoskelet Disord. 2015; 16: 221
- The effect of lumbar rotatory manipulation combined with acupuncture for lumbar intervertebral disc protrusion.Clin Med. 2010; 3: 100-101
- Stress distributions inside intervertebral discs the effect of age and degeneration.J Bone Joint Surg Br. 1996; 78: 965-972
- Mechanical properties of human lumbar spine motion segments: influences of age, sex, disc level, and degeneration.Spine (Phila Pa 1976). 1979; 4: 1-8
- Reduction in disk and fiber stresses by axial distraction is higher in cervical disk with fibers oriented toward the vertical rather than horizontal plane: a finite element model analysis.J Manipulative Physiol Ther. 2010; 33: 252-260
- A combined finite element and optimization investigation of lumbar spine mechanics with and without muscles.Spine (Phila Pa 1976). 1993; 18: 1531-1541
- Risk factors for lumbar disc degeneration. A 5-year prospective MRI study in asymptomatic individuals.Spine (Phila Pa 1976). 2007; 27: 125-134
Article info
Publication history
Accepted:
July 20,
2017
Received in revised form:
June 30,
2017
Received:
October 17,
2016
Identification
Copyright
© 2017 by National University of Health Sciences.
