We determined whether spinal manipulation could prevent and/or reverse the decrease and increase in paraspinal muscle spindle responsiveness caused respectively by lengthening and shortening histories of the lumbar muscles. Single unit spindle activity from multifidus and longissimus muscles was recorded in the L6 dorsal root in anesthetized cats. Muscle history was created and spinal manipulation delivered (thrust amplitude: 1.0mm, duration: 100ms) using a feedback-controlled motor attached to the L6 spinous process. Muscle spindle discharge to a fixed vertebral position (static test) and to vertebral movement (dynamic test) was evaluated following the lengthening and shortening histories. For the static test, changes in muscle spindle responsiveness were significantly less when spinal manipulation followed muscle history (p<0.01), but not when spinal manipulation preceded it (p>0.05). For the dynamic test, spinal manipulation did not significantly affect the history-induced change in muscle spindle responsiveness. Spinal manipulation may partially reverse the effects of muscle history on muscle spindle signaling of vertebral position.
Muscle spindle; proprioception; spinal manipulation; lumbar spine; paraspinal muscle; thixotropy; muscle history; chiropractic; Fuseau musculaire; proprioception; manipulation vertébrale; colonne lombaire; muscle paravertébral; thixotropie; antécédent musculaire; chiropratique
Increasing our knowledge regarding intrafusal fiber distribution and physiology of paraspinal proprioceptors may provide key insights regarding proprioceptive deficits in trunk control associated with low back pain and lead to more effective clinical intervention. The use of vertebral movement as a means to reliably stretch paraspinal muscles would greatly facilitate physiological study of paraspinal muscle proprioceptors where muscle tendon isolation is either very difficult or impossible. The effects of succinylcholine (SCh) on 194 muscle spindle afferents from lumbar longissimus or multifidus muscles in response to computer-controlled, ramp and hold movements of the L6 vertebra were investigated in anesthetized cats. Paraspinal muscles were stretched by moving the L6 vertebra 1.5 to1.7mm in the dorsal-ventral direction. Initial frequency (IF), dynamic difference (DD), their changes (Δ) following SCh injection (100-400μg ·kg−1), and post-SCh dynamic difference (SChDD) were measured. Muscle spindle intrafusal fiber terminations were classified as primary or secondary fibers as well as bag1 (b1c), bag2 (b2c), b1b2c, or chain (c) fibers. Intrafusal fiber subpopulations were distinguished using logarithmic transformation of SChDD and ΔIF distributions as established by previous investigators. Increases in DD indicate strength of b1c influence while increases in IF indicate strength of b2c influence. Out of 194 afferents, 46.9% of afferents terminated on b2c fibers, 46.4% on b1b2c fibers, 1% on b1c fibers and 5.7% terminated on c fibers. Based on these intrafusal fiber subpopulation distributions, controlled vertebral movement can effectively substitute for direct tendon stretch and allow further investigation of paraspinal proprioceptors in this anatomically complex body region.
Muscle Spindle; Neurophysiology; Paraspinal Muscles; Trunk; Lumbar Spine; Succinylcholine
Mechanical characteristics of high velocity low amplitude spinal manipulations (HVLA-SM) can be variable. Sustained changes in peripheral neuronal signaling due to altered load transmission to a sensory receptor’s local mechanical environment are often considered a mechanism contributing to the therapeutic effects of spinal manipulation. The purpose of this study was to determine whether an HVLA-SM’s thrust amplitude or duration altered neural responsiveness of lumbar muscle spindles to either vertebral movement or position.
Anesthetized cats (n=112) received L6 HVLA-SMs delivered to the spinous process. Cats were divided into 6 cohorts depending upon the peak thrust force (25%, 55%, 85% body weight) or thrust displacement (1, 2, 3mm) they received. Cats in each cohort received 8 thrust durations (0–250ms). Afferent discharge from 112 spindles was recorded in response to ramp and hold vertebral movement before and after the manipulation. Changes in mean instantaneous frequency (MIF) during the baseline period preceding the ramps (ΔMIFresting), during ramp movements (ΔMIFmovement), and with the vertebra held in the new position (ΔMIFposition) were compared.
Thrust duration had a small but statistically significant effect on ΔMIFresting at all six thrust amplitudes compared to control (0ms thrust duration). The lowest amplitude thrust displacement (1mm) increased ΔMIFresting at all thrust durations. For all the other thrust displacements and forces, the direction of change in ΔMIFresting was not consistent and the pattern of change was not systematically related to thrust duration. Regardless of thrust force, displacement, or duration, ΔMIFmovement and ΔMIFposition were not significantly different from control.
Relatively low amplitude thrust displacements applied during an HVLA-SM produced sustained increases in the resting discharge of paraspinal muscle spindles regardless of the duration over which the thrust was applied. However, regardless of the HVLA-SM’s thrust amplitude or duration, the responsiveness of paraspinal muscle spindles to vertebral movement and to a new vertebral position was not affected.
spinal manipulation; dose; neurophysiology; paraspinal muscles; muscle spindle; Spine; Chiropractic
In the lumbar spine, muscle spindle responsiveness is affected by the duration and direction of a lumbar vertebra’s positional history. The purpose of the present study was to determine the relationship between changes in the magnitude of a lumbar vertebra’s positional history and the responsiveness of lumbar muscle spindles to a subsequent vertebral position and subsequent vertebral movement. Neural activity from multifidus and longissimus muscle spindle afferents in deeply anesthetized cats was recorded while creating positional histories of the L6 vertebra. History was induced using a displacement-controlled feedback motor. It held the L6 vertebra for 4 seconds at an intermediate position (hold-intermediate at 0mm) and at 7 positions from 0.07 to 1.55mm more ventralward and dorsalward which lengthened (hold-long) and shortened (hold-short) the lumbar muscles. Following the conditioning hold positions, L6 was returned to the intermediate position. Muscle spindle discharge at this position and during a lengthening movement was compared between hold-intermediate and hold-short conditionings and between hold-intermediate and hold-short conditionings. We found that regardless of conditioning magnitude, the 7 shortening magnitudes similarly increased muscle spindle responsiveness to both vertebral position and movement. In contrast, the 7 lengthening magnitudes produced a graded decrease in responsiveness to both position and movement. The decrease to position became maximal following conditioning magnitudes of ~0.75 mm. The decrease to movement did not reach a maximum even with conditioning magnitudes of ~1.55 mm. The data suggest that the fidelity of proprioceptive information from muscle spindles in the low back is influenced by small changes in the previous length history of lumbar muscles.
lumbar spine; muscle spindle; proprioception; thixotropy; multifidus; longissimus
High velocity low amplitude spinal manipulation (HVLA-SM) is used frequently to treat musculoskeletal complaints. Little is known about the intervention's biomechanical characteristics that determine its clinical benefit. Using an animal preparation, we determined how neural activity from lumbar muscle spindles during a lumbar HVLA-SM is affected by the type of thrust control and by the thrust's amplitude, duration, and rate. A mechanical device was used to apply a linear increase in thrust displacement or force and to control thrust duration. Under displacement control, neural responses during the HVLA-SM increased in a fashion graded with thrust amplitude. Under force control neural responses were similar regardless of the thrust amplitude. Decreasing thrust durations at all thrust amplitudes except the smallest thrust displacement had an overall significant effect on increasing muscle spindle activity during the HVLA-SMs. Under force control, spindle responses specifically and significantly increased between thrust durations of 75 and 150 ms suggesting the presence of a threshold value. Thrust velocities greater than 20–30 mm/s and thrust rates greater than 300 N/s tended to maximize the spindle responses. This study provides a basis for considering biomechanical characteristics of an HVLA-SM that should be measured and reported in clinical efficacy studies to help define effective clinical dosages.
High velocity low amplitude spinal manipulation (HVLA-SM), as performed by
manual therapists (eg, doctors of chiropractic and osteopathy) results in mechanical
hypoalgesia in clinical settings. This hypoalgesic effect has previously been attributed
to alterations in peripheral and/or central pain processing. The objective of this study
was to determine whether thrust magnitude of a simulated HVLA-SM alters mechanical trunk
response thresholds in wide dynamic range (WDR) and/or nociceptive specific (NS) lateral
Extracellular recordings were carried out in the thalamus of 15 anesthetized
Wistar rats. Lateral thalamic neurons having receptive fields which included the lumbar
dorsal-lateral trunk were characterized as either WDR (n=22) or NS
(n=25). Response thresholds to electronic von Frey (rigid tip) mechanical trunk
stimuli were determined in three directions (dorsal-ventral, 45°caudalward, and
45°cranialward) prior to and immediately following the dorsal-ventral delivery
of a 100ms HVLA-SM at three thrust magnitudes (control, 55%, 85% body
There was a significant difference in mechanical threshold between 85%
BW manipulation and control thrust magnitudes in the dorsal-ventral direction in NS
neurons (p=.01). No changes were found in WDR neurons at either HVLA-SM thrust
This study is the first to investigate the effect of HVLA-SM thrust magnitude
on WDR and NS lateral thalamic mechanical response threshold. Our data suggest that at
the single lateral thalamic neuron level, there may be a minimal spinal manipulative
thrust magnitude required to elicit an increase in trunk mechanical response
spinal manipulation; thalamus; nociceptive neurons; lumbar vertebrae; chiropractic
Manual therapy practitioners commonly assess lumbar intervertebral mobility before deciding treatment regimens. Changes in mechanoreceptor activity during the manipulative thrust are theorized to be an underlying mechanism of spinal manipulation (SM) efficacy. The objective of this study was to determine if facet fixation or facetectomy at a single lumbar level alters muscle spindle activity during 5 SM thrust durations in an animal model.
Spinal stiffness was determined using the slope of a force-displacement curve. Changes in the mean instantaneous frequency of spindle discharge were measured during simulated SM of the L6 vertebra in the same 20 afferents for laminectomy-only, 19 laminectomy & facet screw conditions; only 5 also had data for the laminectomy & facetectomy condition. Neural responses were compared across conditions and five thrust durations (≤ 250ms) using linear mixed models.
Significant decreases in afferent activity between the laminectomy-only and laminectomy & facet screw conditions were seen during 75ms (P<.001), 100ms (P=.04) and 150ms (P=.02) SM thrust durations. Significant increases in spindle activity between the laminectomy-only and laminectomy & facetectomy conditions were seen during the 75ms (P<.001) and 100ms (P<.001) thrust durations.
Intervertebral mobility at a single segmental level alters paraspinal sensory response during clinically relevant high velocity low amplitude SM thrust durations (≤150ms). The relationship between intervertebral joint mobility and alterations of primary afferent activity during and following various manual therapy interventions may be used to help to identify patient subpopulations who respond to different types of manual therapy and better inform practitioners (eg, chiropractic, osteopathic) delivering the therapeutic intervention.
Manipulation, Spinal; Muscle Spindle; Zygapophyseal Joint; Neurons, Afferent; Chiropractic
Individuals experiencing low back pain often present clinically with intervertebral joint dysfunction. The purpose of this study was to determine whether relative changes in stiffness at a single spinal joint alters neural responsiveness of lumbar muscle spindles to either vertebral movement or position.
Muscle spindle discharge was recorded in response to 1mm L6 ramp and hold movements (0.5mm/s) in the same animal for lumbar laminectomy-only (n=23), laminectomy & L5/6 facet screw (n=19), laminectomy & L5/6 facetectomy (n=5) conditions. Mean instantaneous frequency (MIF) was calculated for the ramp-up, hold, ramp-down and post-ramp phases during each joint condition.
Mean MIFs were not significantly different between the laminectomy-only and the other two types of joint dysfunction for the ramp-up, hold, ramp-down, or post-ramp phases.
Stiffness changes caused by single facet joint dysfunction failed to alter spindle responses during slow 1mm ramp and hold movements of the L6 vertebra.
stiffness; joint; muscle spindle; chiropractic; rigidité; articulation; fuseau musculaire; chiropratique
The aim of this study was to determine the effect of spinal manipulation therapy (SMT) force magnitude and force duration on the spinal stiffness of a feline preparation. A mechanical device performed simulated SMTs at the L6 spinous process in 22 anesthetised felines. Subjects were divided into four groups. Two groups (no preload, preload) received SMT having maximal displacements of 1.0mm, 2.0mm and 3.0mm of total displacement (displacement control). In two other groups (preload, no preload), SMTs were applied with maximal loads of 25%, 55% and 85% body weight (force control). Each of the SMTs were applied in order of increasing displacement or force amplitudes, at increasing durations ranging from 25 to 250 ms. Spinal stiffness was quantified by applying an indentation load to external surface of the back. Linear mixed effects models were fit for post-SMT stiffness variables. When SMT was applied under displacement control with and without a preceding preload, a significant interactive effect occurred between force magnitude and force duration (p≤0.05) for some of the stiffness variables. The findings from this experiment demonstrate that spinal stiffness in a feline model was affected by the interaction of the force amplitude and force duration parameters but the exact nature of this interaction remains unclear. This study provides guidance for further investigation given other SMT parameters not tested here may facilitate the ability of SMT to alter spinal stiffness.
Spinal Manipulative Therapy; Biomechanics
Manually-applied movement and mobilisation of body parts as a healing activity has been used for centuries. A relatively high velocity, low amplitude force applied to the vertebral column with therapeutic intent, referred to as spinal manipulative therapy (SMT), is one such activity. It is most commonly used by chiropractors, but other healthcare practitioners including osteopaths and physiotherapists also perform SMT. The mechanisms responsible for the therapeutic effects of SMT remain unclear. Early theories proposed that the nervous system mediates the effects of SMT. The goal of this article is to briefly update our knowledge regarding several physical characteristics of an applied SMT, and review what is known about the signalling characteristics of sensory neurons innervating the vertebral column in response to spinal manipulation. Based upon the experimental literature, we propose that SMT may produce a sustained change in the synaptic efficacy of central neurons by evoking a high frequency, bursting discharge from several types of dynamically-sensitive, mechanosensitive paraspinal primary afferent neurons.
High-velocity, low-amplitude spinal manipulation (HVLA-SM) is an efficacious treatment for low back pain, although the physiological mechanisms underlying its effects remain elusive. The lumbar facet joint capsule (FJC) is innervated with mechanically sensitive neurons and it has been theorized that the neurophysiological benefits of HVLA-SM are partially induced by stimulation of FJC neurons. Biomechanical aspects of this theory have been investigated in humans while neurophysiological aspects have been investigated using cat models. The purpose of this study was to determine the relationship between human and cat lumbar spines during HVLA-SM. Cat lumbar spine specimens were mechanically tested, using a displacement-controlled apparatus, during simulated HVLA-SM applied at L5, L6, and L7 that produced preload forces of ~25% bodyweight for 0.5 s and peak forces that rose to 50–100% bodyweight within ~125 ms, similar to that delivered clinically. Joint kinematics and FJC strain were measured optically. Human FJC strain and kinematics data were taken from a prior study. Regression models were established for FJC strain magnitudes as functions of factors species, manipulation site, and interactions thereof. During simulated HVLA-SM, joint kinematics in cat spines were greater in magnitude compared with humans. Similar to human spines, site-specific HVLA-SM produced regional cat FJC strains at distant motion segments. Joint motions and FJC strain magnitudes for cat spines were larger than those for human spine specimens. Regression relationships demonstrated that species, HVLA-SM site, and interactions thereof were significantly and moderately well correlated for HVLA-SM that generated tensile strain in the FJC. The relationships established in the current study can be used in future neurophysiological studies conducted in cats to extrapolate how human FJC afferents might respond to HVLA-SM. The data from the current study warrant further investigation into the clinical relevance of site targeted HVLA-SM.
feline; biomechanics; low back pain; mechanical; range of motion; zygapophyseal joint; facet joint
The lumbar facet joint capsule (FJC) is innervated with mechanically sensitive neurons and is thought to contribute to proprioception and pain. Biomechanical investigations of the FJC have commonly used human cadaveric spines, while combined biomechanical and neurophysiological studies have typically used non-human animal models. The purpose of this study was develop mathematical relationships describing vertebral kinematics and facet joint capsule strain in cat and human lumbar spine specimens during physiological spinal motions in order to facilitate future efforts at understanding the mechanosensory role of the FJC.
Cat lumbar spine specimens were tested during extension, flexion and lateral bending. Joint kinematics and FJC principal strain were measured optically. FJC strain-intervertebral angle (IVA) regression relationships were established for the three most caudal lumbar joints using cat (current study) and human (prior study) data. FJC strain-IVA relationships were utilized to estimate cat and human spine kinematics that corresponded to published sensory neuron response thresholds for low threshold mechanoreceptors (5% and 10%).
Significant linear relationships between IVA and strain were observed for both human and cat during motions that produced tension in the FJCs (p<0.01). During motions that produced tension in the FJCs, the models predicted that FJC strain magnitudes corresponding to published sensory neuron response thresholds would be produced by IVA magnitudes within the physiological range of lumbar motion.
Data from the current study support the proprioceptive role of lumbar spine FJC and low threshold mechanoreceptive afferents, and can be utilized in interpreting combined neurophysiological and biomechanical studies of cat lumbar spines.
Spinal manipulation therapy (SMT), an intervention used to treat low back pain, has been demonstrated to affect the stiffness of the spine. To adequately quantify the effects of SMT on stiffness, a device capable of applying specific parameters of manipulation in addition to measuring force-displacement values has been developed previously. Previously developed indentation techniques that quantify stiffness have been modified for novel use in evaluating SMT parameters. The reliability of stiffness measurements performed by the newly adapted device was assessed in this study.
Seven springs of varying stiffness were each indented 10 times by a Variable Rate Force/Displacement (VRFD) device. Indentations were performed at a rate of 0.5mm/s to a maximal displacement of 4 mm. The stiffness coefficients for a middle portion of the resulting force-displacement graph and the terminal instantaneous stiffness (stiffness at end displacement) were calculated. The intra class correlation and confidence interval were calculated for these stiffness measurements to assess device reliability.
Repeated spring stiffness measures yielded an ICC value of 1.0. The mean stiffness values had narrow 95% confidence intervals ranging from 0.01 N/mm to 0.06 N/mm and small coefficients of variation.
This VRFD device provides highly reliable stiffness measurements in controlled conditions. Although in vivo reliability remains to be established, the results of this study support the use of the VRFD device in future trials investigating the impact of SMT various parameters on spinal stiffness.
Manipulation; Spinal; Reproducibility of Results; Elastic Modulus; Chiropractic
Quadruped animal models have been validated and utilized as biomechanical models for the lumbar spine. The biomechanics of the cat lumbar spine has not been well characterized, even though it is a common model used in neuromechanical studies.
Compare the physiological ranges of motion and determine torque-limits for cat and human lumbar spine specimens during physiological motions.
Cat and human lumbar spine specimens.
Intervertebral angle (IVA), joint moment, yield point, torque-limit, correlation coefficients.
Cat (L2-sacrum) and human (T12-sacrum) lumbar spine specimens were mechanically tested to failure during displacement-controlled extension, lateral bending, and axial rotation. Single trials consisted of 10 cycles (10mm/s or 5°/s) to a target displacement where the magnitude of the target displacement was increased for subsequent trials until failure occurred. Whole-lumbar stiffness, torque at yield point, and joint stiffness were determined. Scaling relationships were established using equations analogous to those that describe the load response of elliptically-shaped beams.
IVA magnitudes for cat and human lumbar spines were similar during physiological motions. Human whole-lumbar and joint stiffness magnitudes were significantly greater than those for cat spine specimens (p<0.05). Torque-limits were also greater for humans compared to cats. Scaling relationships with high correlation (R2>0.77) were established during later lateral bending and axial rotation.
The current study defined “physiological ranges of movement” for human and cat lumbar spine specimens during displacement-controlled testing, and should be observed in future biomechanical studies conducted under displacement control.
In neutral spinal postures with low loading moments the lumbar spine is not inherently stable. Small compromises in paraspinal muscle activity may affect lumbar spinal biomechanics. Proprioceptive feedback from muscle spindles is considered important for control of muscle activity. Because skeletal muscle and muscle spindles are thixotropic, their length history changes their physical properties. The present study explores a mechanism that can affect the responsiveness of paraspinal muscle spindles in the lumbar spine.
This study had two aims: to extend our previous findings demonstrating the history dependent effects of vertebral position on the responsiveness of lumbar paraspinal muscle spindles; and to determine the time course for these effects. Based upon previous studies, if a crossbridge mechanism underlies these thixotropic effects, then the relationship between the magnitude of spindle discharge and the duration of the vertebral position will be one of exponential decay or growth.
A neurophysiological study using the lumbar spine of a feline model.
The discharge from individual muscle spindles afferents innervating lumbar paraspinal muscles in response to the duration and direction of vertebral position were obtained from teased filaments in the L6 dorsal roots of 30 Nembutal-anesthetized cats. The L6 vertebra was controlled using a displacement-controlled feedback motor and was held in each of 3 different conditioning positions for durations of 0, 0.5, 1, 1.5, and 2 seconds. Two of the conditioning positions stretched or shortened the lumbar muscles relative to an intermediate conditioning position. Conditioning positions for all cats ranged from 0.9 – 2.0 mm dorsal and ventralward relative to the intermediate position. These magnitudes were determined based upon the displacement that loaded the L6 vertebra to 50–60% of the cat’s body weight. Conditioning was thought to simulate a motion segment’s position that might be passively maintained due to fixation, external load, a prolonged posture, or structural change. Following conditioning positions that stretched (hold-long) and shortened (hold-short) the spindle, the vertebra was repositioned identically and muscle spindle discharge at rest and to movement was compared with conditioning at the intermediate position.
Lumbar vertebral positions maintained for less than 2 seconds were capable of evoking different discharge rates from lumbar paraspinal muscle spindles despite the vertebra having been returned to identical locations. Both resting spindle discharge and their responsiveness to movement were altered. Conditioning vertebral positions that stretched the spindles decreased spindle activity and positions that unloaded the spindles increased spindle activity upon returning the vertebra to identical original (intermediate) positions. The magnitude of these effects increased as conditioning duration increased to 2 seconds. These effects developed with a time course following a first order exponential reaching a maximal value after approximately 4 seconds of history. The time constant for a hold-short history was 2.6 seconds and for a hold-long history was approximately half of that at 1.1 seconds.
Thixotropic contributions to the responsiveness of muscles spindles in the low back are caused by the rapid, spontaneous formation of stable crossbridges. These sensory alterations due to vertebral history would represent a proprioceptive input not necessarily representative of the current state of intersegmental positioning. As such, they would constitute a source of inaccurate sensory feedback. Examples are presented suggesting ways in which this novel finding may affect spinal physiology.
Spinal manipulation (SM) is a form of manual therapy used clinically to treat patients with low back and neck pain. The most common form of this maneuver is characterized as a high velocity (duration < 150ms), low amplitude (segmental translation < 2mm, rotation < 4°, and applied force 220-889N) impulse thrust (HVLA-SM). Clinical skill in applying an HVLA-SM lies in the practitioner's ability to control the duration and magnitude of the load (i.e., the rate of loading), the direction in which the load is applied, and the contact point at which the load is applied. Control over its mechanical delivery presumably related to its clinical effects. Biomechanical changes evoked by an HVLA-SM are thought to have physiological consequences caused, at least in part, by changes in sensory signaling from paraspinal tissues.
If activation of afferent pathways does contribute to the effects of an HVLA-SM, it seems reasonable to anticipate that neural discharge might increase or decrease in a non-linear fashion as the thrust duration thrust approaches a threshold value. We hypothesized that the relationship between the duration of an impulsive thrust to a vertebra and paraspinal muscle spindle discharge would be non-linear with an inflection near the duration of an HVLA-SM delivered clinically (<150ms). In addition, we anticipated that muscle spindle discharge would be more sensitive to larger amplitude thrusts.
A neurophysiological study of spinal manipulation using the lumbar spine of a feline model.
Impulse thrusts (duration: 12.5, 25, 50, 100, 200, and 400 ms; amplitude 1 or 2mm posterior to anterior) were applied to the spinous process of the L6 vertebra of deeply anesthetized cats while recording single unit activity from dorsal root filaments of muscle spindle afferents innervating the lumbar paraspinal muscles. A feedback motor was used in displacement control mode to deliver the impulse thrusts. The motor's drive arm was securely attached to the L6 spinous process via a forceps.
As thrust duration became shorter the discharge of the lumbar paraspinal muscle spindles increased in a curvilinear fashion. A concave up inflection occurred near the 100ms duration eliciting both a higher frequency discharge compared to the longer durations and a substantially faster rate of change as thrust duration was shortened. This pattern was evident in paraspinal afferents with receptive fields both close and far from the midline. Paradoxically, spindle afferents were almost twice as sensitive to the 1mm compared to the 2mm amplitude thrust (6.2 vs 3.3 spikes/s/mm/s). This latter finding may be related to the small vs large signal range properties of muscle spindles.
. The results indicate that the duration and amplitude of a spinal manipulation elicits a pattern of discharge from paraspinal muscle spindles different from slower mechanical inputs. Clinically, these parameters may be important determinants of an HVLA-SM's therapeutic benefit.
lumbar spine; spinal manipulation; chiropractic; osteopathy; paraspinal muscles; muscle spindle
College research departments use students as participants in trials and often receive course credit or other incentives, but sometimes challenges are found in recruiting participants without compensation. This commentary describes methods of recruitment for one study at Palmer Center for Chiropractic Research and comments from two other schools about how they recruit volunteers.
chiropractic; human experimentation; patient selection; student
A challenge for practitioners using spinal manipulation is identifying when an intervention is required. It has been recognized that joint pain can interfere with the ability to position body parts accurately and that the recent history of muscle contraction can play a part in that interference. In this study, we tested whether repositioning errors could be induced in a normal population by contraction or shortening of the neck muscles.
In the experimental protocol, volunteers free of neck problems first found a comfortable neutral head posture with eyes closed. They deconditioned their cervical muscles by moving their heads 5 times in either flexion/extension or lateral flexion and then attempted to return to the same starting position. Two conditioning sequences were interspersed within the task: hold the head in an extended or laterally flexed position for 10 seconds; or hold a 70% maximum voluntary contraction in the same position for 10 seconds. A computer-interfaced electrogoniometer was used to measure head position while a force transducer coupled to an auditory alarm signaled the force of isometric contraction. The difference between the initial and final head orientation was calculated in 3 orthogonal planes. Analysis of variance (1-way ANOVA) with a blocking factor (participants) was used to detect differences in proprioceptive error among the conditioning sequences while controlling for variation between participants.
Forty-eight chiropractic students participated: 36 males and 12 females, aged 28.2 ± 4.8 yrs. During the neck extension test, actively contracting the posterior neck muscles evoked an undershoot of the target position by 2.1° (p <0.001). No differences in repositioning were found during the lateral flexion test.
The results suggest that the recent history of cervical paraspinal muscle contraction can influence head repositioning in flexion/extension. To our knowledge this is the first time that muscle mechanical history has been shown to influence proprioceptive accuracy in the necks of humans. This finding may be used to elucidate the mechanism behind repositioning errors seen in people with neck pain and could guide development of a clinical test for involvement of paraspinal muscles in cervical pain and dysfunction.