Short term modulation of trunk neuromuscular responses following spinal manipulation: a control group study

Abstract

BackgroundLow back pain (LBP) is one of the most frequent musculoskeletal conditions in industrialized countries and its economic impact is important. Spinal manipulation therapy (SMT) is believed to be a valid approach in the treatment of both acute and chronic LBP. It has also been shown that SMT can modulate the electromyographic (EMG) activity of the paraspinal muscle. The purpose of this study was to investigate, in a group of patients with low back pain, the persistence of changes observed in trunk neuromuscular responses after a spinal manipulation (SMT).MethodsSixty adult participants with LBP performed a block of 5 flexion-extension movements. Participants in the experimental group (n=30) received lumbar SMT whereas participants in the control group (n=30) were positioned similarly for the treatment but did not receive SMT. Blocks of flexion-extension movements were repeated immediately after the manipulation as well as 5 and 30 minutes after SMT (or control position). EMG activity of paraspinal muscles was recorded at L2 and L5 level and kinematic data were collected to evaluate the lumbo-pelvic kinematics. Pain intensity was noted after each block. Normalized EMG, pain intensity and lumbo-pelvic kinematics were compared across experimental conditions.ResultsParticipants from the control group showed a significant increase in EMG activity during the last block (30 min) of flexion-extension trials in both flexion and full-flexion phases at L2. Increase in VAS scores was also observed in the last 2 blocks (5 min and 30 min) in the control group. No significant group x time interaction was seen at L5. No significant difference was observed in the lumbo-pelvic kinematics.ConclusionChanges in trunk neuromuscular control following HVLA spinal manipulation may reduce sensitization or muscle fatigue effects related to repetitive movement. Future studies should investigate short term changes in neuromuscular components, tissue properties and clinical outcomes.

Effect of mobilization time by maitland method in nonspecific low back pain and neck pain.

“…In the cervical region there was a trend to a better activation of the muscles in the MEG; already in the lumbar region there were no changes in muscle response when compared to baseline (T0) and revaluation (T1). In the research of Harvey & Descarreaux (27) was observed an increase in muscle electrical activity of paraspinal muscles during flexion-extension movements in the control group, what disagree with our finds that the extension movement, once finalized the spinal manipulation.…”

Preliminary Findings on the Use of Osteopathic Manipulative Treatment: Outcomes During the Formation of the Practice-Based Research Network, DO-Touch.NET

“…In the current study, a large majority (92%) of pa- For example, current evidence indicates that changes in neural activities from manual treatments are sustained for less than 1 minute and often less than 1 second, [65][66][67][68][69][70][71][72][73][74] but somatohumeral changes persist from hours to up to 1 day, particularly β-endorphin, 75,76 substance P, 77 tumor-necrosis factor α, 77 interleukin 1β 78 and 2, 79 and the endocannabinoid-like substance palmitylethanolamide. 75,80 Consequently, somatohumeral changes may be responsible for the response noted in the current study.…”

Comparison between high-velocity low-amplitude manipulation and muscle energy technique on pain and trunk neuromuscular postural control in male workers with chronic low back pain: A randomised crossover trial

“…However, when we compared the ES after 15 days, we noticed that the HVLA group presented a result three times greater than the MET group, although the effect size is weak. We believe this small beneficial effect in the HVLA group is due to the fact that this technique is applied directly to the joints (Evans 2002 ; Hamilton et al 2007 ; Rubinstein et al 2012 ; Unsworth et al 1971 ) and promotes a decrease in pain (gate control theory; Hamilton et al 2007 ; Melzack & Wall 1965 ) and increased ROM (joint capsules stretch; Hamilton et al 2007 ; Harvey & Descarreaux 2013 ). A study that evaluated the movement of the spine, but at angles, also showed improvement in mobility after intervention with manual techniques (Langevin et al 2015 ), which could support our findings.…”

“…High-velocity low-amplitude thrust manipulation is a passive technique, applied near the end of the joint range of motion (ROM) and can cause cavitation (Evans 2002 ; Unsworth, Dowson & Wright 1971 ). There are two hypotheses often cited to explain the decrease in pain with this technique: (1) joint manipulation activates mechanoreceptors that inhibit nociceptive afferents (gate control theory; Hamilton et al 2007 ; Melzack & Wall 1965 ), and (2) manipulation releases adhesions in the joint, reduces zygapophyseal peri-articular oedema (improving the drainage) and consequently improves the ROM (Hamilton et al 2007 ; Harvey & Descarreaux 2013 ). On the contrary, MET is an active or passive technique, characterised by voluntary contractions and relaxations of the patient’s muscles (Chaitow 2006 ; Franke et al 2015 ; Hamilton et al 2007 ; Rubinstein et al 2012 ) and uses reciprocal inhibition physiological mechanisms; a muscle contraction inhibits or decreases the motor neurons’ excitability that innervates the antagonist muscle (Chaitow 2006 ).…”