Back Pain
Conditions
Keywords
spinal manipulation, spinal mobilization, spinal stiffness
Brief summary
The objective of the present study is to compare the neuromechanical responses to spinal manipulation and spinal mobilization in participants with chronic nonspecific middle back pain.
Detailed description
Although evidences suggest a similar effectiveness of spinal manipulation and spinal mobilization, there is no study that compares the neuromechanical effects of these manual therapies in a experimental context and with the standardization of both interventions. Therefore, the objective of the present study is to compare the neuromechanical responses to spinal manipulation (low-amplitude and high-velocity dynamic thrust) and spinal mobilization (repetitions of a low-amplitude and low-velocity nonthrust movement) in participants with and without chronic nonspecific back pain.
Interventions
PROCEDURESpinal manipulation
A high-velocity and low-amplitude thrust delivered posteroanteriorly to a thoracic vertebra
PROCEDURESpinal mobilization
Three repetitions of a low-velocity and low-amplitude nonthrust movement delivered posteroanteriorly to a thoracic vertebra
Sponsors
Canadian Institutes of Health Research (CIHR)
Fonds de la Recherche en Santé du Québec
Unité de recherche en santé musculosqulettique
Université du Québec à Trois-Rivières
Study design
Allocation
NON_RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
BASIC_SCIENCE
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 60 Years
Healthy volunteers
Yes
Inclusion criteria
* presenting or not a history of chronic nonspecific back pain
Exclusion criteria
* History of back trauma or surgery * Severe osteoarthritis * Inflammatory arthritis * Vascular conditions * Contraindication to the use of spinal manipulation or spinal mobilization * Pregnancy * Scoliosis
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Global Spinal Stiffness | two-minutes before spinal manipulation delivery up to two-minutes after | Global stiffness was defined as the slope of the straight-line best fitting the force-displacement data between 10 and 45 N |
| Terminal Spinal Stiffness | two-minutes before spinal mobilization delivery up to two-minutes after | Terminal stiffness was defined as the ratio of the variation of force and displacement between 10 and 45 N |
| Pressure Provoked Pain | immediately after the therapeutic modality application | Pressure provoked pain intensity was assessed immediately after each spinal stiffness assessment using a 0 to 100 visual analog pain scale minimum value=0, maximum value=100. 0 is no pain while 100 is the worse outcome |
| Muscular Response, Superior Level Ratio | During the spinal manipulation and mobilization | To assess the muscular response during therapeutic modalities, the resulting bipolar sEMG signals were first digitally band-pass filtered using a frequency bandwidth of 20-450 Hz (2nd order Butterworth filter). For SMa, the peak root mean square (RMS) value was computed for each electrode using a 250 ms window (125 ms before and 125 ms after the peak force). The RMS values obtained for each electrode were then normalized (nRMS) to the respective RMS value calculated during the sEMG normalization trial. |
| Muscular Response, Inferior Level Ratio, Normalized RMS | During the spinal manipulation and mobilization | To assess the muscular response during therapeutic modalities, the resulting bipolar sEMG signals were first digitally band-pass filtered using a frequency bandwidth of 20-450 Hz (2nd order Butterworth filter). For SMa, the peak root mean square (RMS) value was computed for each electrode using a 250 ms window (125 ms before and 125 ms after the peak force). The RMS values obtained for each electrode were then normalized (nRMS) to the respective RMS value calculated during the sEMG normalization trial. |
Countries
Canada
Participant flow
Recruitment details
the participants were recruited among the local community
Participants by arm
| Arm | Count |
|---|---|
| All Participants Experimental group 1: spinal manipulation, spinal mobilization Participants first received spinal manipulation. After a washout period of 48h, they then received a spinal mobilization at the same spinal level.
Experimental group 2: spinal mobilization, spinal manipulation Participants first received spinal mobilization. After a washout period of 48h, they then received a spinal manipulation at the same spinal level. | 26 |
| Total | 26 |
Baseline characteristics
| Characteristic | All Participants |
|---|---|
| Age, Continuous | 29.9 years STANDARD_DEVIATION 9.14 |
| Ethnicity (NIH/OMB) Hispanic or Latino | 0 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 26 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants |
| Global spinal stiffness Spinal Manipulation | 7.7 N/mm STANDARD_DEVIATION 1.4 |
| Global spinal stiffness Spinal mobilization | 7.6 N/mm STANDARD_DEVIATION 1.8 |
| Pressure provoked pain Spinal manipulation | 47.9 units on a scale STANDARD_DEVIATION 22.8 |
| Pressure provoked pain Spinal mobilization | 47.2 units on a scale STANDARD_DEVIATION 23.2 |
| Region of Enrollment Canada | 26 Participants |
| Sex: Female, Male Female | 15 Participants |
| Sex: Female, Male Male | 11 Participants |
| Terminal spinal stiffness Spinal manipulation | 7.9 N/mm STANDARD_DEVIATION 1.5 |
| Terminal spinal stiffness Spinal mobilization | 7.8 N/mm STANDARD_DEVIATION 1.9 |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 11 | 0 / 15 |
| other Total, other adverse events | 0 / 11 | 0 / 15 |
| serious Total, serious adverse events | 0 / 11 | 0 / 15 |
Outcome results
Primary
Global Spinal Stiffness
Global stiffness was defined as the slope of the straight-line best fitting the force-displacement data between 10 and 45 N
Time frame: two-minutes before spinal manipulation delivery up to two-minutes after
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Spinal Manipulation | Global Spinal Stiffness | 7.6 N/mm | Standard Deviation 1.8 |
| Spinal Mobilization | Global Spinal Stiffness | 7.8 N/mm | Standard Deviation 1.7 |
Primary
Muscular Response, Inferior Level Ratio, Normalized RMS
To assess the muscular response during therapeutic modalities, the resulting bipolar sEMG signals were first digitally band-pass filtered using a frequency bandwidth of 20-450 Hz (2nd order Butterworth filter). For SMa, the peak root mean square (RMS) value was computed for each electrode using a 250 ms window (125 ms before and 125 ms after the peak force). The RMS values obtained for each electrode were then normalized (nRMS) to the respective RMS value calculated during the sEMG normalization trial.
Time frame: During the spinal manipulation and mobilization
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Spinal Manipulation | Muscular Response, Inferior Level Ratio, Normalized RMS | 0.79 ratio | Standard Deviation 0.6 |
| Spinal Mobilization | Muscular Response, Inferior Level Ratio, Normalized RMS | 0.16 ratio | Standard Deviation 0.1 |
Primary
Muscular Response, Superior Level Ratio
To assess the muscular response during therapeutic modalities, the resulting bipolar sEMG signals were first digitally band-pass filtered using a frequency bandwidth of 20-450 Hz (2nd order Butterworth filter). For SMa, the peak root mean square (RMS) value was computed for each electrode using a 250 ms window (125 ms before and 125 ms after the peak force). The RMS values obtained for each electrode were then normalized (nRMS) to the respective RMS value calculated during the sEMG normalization trial.
Time frame: During the spinal manipulation and mobilization
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Spinal Manipulation | Muscular Response, Superior Level Ratio | 0.78 ratio | Standard Deviation 0.56 |
| Spinal Mobilization | Muscular Response, Superior Level Ratio | 0.16 ratio | Standard Deviation 0.09 |
Primary
Pressure Provoked Pain
Pressure provoked pain intensity was assessed immediately after each spinal stiffness assessment using a 0 to 100 visual analog pain scale minimum value=0, maximum value=100. 0 is no pain while 100 is the worse outcome
Time frame: immediately after the therapeutic modality application
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Spinal Manipulation | Pressure Provoked Pain | 36.6 score on a scale | Standard Deviation 23.7 |
| Spinal Mobilization | Pressure Provoked Pain | 45.4 score on a scale | Standard Deviation 24.3 |
Primary
Terminal Spinal Stiffness
Terminal stiffness was defined as the ratio of the variation of force and displacement between 10 and 45 N
Time frame: two-minutes before spinal mobilization delivery up to two-minutes after
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Spinal Manipulation | Terminal Spinal Stiffness | 7.9 N/mm | Standard Deviation 1.5 |
| Spinal Mobilization | Terminal Spinal Stiffness | 7.8 N/mm | Standard Deviation 1.9 |