Muscle Stiffness
Conditions
Keywords
Manual Therapy, Spinal Mobilization, Posteroanterior Mobilization, Maitland Mobilization, Muscle Stiffness, Shear Wave Elastography
Brief summary
This randomized controlled crossover study will investigate the immediate effect of central posteroanterior lumbar mobilization on the intrinsic stiffness of the erector spinae and multifidus muscles in healthy adults without low back pain. Twenty-four participants will complete two experimental visits in randomized order. During one visit, participants will receive Maitland Grade III++ central posteroanterior mobilization at the L4 vertebral level, while during the other visit they will receive a sham mobilization condition involving gentle rhythmic pressure. Muscle stiffness will be assessed using shear wave elastography immediately before and after each intervention.
Detailed description
The study will be designed as a randomized controlled crossover trial to investigate the immediate effects of manual spinal mobilization on lumbar paraspinal muscle stiffness in healthy adults without low back pain. Each participant will attend two separate study visits and will receive both experimental conditions in a randomized order. In the experimental condition, Maitland Grade III++ central posteroanterior mobilization will be applied over the spinous process of L4. The intervention will consist of three 60-second sets of passive rhythmic oscillatory pressures performed at approximately 2 Hz, with 30-second rest periods between sets. In the control condition, participants will receive a sham mobilization presented as a Grade I mobilization technique. The sham intervention will follow the same timing structure but will consist of gentle rhythmic pressure over the L4 spinous process. Intrinsic muscle stiffness of the right erector spinae and multifidus muscles will be assessed using shear wave elastography. Three measurements will be obtained immediately before and after each intervention, and the mean value will be expressed in kilopascals. Measurements will be performed in a standardized prone position at the L4-L5 level.
Interventions
PROCEDUREMaitland Grade III++ Central Posteroanterior Mobilization
Central posteroanterior mobilization is applied over the L4 spinous process with the participant in a prone position. The intervention consists of three 60-second sets of passive rhythmic oscillatory pressures performed at approximately 2 Hz, with 30-second rest periods between sets, resulting in approximately 360 oscillatory pressures in total.
PROCEDURESham Lumbar Mobilization
Sham mobilization is applied over the L4 spinous process with the participant in a prone position. The procedure consists of three 60-second sets of gentle rhythmic pressures with 30-second rest periods between sets. The timing and therapist contact are matched to the experimental condition, while substantial mobilization pressure is avoided.
Sponsors
University of Primorska
Study design
Allocation
RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
BASIC_SCIENCE
Masking
SINGLE (Subject)
Intervention model description
Participants will complete both intervention conditions during two separate study visits. The order of Maitland Grade III++ central posteroanterior mobilization and sham mobilization will berandomized, with the alternate condition administered during the second visit.
Eligibility
Sex/Gender
ALL
Age
18 Years to 45 Years
Healthy volunteers
Yes
Inclusion criteria
* Men and women aged 21 to 38 years. * Resident of the Republic of Slovenia. * No current low back pain. * No contraindications to lumbar manual mobilization. * Ability to assume and maintain the required prone testing position. * Provision of written informed consent.
Exclusion criteria
* Current low back pain. * Spondylolisthesis. * Severe osteoporosis. * Spinal stenosis. * Lumboischialgia or other significant structural spinal deformity. * Fibromyalgia. * Recent spinal surgery or lumbar spinal fixation. * Cauda equina syndrome. * Nerve root compression associated with neurological deficits. * Malignancy. * Recent relevant trauma. * Joint instability. * Active rheumatoid arthritis. * Acute local or systemic infection. * Long-term local corticosteroid use. * Inability to assume or maintain the required testing position.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in Erector Spinae Muscle Stiffness | Immediately before and immediately after each intervention session | Intrinsic stiffness of the right erector spinae muscle is assessed using shear wave elastography and expressed as shear modulus in kilopascals (kPa). Three measurements are obtained at each time point and averaged. The outcome is the change from the pre-intervention to the immediate post-intervention measurement. |
| Change in Multifidus Muscle Stiffness | Immediately before and immediately after each intervention session | Intrinsic stiffness of the right multifidus muscle is assessed using shear wave elastography and expressed as shear modulus in kilopascals (kPa). Three measurements are obtained at each time point and averaged. The outcome is the change from the pre-intervention to the immediate post-intervention measurement. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in Erector Spinae Muscle Stiffness Assessed by Myotonometry | Immediately before and immediately after each intervention session | Myotonometry will be used to assess mechanical muscle stiffness at the same measurement location used for the erector spinae shear wave elastography assessment. Measurements will be performed immediately before and after each intervention condition. The outcome will be the change in muscle stiffness from pre-intervention to immediate post-intervention. |
| Change in Multifidus Muscle Stiffness Assessed by Myotonometry | Immediately before and immediately after each intervention session | Myotonometry will be used to assess mechanical muscle stiffness at the same measurement location used for the multifidus shear wave elastography assessment. Measurements will be performed immediately before and after each intervention condition. The outcome will be the change in muscle stiffness from pre-intervention to immediate post-intervention. |
Countries
Slovenia
Contacts
CONTACTŽiga Kozinc, PhD
Outcome results
None listed