Journal of Manipulative and Physiological Therapeutics
Original ArticlesThe influence of a chiropractic manipulation on lumbar kinematics and electromyography during simple and complex tasks: A case study☆,☆☆
Introduction
Optimal treatment of spine problems with manipulation must be based on a solid understanding of the effects on biomechanics. Immediate changes in lateral flexion in the cervical spine have been reported in the literature; however, to our knowledge, no research has been reported on the immediate influence of manipulation on lumbar range of motion (ROM). A long-term study1 found no correlation, after manipulative therapy, in the long-term changes in sagittal flexion ROM and pain scores. Typically, assessment of an adjustment's influence on spinal electromyography (EMG) has focused on simple static tasks.2 By using such simple measures of movement kinematics (ie, one plane or about one axis only), one may overlook the possibility of effects on motion about the other 2 axes, which can provide information on the quality of motion. In this article two suggestions are proposed as ways to better elucidate the short-term influence of an adjustment on spinal motion: (1) the use of full 3-dimensional analysis of spine kinematics and (2) analysis of more complex motor control tasks (eg, golf swing) rather than simple tasks that comprise a clinical test.
Specifically, this study presents documentation of the influence of a manipulation on lumbar spine kinematics about all 3 axes (flexion-extension, lateral bend, and axial twist) while performing motions of forward flexion, lateral bend, and axial twist, as well as during a complex motor task (the golf swing) because it was possible that the effects of manipulation would not be manifested until a complex task was assessed, requiring a large amount of coupled motion, with additional integration of kinesthetic components. In addition, trunk muscle activity was assessed before and after manipulation during these tasks, as well as during quiet stance.
Section snippets
Subject characteristics
Our subject, a 31-year-old carded member of the Professional Golfer's Association with chronic low back pain, was assessed before and after receiving a chiropractic manipulation. The fact that the subject was a professional golfer is important because professional golfers spend years developing consistent, efficient, and repeatable kinematic profiles to their golf swing.
Tasks
The sequence of events was as follows:
- 1.
3 trials of full flexion;
- 2.
3 trials of right and left lateral bend;
- 3.
3 trials of right and
Peak ROM changes during simple tasks
The subject showed no changes in peak ROM during simple flexion or axial twist tasks. During right lateral bend, the subject increased his ROM by 1.26 degrees (before, 26.93 degrees [0.15]; after, 28.19 degrees [0.49]). During left lateral bend, the subject increased his ROM by 4.63 degrees (before, 23.27 degrees [1.42]; after, 27.91 degrees [0.49]).
Changes in off-axes ROM during simple movement tasks
Average left lateral bending movement during peak flexion decreased from 4.92 degrees to 0.89 degrees (Fig 1).
Discussion
The aim of this article is to evaluate the potential of more sophisticated analysis approaches to better elucidate the effects of manipulation on spinal biomechanics.
This single case study proves that documenting just a single axis of motion, usually the sagittal plane, may overlook clinically significant changes after manipulation in a subject's lumbar kinematics. This is seen in the changes found in peak lateral-bend ROM. Furthermore, simply assessing motion in the primary plane of movement
Conclusion
It must be stressed that this is a single case study with few trials. This limits the ability to draw a causal link between an adjustment and the changes found in this study. The data simply imply a need to consider tasks other than the usual clinical tasks to evaluate the effects of manipulation. Future work should consider these tasks by using a more rigorous study design and increased number of subjects, together with the use of a sham manipulation control group. Despite the limitations of
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Lumbar sagittal mobility and low back symptoms in patients treated with manipulation
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Cited by (0)
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Submit reprint requests to: Stuart M. McGill, PhD, Professor, Faculty of Applied Health Sciences, Department of Kinesiology, University of Waterloo, Waterloo, Ontario, N2L 3G1, Canada.
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Supported by the Natural Sciences and Engineering Research Council and the Canadian Memorial Chiropractic College.