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Research Abstracts From the Journal of Manipulative and Physiological Therapeutics

Nov-Dec 2011 Abstracts Volume 34, Issue 9

The JMPT is the premier scientific journal of the chiropractic profession, dedicated to the advancement of chiropractic health care.

The National University of Health Sciences, owner of the journal, upholds the journal's compliance with the highest publication standards, which expressly support editorial freedom and best publication practices. The JMPT is an independent publication that strives to provide the best scientific information that improves health care practice and future research.

Cavitation Distribution Identified During Lumbar Spinal Manipulation

Gregory Cramer, DC, PhD, et al.

Objective: This project determined the location and distribution of cavitations (producing vibrations and audible sounds) in the lumbar zygapophyseal (Z) joints that were targeted by spinal manipulative therapy (SMT).

Methods: This randomized, controlled, clinical study assessed 40 healthy subjects (20 men, 20 women) 18 to 30 years of age who were block randomized into SMT (group 1, n = 30) or side-posture positioning only (group 2; control, n = 10) groups. Nine accelerometers were placed on each patient (seven on spinous processes/sacral tubercles of L1-S2 and two placed 3 cm left and right lateral to the L4/L5 interspinous space). Accelerometer recordings were made during side-posture positioning (groups 1 and 2) and SMT (group 1 only). The SMT was delivered by a chiropractic physician with 19 years of practice experience and included two high-velocity, low-amplitude thrusts delivered in rapid succession. Comparisons using X2 or McNemar test were made between number of joints cavitating from group 1 vs. group 2, upside (contact side for SMT) vs. downside, and Z joints within the target area (L3/L4, L4/L5, L5/S1) vs. outside the target area (L1/L2, L2/L3, sacroiliac).

Results: Fifty-six cavitations were recorded from 46 joints of 40 subjects. Eight joints cavitated more than once. Group 1 joints cavitated more than group 2 joints (P < .0001), upside joints cavitated more than downside joints (P < .0001), and joints inside the target area cavitated more than those outside the target area (P < .01).

Conclusions: Most cavitations (93.5%) occurred on the upside of SMT subjects in segments within the target area (71.7%). As expected, SMT subjects cavitated more frequently than did subjects with side-posture positioning only (96.7% vs. 30%). Multiple cavitations from the same Z joints had not been previously reported.

Usefulness of Clinical Measures of Psychologic Factors in Spinal Pain Patients

Donald Murphy, DC, et al.

Objective: The purposes of this study were to investigate whether a screening procedure could capture important psychologic factors with minimum burden to the patient and to investigate whether correlations exist among the various psychologic factors.

Methods: A screening procedure consisting of the 11-item Tampa Scale for Kinesiophobia, a two-question coping strategies screen, and the depression and anxiety subscales of the Bournemouth Disability Questionnaire was provided to consecutive patients with neck pain (NP) or low back pain (LBP) as part of the usual initial assessment process at a busy spine center, which includes chiropractic and physical therapy. Correlations and associations between these variables were determined.

Results: Data were collected on 95 patients with NP and 260 patients with LBP. Statistically significant correlations and associations were found between all measures in both cohorts with the exception of depression and coping in patients with NP. Statistically significant associations were found among all measures in both cohorts with the exception of depression and coping and coping and fear in patients with NP.

Conclusion: This study showed that a screening procedure may provide useful clinical information regarding psychologic factors that are of potential relevance in patients with NP and LB.

Baseline Paraspinal Muscle Function in Patients With Back-Related Leg Pain

Edward Owens Jr., MS, DC, et al.

Objective: The purpose of this study was to assess back muscle status at baseline in patients with back-related leg pain (BRLP) and to correlate those findings with baseline demographic and clinical factors.

Methods: Surface electromyography (EMG) and electromagnetic motion-tracking detected flexion-relaxation response in 135 patients with BRLP. Surface EMG electrodes were attached with standard skin preparation over the right and left paraspinal muscles at L3. Participants moved from upright standing into full forward flexion, rested flexed for 1 second, and returned to the upright position. A flexion-relaxation ratio (FRR) factor was calculated as the root mean square EMG amplitude during forward flexion divided by the activity at full flexion.

Results: High repeatability was found (intraclass correlation coefficient [ICC][1,3] = 0.94 and 0.86) between 3 cycles of assessment at the same session. Patients with BRLP exhibited low FRR values, indicating a loss of the flexion-relaxation response similar to that seen in low back pain patients. Patients with very low FRR had higher Roland-Morris Disability Questionnaire scores than the other patients, had increased incidence of straight leg raise test, and had decreased range and rate of forward flexion.

Conclusions: A subgroup of patients with BRLP was identified with very low FRR who exhibited more disability and clinical findings and decreased motion. The use of the inverted FRR factor, expressing muscle activity at the fully flexed and resting position as a percentage of peak activity during flexion, provides more stable numerical behavior and another perspective on interpreting FRRs.

Effects of Chest and Neck Mobilization on Spirometric Responses

Isnammya S.A. Lima, PT, et al.

Objectives: In this observational study, we evaluated the effects of chest and neck mobilization on spirometric parameters in healthy subjects.

Methods: We conducted an observational, quantitative, and experimental study in a sample of 100 healthy subjects. We evaluated spirometric parameters before and after pompage mobilization techniques. Three techniques were used, and each technique was performed six times.

Results: Forced vital capacity (3.4 ± 0.1 L vs. 3.5 ± 0.1 L), forced expiratory volume at the first second (3.2 ± 0.09 L vs. 3.3 ± 0.09 L), and peak expiratory flow (6.4 ± 0.27 L/s vs. 6.6 ± 0.25 L/s) were significantly increased after mobilization (P < .0001), whereas Tiffeneau index (94% ± 1% vs. 6% ± 0.2%) was decreased (P < .0001).

Conclusion: Chest and neck mobilization techniques used in this study improved spirometric parameters in a group of young and healthy subjects.

Adolescent Lumbar Lordosis and Pelvic Alignment When Wearing High Heels

Patricia A. de Oliveira Pezzan, MS, et al.

Objective: The aims of this study were (1) to analyze the influence of wearing high-heeled shoes on lumbar lordosis and pelvic inclinations among adolescents aged between 13 and 20 years were users and nonusers of high-heeled shoes and (2) to correlate these postural angles with age.

Methods: Fifty adolescents from the nonuser group (NUG) of high-heeled shoes and 50 from the user group (UG) were evaluated. Postural assessments were obtained by photogrammetry under 2 conditions—barefoot and with high-heeled shoes—and analyzed using the evaluation postural software. The measured angles included lumbar lordosis and the horizontal alignment of the pelvis. Descriptive analyses were carried out, with a significance level of 5%.

Results: With high-heeled use, the NUG demonstrated rectification of the lumbar spine and pelvic retroversion, whereas the UG demonstrated hyperlordosis and pelvic anteversion. When barefoot, smaller lumbar lordosis angles for both groups were observed. However, the pelvic angles were lower for the UG group and higher for the NUG. The studied angles showed high reliabilities. Age was correlated with lumbar lordosis angles for the NUG in the barefoot condition and with pelvic alignments in both conditions for the UG.

Conclusion: For the subjects in this study, the use of high-heeled shoes is correlated with increased lumbar lordosis and pelvic anteversions. Lumbar lordosis angles are correlated with age for the NUG when barefoot.

A Mechano-Acoustic Indentor System to Measure Properties of Soft Tissue

Koo TK, PhD, et al.

Objectives: Soft tissue exhibits nonlinear stress-strain behavior under compression. Characterizing its nonlinear elasticity may aid detection, diagnosis, and treatment of soft-tissue abnormality. The purposes of this study were to develop a rate-controlled mechano-acoustic indentor system and a corresponding finite element optimization method to extract nonlinear elastic parameters of soft tissue and evaluate its test-retest reliability.

Methods: An indentor system using a linear actuator to drive a force-sensitive probe with a tip-mounted ultrasound transducer was developed. Twenty independent sites at the upper lateral quadrant of the buttock from 11 asymptomatic subjects (seven men and four women from a chiropractic college) were indented at 6% per second for three sessions, each consisting of five trials. Tissue thickness, force at 25% deformation, and area under the load-deformation curve from 0% to 25% deformation were calculated. Optimized hyperelastic parameters of the soft tissue were calculated with a finite element model using a first-order Ogden material model. Load-deformation response on a standardized block was then simulated, and the corresponding area and force parameters were calculated. Between-trials repeatability and test-retest reliability of each parameter were evaluated using coefficients of variation and intraclass correlation coefficients, respectively.

Results: Load-deformation responses were highly reproducible under repeated measurements. Coefficients of variation of tissue thickness, area under the load-deformation curve from 0% to 25% deformation, and force at 25% deformation averaged 0.51%, 2.31%, and 2.23%, respectively. Intraclass correlation coefficients ranged between 0.959 and 0.999, indicating excellent test-retest reliability.

Conclusions: The automated mechano-acoustic indentor system and its corresponding optimization technique offers a viable technology to make in vivo measurement of the nonlinear elastic properties of soft tissue. This technology showed excellent between-trials repeatability and test-retest reliability with potential to quantify the effects of a wide variety of manual therapy techniques on the soft tissue elastic properties.

JMPT abstracts appear in DC with permission from the journal. Due to space restrictions, we cannot always print all abstracts from a given issue. Visit for access to the complete November-December 2011 issue of JMPT.

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