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Subject: search.filters.subject.Spinal manipulative therapy

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    Muscle recruitment patterns of selected upper extremity muscles in Chiropractors within the eThekwini Municipality while performing a simulated sacroiliac joint manipulation
    (2024) Luke Hardy, Benjamin; Murphy, Bernadette; O’Connor, Laura
    Background: Spinal manipulative therapy in the form of a high velocity, low amplitude manipulation, is a specialised therapeutic technique utilised by chiropractors and other manual therapists. Little is known about the shoulder muscular recruitment pattern utilised by practitioners/student’s to deliver this technique. This study aims to profile the muscle recruitment patterns of selected upper extremity musculature during a simulated sacroiliac joint manipulation to provide objective teaching material for future spinal manipulative therapy students regarding this specific manipulation. Methods: A quantitative, descriptive, observational design in which surface electromyography (sEMG) was used captured muscle activation patterns of 11 shoulder muscles in 20 qualified chiropractors who practiced in the eThekwini Municipality. Muscle activity was recorded while the chiropractors performed a simulated sacro-iliac joint manipulation, while simultaneous live video recording was obtained. The manipulation was assessed during its three phases: preload, thrust and resolution. Participants gave informed consent. Raw data was processed and normalised for comparability. Results: All 11 muscles displayed activity throughout the three phases of the adjustment. During preload, the clavicular and sternal pectoralis major and biceps brachii had the greatest mean and median muscle activation magnitude, with the middle and upper trapezius and clavicular pectoralis major showing the greatest maximum muscle activation magnitude. In the thrust phase all muscles showed high activity levels, except for the posterior deltoid which showed moderate activation. The middle and lower trapezius and infraspinatus had the greatest mean, median and maximum muscle activation magnitude. During the resolution phase, the greatest median muscle activation magnitude was found in the middle and lower trapezius and posterior deltoid muscle. This was similar to the greatest mean and maximum muscle activation with the triceps brachii replacing the lower trapezius. The maximum force output during the adjustment was averaged at ± 1.9 Kg. Conclusion: This study highlights the role of the shoulder muscles, specifically the pectoralis and the scapular stabilizer muscles, especially the middle trapezius, in the execution of the spinal manipulative technique investigated in this study. Future studies should confirm these findings in larger population where subgroup analysis can be undertaken.
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    The immediate effect of lumbar spinal manipulative therapy on performance in female field hockey players
    (2022-05-13) Muller, Arline; Matkovich, Grant; Prince, Cleo Kirsty
    Background: Hockey is a popular recreational sport that is played not only by South Africans but people worldwide. Like all athletes, hockey players are continually seeking to improve their performance which can be measured by means of a sport-specific test battery (SSTB). Spinal manipulative therapy (SMT) has been demonstrated to improve performance in some sports and also in field hockey. Moreover, it has been shown to be effective in improving a single movement but it is unknown if it can improve the overall performance of a recreational field hockey player. Aim: The aim was to determine the immediate effect of spinal manipulative therapy (SMT) on the performance of female field hockey players. Methods: A quantitative control crossover study involving 20 recreational female field hockey players was chosen for this study. The sample was randomly assigned to either Group 1 or Group 2. The 20 participants completed a field hockey SSTB consisting of the sit-andreach, vertical jump, 40 m sprint, and the 5-0-5 agility test to establish baseline scores. In phase one, after baseline testing, Group 1 received SMT of fixated joints in the lumbar region as determined by lumbar regional assessment. Group 2 received a control treatment involving setting up the participant for an adjustment but not administering the thrust. In phase two, Group 1 received the control treatment and SMT was administered to Group 2. Thereafter all the participants completed the SSTB and the results were compared to their earlier baseline scores. A 0.05 p-value was considered statistically significant. Results and discussion: There was a significant improvement in the results of the sit-and-reach, vertical jump, 40 m sprint and 5-0-5 tests after the administration of SMT. A carryover effect was detected in the 40 m sprint test indicating that the treatment effect could not be interpreted as the effect of treatment depended on the order in which the participants received the treatments. Conclusion: Lumbar spinal manipulation therapy can improve the performance of female recreational field hockey players in terms of a sport specific tests battery (SSTB).
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    The effect of spinal manipulative therapy and ischaemic compression versus muscle energy technique in chronic nonspecific neck pain
    (2022-05-13) Dicks, Tyron D.; Varatharajullu, Desiree; Abdul-Rasheed, Ashura
    Neck pain has become a problem experienced worldwide and it poses a global healthcare challenge to practising medical professions. There are numerous manual and non-manual treatments available for this frequently encountered problem. Frequently utilised and effective therapies are spinal manipulative therapy (SMT) and ischaemic compression (IC); however, these have been associated with several contraindications. An alternative form of treatment with less contraindications that may be of benefit to the patient is muscle energy technique (MET). Therefore, the aim of this study was to determine the effect of spinal manipulative therapy and ischaemic compression compared to muscle energy technique in chronic nonspecific neck pain. Methodology: This study was a quantitative randomised, single blinded clinical trial. Forty participants with nonspecific pain, aged 20-50 years, were randomly allocated into two groups using a random allocation chart provided by a statistician. Group one received SMT and IC, whereas group two received MET alone. The numerical pain rating scale (NRS) was used to determine the level of neck pain. The cervical range of motion (CROM) goniometer was used to calculate the degree of lateral flexion occurring at the neck. The pain pressure algometer was used to determine the pain pressure thresholds (PPT). The Canadian Memorial Chiropractic College (CMCC) Neck Disability Index (NDI) was used to assess the disability in activities of daily living as a consequence of neck pain. Each participant had four consultations over a two-week period, receiving treatment on the first three consultations with the fourth being purely subjective and objective measurements. Results: Repeated measures ANOVA testing was utilised to examine the changes over time in each group. Profile plots were used to visually explore the trends of each group over time. Intra-group analysis of subjective and objective measurements revealed that both groups had a beneficial response to the treatment over time. Inter-group analysis showed that there were no statistically significant differences between the two groups in terms of subjective and objective measurements. Conclusion: In conclusion, this study revealed that the use of MET is as equally effective as a combination of SMT and IC in the treatment of chronic nonspecific neck pain
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    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
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    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.
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    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).
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    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.
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    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.
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    The effectiveness of lower thoracic spinal manipulation on lumbar extensor muscle endurance and range of motion in asymptomatic males : a placebo controlled study
    (2015) Matsebula, Lindelwe; O'Connor, Laura
    Background: Spinal manipulative therapy (SMT) is a commonly used treatment for many musculoskeletal conditions although the exact mechanism explaining its effectiveness is not well understood. Several studies have investigated the effect of SMT on the paraspinal muscles where neuromuscular effects have been observed, however few studies have assessed whether these changes result in a change in the functioning of the paraspinal muscles. This study aimed to determine the effect of lower thoracic spinal manipulation compared to a placebo intervention on lumbar extensor muscle endurance in asymptomatic participants. Methodology: This was a quantitative, pre-test post-test, placebo controlled trial involving 40 male participants between the ages of 20 and 40 years. The participants were randomly allocated to either the lower thoracic spinal manipulation group or a placebo group. Manipulation was delivered using the Impulse Adjusting Instrument®. Objective measures included lumbar spinal range of motion, a paraspinal muscle endurance test, and surface electromyography readings. Subjective measures were the verbalisation of pain and/or discomfort during the paraspinal muscle endurance test. IBM® SPSS® statistics version 21 and STATA 11 were used to analyse the data. A p-value of <0.05 was considered statistically significant. Results: There were no statistically significant differences between the groups in terms of subjective and objective measurements. A trend of treatment effect was observed for paraspinal muscle endurance where the intervention group showed noticeable improvements in endurance scores. Conclusion: Further studies need to be conducted to determine if the trends observed would occur in a larger study population.
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    An investigation into the relative effectiveness of Transeva and spinal manipulative therapy for mechanical low back pain
    (2009) Marshall, Caryn Natalie; White, Rowan; Korporaal, Charmaine Maria
    The aim of this study was to investigate the relative effectiveness of Transeva and spinal manipulative therapy for mechanical low back pain. The objectives evaluated the effectiveness of only administering Transeva therapy alone, or Spinal manipulative therapy alone as well as Transeva therapy with Spinal manipulative therapy on mechanical low back pain with respect to the patients’ subjective and objective responses to the respective treatment group. The final objective was to correlate the subjective and objective data collected to determine the effectiveness of each of the therapies in comparison with another. Design: A sample of thirty patients diagnosed with mechanical low back pain were accepted into the study. These patients were randomly divided into three groups of 10, which received different treatment protocols for mechanical low back pain. Outcome Measure: The following outcomes were measured; a decrease in pain (measured with the Numerical Pain Rating Scale (NRS), a decrease in disability (measured with the Roland-Morris Questionnaire), a decrease in local tenderness (measured with the pressure Algometer) and an increase in lumbar range of motion (measured with the Inclinometer). The data was collected prior to treatment one, prior to treatment four and at the sixth follow-up visit. Results and Conclusion: All groups improved with the treatments they received; however, no single treatment was statistically better than any other treatment intervention tested. However, the Spinal manipulative therapy group had a statistically significant faster reduction in pain on the NRS readings with p=0.048.