Theses and dissertations (Health Sciences)

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The effects of an upper cervico-thoracic segment manipulation on posture and muscle activity in participants with forward head and round-shouldered posture
(2023-05-31) Petzer, Matthew; Abdul-Rasheed, Ashura
Background: Postural dysfunction in the cervico-thoracic spine often leads to segmental restrictions and hypomobility, and this is often caused by biomechanical alterations due to postural changes and over activity of skeletal muscles in that region. These muscles include the pectoralis and trapezius muscles. Postural dysfunction and joint restrictions are often treated by manual therapies, such as spinal manipulation. Previous studies have established that joint manipulation reduces postural dysfunction and improves joint mobility, which could be explained by a combination of neurophysiological,and biomechanical effects.In literature, the immediate benefitsof acervico-thoracicmanipulation on muscleactivityandposture are not well understood and, therefore, an investigation into the immediate effects of manipulation on muscle activity and posture was implemented in this study. Aim: This study aimed to observe the immediate effect of an uppercervico-thoracic segment manipulation on posture and muscle activity in participants with forward head and round-shouldered posture. Methods: This study was a quantitative, observational study with a pre-test posttest design. Surface electromyography was used to measure the muscle activity of the pectoralis major, upper and middle trapezius muscles prior to and after the cervico-thoracic intervention. A sample size of 40 asymptomatic participants were recruited to participate. The participants were randomly divided into two groups: group A, which was the control group, and group B, which was the intervention group. The intervention group received a cervico-thoracic manipulation, but the control group received no intervention and remained prone for 3 minutes between the pre-test and post-test readings. The within-group comparisons of pre- and postmuscleactivity were achieved usingpairedT-tests. Within groupandbetween group comparisonsof the change between pre- andpost-intervention wereachieved using repeated ANOVA testing. A p-value below 0.05 was statistically significant. IBM Statistical Package for Social Sciences (SPSS) version 26 software was used to process the data. Results: There was no statistically significant treatment effect of cervico-thoracic spinal manipulation in the effects on muscle activity. Although there was not a statistically significant change in muscle activity, there was a positive change in pectoralis major compared to the upper or middle trapezius. The upper and middle trapezius muscles decrease activity followed an evident trend between the participants who received the intervention compared to the control group. Postural results were not statistically significant but positive correlations to treatment were found. The craniovertebral angle was seen to decrease at a higher rate compared to the control group. Additionally, the study provided evidence of a treatment effect on the acromiovertebral angle, decreasing overall in severity. Conclusion: The results of this study do not provide conclusive evidence that the intervention has any immediate statistical effect on the three muscle activity measurements outcomes observed. In terms of the Posture Pro Analysis System measurements, changes (decrease in angles) between the pre- and postintervention were mostly significant in both groups, but statistically there was no difference between the control and intervention groups. Posture Pro ratings did not provide evidence of changes in categories within the groups. Therefore, the null hypothesis was retained.
The immediate effects of thoracic spine grade III mobilisation on the muscle activity of the middle and lower trapezius muscle
(2022-05-13) Smit, Shinay Elizabeth; Abdul-Rasheed, Ashura
Background: Thoracic spine dysfunction often presents with regional hypomobility which is often caused by abnormal muscle activity in the overlying area. Such as the trapezius muscle. Joint dysfunction is often treated by manual therapies such as joint mobilisation. Previous studies have established that joint mobilisation improves joint mobility, achieves hypoalgesia, improves stability, range of motion and proprioception. Although documented in the literature, the direct benefits of joint mobilisation on muscle activity are not well understood. Therefore, an investigation into the effects of mobilisation on muscle activity was explored. Aim: This study aim was to determine the immediate effects of thoracic spine grade III mobilisation on the muscle activity of the middle and lower trapezius muscles. Methods: This was a quantitative, experimental, study with a pre-test post-test design. Surface electromyography was used to measure the muscle activity of the middle and lower trapezius muscle. A sample size of 48 asymptomatic participants were recruited and randomly divided into the intervention or control group. The intervention group received thoracic grade III mobilisation and the control group remained prone between the pre-test and post-test readings. Within group comparisons was achieved using paired T-tests. Within group and between group comparisons of the change between pre and post intervention was achieved using repeated ANOVA testing. A p-value below 0.05 was considered significant. Results: Spinal mobilisation had no effect on muscle activity. Despite the lack of statistical evidence, there was a positive trend in the effects of thoracic spine mobilisation with a borderline treatment effect in the left middle trapezius muscle (p = 0.063). There was an overall decrease in muscle activity in the intervention group. Conclusion: The results showed that mobilisation did not produce a noteworthy change in muscle activity of middle and lower trapezius muscles between the intervention and control groups and the null hypothesis was not rejected.
The relative effect of upper cervical spine manipulation, placebo and a control, on neck muscle activity, pain and disability in participants with cervicogenic headache
(2020-11-30) Brann, William Edward; O’Connor, Laura; Venketsamy, Yomika
Objectives: Cervical spinal manipulation (CSM) has been shown to be effective in treating cervicogenic headache (CGH) by reducing pain and disability. There is a paucity of research investigating whether changes in muscle activity account for the changes in patient reported outcomes in patients with CGH following CSM. The aim of this study was to determine the effect of upper CSM compared to a placebo and a control intervention in terms of subjective (pain and disability rating) and objective measures (muscle activity and force output of the trapezius, posterior cervical and sternocleidomastoid muscles) in the treatment of CGH. Methods: A randomized, controlled, pre-test, post-test, experimental design allowed for 45 participants, aged 18-50, with CGH to be allocated to a CSM, placebo or control group. Pain and disability were measured before and telephonically 48 hours after the intervention. Muscle activity and force output of the trapezius, posterior cervical and sternocleidomastoid (SCM) muscles were measured before and immediately after the intervention. IBM SPSS was used to analyse the data with significance set at p=0.05. The subjective and objective measures were not normally distributed and this resulted in nonparametric statistical tests being utilised to analyse the data. Wilcoxon Signed Rank Tests were used to determine significance within groups and Independent-samples KruskalWallis Tests and Pairwise multiple comparison tests were used to determine significance between groups. Results: No significant differences were found between the three groups for age (p=0.460) and gender (p=0.566), with a marginally significant finding for race (p=0.046). Subjective measure assessment found only a significant decrease in pain (p=0.001) and disability (p=0.001) from pre- post-test within the CSM group. Intergroup analysis found that the CSM group experienced the greatest reduction in pain (p=0.001) and disability (p=0.001) when compared to the placebo and control groups. Clinically, only pain in the CSM group decreased significantly. Objective findings showed significant intragroup increases in muscle activity, found bilaterally in the SCM (p=0.017 SCMR) (p=0.012 SCML) and trapezius muscles (p=0.041 TrapR) (p=0.041 TrapL) in the CSM group and only in the trapezius muscle (p=0.031 TrapR) (p=0.027 TrapL) bilaterally in the placebo group. Force output only increased in the trapezius muscle on the left (p=0.027) in the placebo group and bilaterally in the control group (p=0.031 TrapR) (p=0.041 TrapL) There were no significant intergroup differences between the groups for muscle activity and force output in the trapezius, posterior cervicals and SCM
The effect of lumbar spine manipulation on the muscle activity of the quadriceps femoris and hamstring muscle groups
(2020-11-30) Parkes, Jenna-Leigh; Abdul-Rasheed, Ashura
Background: The clinical use of spinal manipulative therapy is becoming increasingly evident in the treatment of musculoskeletal conditions. However, the exact neurophysiological mechanisms behind spinal manipulative therapy and its effects on muscle activity require further investigation. Fixated joints within the spine have been shown to cause changes in muscle activity in both segmentally related muscles and extremity muscles. When present in symptomatic or asymptomatic individuals, fixations in the spine may not only lead to local neurophysiological changes but may affect global neurophysiology. Chronic lower back pain has been associated with the presence of arthrogenic muscle inhibition in lower limb musculature which prevents an individual from fully activating the affected muscle. Although this form of inhibition is predominately present in symptomatic individuals, there is evidence to suggest that asymptomatic individuals undergo a similar neuromuscular change. However, further research is needed to determine if the extent of the effects of arthrogenic muscle inhibition differs between symptomatic and asymptomatic subjects. Aim: This study aims to determine and compare the effects of a lumbar spine manipulation on the muscle activity in the quadriceps femoris and hamstring muscle groups in asymptomatic and symptomatic participants. Method: This study was a randomised controlled trial which utilised a pre- and postexperimental design. A total of 48 participants between the ages of 18-45 years of both genders and all races were recruited. The sample population included a symptomatic and asymptomatic clinical group. Each clinical group had a treatment and control group. Once placed into their respective groups, individuals were randomly allocated to the intervention or control group. Muscle activity readings of the quadriceps femoris and hamstring muscles were obtained during sets of maximum voluntary contractions that occurred at the pre-intervention/control, post-intervention/control and post 10- minute intervention/control. IBM SPSS version 26 was used to analyse the data. Repeated measures ANOVA tests were used to compare each outcome between preand immediate post-treatment between the intervention and control groups for immediate effects, and pre- and 10-minute post-treatment between the intervention and control groups for short-term effects. This was initially done within the asymptomatic and symptomatic participants separately. Results: There were no statistically significant differences between the age and gender of the symptomatic and asymptomatic groups. With regards to muscle activity, no significant changes in the quadriceps femoris or hamstring muscle groups were identified in the asymptomatic group. Significant changes were detected in the right rectus femoris of the quadriceps muscle demonstrating evidence of a treatment effect (p=0.047). However, this change did not persist in the 10-minute readings. Although not statistically significant, there was clear evidence of a clinical trend that presented in the quadriceps femoris muscle (rectus femoris and vastus medialis) of the symptomatic group, as the overall muscle activity of the participants who received the intervention increased bilaterally. There were no statistically significant differences found when comparing the data between the symptomatic and asymptomatic clinical groups. Conclusion: The results showed that lumbar spine manipulation did not produce significant differences in the immediate post-readings and the 10-minute readings in the quadriceps femoris and hamstring muscles of the symptomatic and asymptomatic groups. When comparing the clinical groups, there was no significant difference between the asymptomatic and symptomatic groups in terms of the pre-intervention readings of muscle activity and the post-intervention measures immediately and at the 10-minute interval following lumbar spine manipulation.
The effect of sacroiliac joint manipulation on gluteus maximus muscle activity in asymptomatic participants
(2020-06-10) Worth, Kevin; Kretzmann, Heidi
Purpose: The effects of spinal manipulation are well documented; however there is a gap in the current literature regarding the exact mechanisms underlying the effectiveness of spinal manipulation. Further evidence is required to improve the understanding of the neurophysiological effects of spinal manipulative therapy and its effect on muscle activity. The objectives of this study were to investigate the effects of sacroiliac joint manipulation on gluteus maximus muscle activity in an asymptomatic sample group when compared to a placebo group Methods: A randomized, controlled, pre-test, post-test repeated measures design allowed for 28 participants, aged 18-40 years old, with sacroiliac joint dysfunction to be allocated into either a sacroiliac joint manipulation or a placebo group. Muscle activity of the gluteus maximus was measured before intervention and again 10 minutes post intervention. IBM SPSS was used to analyse the data with significance set at (p=0.05). Repeated measures ANOVA testing was used to determine the significance within and between groups. Results: There was evidence of an improvement in the intervention compared with the placebo group from pre to post for outcomes of Channel A mean and maximum values, and for Channel B maximum values. In the other measures there was a trend observed but insufficient evidence to conclude that it was a real effect. The partial eta squared values were relatively small for these non-significant effects and medium to large for the significant effects. Conclusion: Analysis of the results revealed that there was evidence of an improvement in the intervention group when compared with the placebo group in some of the outcomes measured while other outcomes measured trended towards an improvement but lacked a sufficiently large sample size to conclude that it was a statistically significant effect.
The effect of a unilateral sacroiliac joint manipulation on muscle activity and force output in the posterior oblique sling muscles
(2020-06-10) McNally, Aimee Paige; O’Connor, Laura; Abdul-Rasheed, Ashura
Objective: The effects of spinal manipulation have been well documented, however, current literature poses a gap regarding the neurophysiological mechanisms responsible for these effects. Further evidence is required in order to uncover the specific neurophysiological mechanisms of spinal manipulative therapy (SMT) and its effect on muscle activity. The study aimed to investigate the immediate effect of a unilateral sacroiliac joint (SIJ) manipulation compared to a control on muscle activity (EMG in mV) and maximum voluntary force output (dynamometer in kg) in the posterior oblique sling (POS) muscles in asymptomatic participants. Methods: A randomised, controlled, pre-test, post-test design allowed for 34 participants, aged 18-45 years old, with joint dysfunction at the SIJ to be allocated to either a manipulation or a control group. Force output and muscle activity of the gluteus maximus (GM) and latissimus dorsi (LD) muscles were measured before and after the intervention. IBM SPSS was used to analyse the data with significance set at (p=0.05). Independent samples t-tests were used to determine significance within, and between, the groups, and Pearson correlation analysis looked for correlations between the muscles in the two slings. Results: There were no significant differences observed between the control and intervention groups for age (p=0.355), gender (p=0.688), race (p=0.338), BMI (p=0.142), and the side of joint fixation (p=0.473). The intra-group analysis and intergroup analysis showed no significant differences for peak amplitude and mean muscle activity of the muscles of the POS when assessed for intra- or intergroup comparisons. A significant difference between pre and post maximum force output in the right GM for both groups (intervention: p=0.016; control: p=0.030), and in the right LD for the control group only (p=0.032), was noted. However, there was no significant difference between group results for any muscle in terms of force output when assessed for intergroup comparisons. Conclusion: The results of this study showed no treatment effect of SIJ manipulation on the muscles of the POS in asymptomatic participants. Consideration should be given to the way SMT is administered, the type of sham intervention used and the protocol followed to elicit maximum voluntary isometric contraction (MVIC).
The effect of cervical spine manipulation compared to muscle energy technique on neck muscle activity and range of motion in asymptomatic participants
(2020-06-10) King, Sasha Lee; Docrat, Aadil; Abdul-Rasheed, Ashura
Background: Clinical evidence supports the use of spinal manipulative therapy (SMT) and muscle energy technique (MET) for the treatment of cervical spine dysfunctions. However, the physiologic mechanism behind their effectiveness is not well understood. Joint dysfunctions are associated with hypertonicity of segmentally related muscles and can occur in both symptomatic and asymptomatic individuals. Neck pain (NP) has been associated with cervical muscle dysfunction, due to the presence of altered muscle activity and impaired kinematics, demonstrated in NP patients. This includes the upper trapezius and posterior cervical muscles, whose dysfunction can be a source of NP. Spinal manipulative therapy and MET are mechanical interventions, that when applied to joint dysfunctions, produce neurophysiological changes, specifically the modulation of muscle activity and improved range of motion (ROM). However, the demonstration and comparison of the neurophysiological effects of SMT and MET in the neck, and its related musculature, are unknown. Aim: The aim is to determine the effect of cervical spine manipulation compared to MET on neck muscle activity and range of motion in asymptomatic participants. Method: This is a quasi-experimental study utilising a pre-test, post-test design, which employed 50 asymptomatic participants aged between 18 – 35 years of both genders and all races. The participants were randomly allocated into one of two treatment groups. Group 1 received cervical spine manipulation (CSM) and Group 2 received MET. Before and after the respective interventions, resting upper trapezius and posterior cervical electromyographic muscle activity and the cervical spine range of motion (CROM) (lateral flexion and extension) were measured. The IBM SPSS version 24 was used to analyse the data. The intra-group changes were compared pre- and post-intervention using paired Wilcoxon signed ranks tests. Median changes between pre- and post- were compared between the two treatment groups using Mann-Whitney U tests. A p value < 0.05 was considered as statistically significant. Results: None of the demographic or background variables differed significantly between the two groups. Both treatments had an effect, although not all significant, involving mostly reductions in resting electromyographic muscle activity and improvements in CROM. This was significant for the right posterior cervical muscles in the SMT group (p = 0.012) and for ROM in both groups (p < 0.001). No evidence of a difference in treatment effect was found. Conclusion: The results of this study suggest that SMT and MET mostly decrease resting neck muscle activity and improve CROM. Muscle energy technique may possibly be equally as effective as CSM. Concurrent changes in both outcomes suggest that more than one physiologic mechanism may likely explain these effects.
The effect of talocrural joint manipulation on muscle activity of the lower limb, balance, pain and disability in participants with chronic ankle instability syndrome
(2019-09-05) McLaren, Murray James; O’Connor, Laura; Puckree, Threethambal
Background and Purpose: Ankle sprain injuries are prevalent in both the sporting and general population and can develop into chronic ankle instability syndrome (CAIS). When this occurs, there is a tendency for the ankle to re-sprain following an acute ankle sprain. Deficits in proprioception and neuromuscular control, specifically of the peroneal muscles, may lead to altered balance and postural stability in patients with CAIS. Recent research suggests that the ankle invertors and plantarflexors are also affected. Joint manipulation has been shown to result in reduced pain and improved foot and ankle functioning in individuals with CAIS, however, the exact mechanism(s) through which joint manipulation brings about these effects is not clear and the field of extremity joint manipulation on arthrogenic muscle inhibition (AMI) is under-investigated. This study aimed to determine the immediate effect of talocrural joint manipulation on postural stability and the muscle activity of the ankle invertors, evertors and plantarflexors by assessing surface electromyography (sEMG) of these muscles during static single-limb postural stability testing. Subjective outcomes of pain and disability were also measured through the use of the foot and ankle disability index (FADI). Methods: This study used a randomized, single blinded placebo controlled pre-test, and a repeated post-test measures experimental design. A sample of 42 participants, with grade I or II CAIS, aged 18-45 years, were randomly allocated into two groups. One group received a long axis distraction talocrural joint manipulation and the other group, a sham manipulation. General pain and disability (FADI), postural stability (Biosway Portable Balance System) and muscle activity (Biopac wireless EMG system) measurements were taken before the intervention. Muscle activity and postural stability were assessed again immediately after the intervention and then again 20 minutes later. Postural stability and muscle activity were measured both with participants’ eyes opened and eyes closed. FADI measurements were taken 24 hours after the intervention. Results: The two groups were comparable at baseline for age, gender, body mass index, pain and disability, postural stability and muscle activity (p > 0.050). An inter-group analysis showed a significant improvement in FADI (p= 0.005) and general pain scores (p= 0.039) when compared to the placebo group post-manipulation. There were no significant changes in the manipulation group for muscle activity and postural stability when compared to the placebo group (p > 0.050). Intra-group analysis showed an overall improvement over time for eyes opened postural stability in the manipulation group (p= 0.040) and decreased fibularis longus muscle activity in the placebo group with eyes open balance testing (p= 0.047) and eyes closed balance testing (p= 0.023). Conclusion: The results of this study showed that talocrural joint manipulation had a positive effect on pain and disability in individuals with CAIS. No significant differences were found between the intervention and placebo groups for limb muscle activity and postural stability. Intra-group analysis showed that the manipulation had a positive effect on eyes-open postural stability performance and that there may have been a trend of an effect of manipulation counteracting muscle fatigue experienced in the fibularis longus of the placebo group. Further investigation to further elucidate the effect of manipulation in CAIS is recommended.
The effect of cervical spine manipulation on grip strength and muscle activity in asymptomatic participants with cervical spine dysfunction
(2018) Fenton, Daniel James; O'Connor, Laura
Objective: The effects of spinal manipulation are well documented, however there is a gap in the current literature regarding the neurophysiological mechanisms responsible for these effects. Further evidence is required to reveal the specific neurophysiological mechanisms of spinal manipulative therapy and its effect on muscle activity. The objectives of this study were to investigate the short-term effects of a single cervical spine manipulation on grip strength and muscle activity of the forearm flexors and extensors in an asymptomatic sample when compared to a control. Methods: A randomised, controlled, pre-test, post-test, repeated measures design allowed for 46 participants, aged 18-35 years old, with joint dysfunction at C7 to be allocated to either a cervical spine manipulation or a control group. Force output and muscle activity of the forearm flexors and extensors were measured before and immediately after the intervention and again at 5, 10 and 15-minutes. IBM SPSS was used to analyse the data with significance set at (p=0.05). Repeated measures ANOVA testing and Post hoc contrast studies were used to determine significance within, and between, groups. Results: In the treatment group there was a statistically significant change in muscle activity over time in the Extensor carpi radialis (p=0,013) and Extensor digitorum (p=0,021). Similarly, force output increased within the treatment group over time (p=0,012). A statistically significant beneficial treatment effect was identified between the groups in the Extensor carpi radialis (p=0,001) and Flexor digitorum superficialis (p=0,019) muscles only. Conclusion: Though statistical significance was not detected in all muscle groups, this study showed a trend of a treatment effect following cervical spine manipulation (C7) with most values lying just outside the parameters set for significance. Specific muscles of the forearm were affected more than others. Future studies are required with a larger sample to validate the trends observed in this study.

Theses and dissertations (Health Sciences)

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