The effects of a single session of lumbar spinal manipulative therapy in terms of physical performance test symmetry in asymptomatic athletes: a single-blinded, randomised controlled study

Bruno A P Alvarenga, Ricardo Fujikawa, Filipa João, Jerusa P R Lara, António P Veloso, Bruno A P Alvarenga, Ricardo Fujikawa, Filipa João, Jerusa P R Lara, António P Veloso

Abstract

Background and aim: Musculoskeletal disorders in athletes, including spinal biomechanical dysfunctions, are believed to negatively influence symmetry. Spinal manipulative therapy (SMT) is recognised as a safe and effective treatment for musculoskeletal disorders, but there is little evidence about whether it can be beneficial in symmetry. Therefore, this study aimed to measure the effects of lumbar SMT in symmetry.

Methods: Forty asymptomatic athletes participated in the study. The randomisation procedure was performed according to the following group allocation: group 1 (SMT) and group 2 (SHAM). Each participant completed a physical activity questionnaire, and also underwent clinical and physical evaluation for inclusion according to eligibility criteria. Statistical significance (P<0.05) between groups and types of therapy were calculated by physical performance tests symmetry (static position, squat and counter movement jump (CMJ), pre- and post-SMT and SHAM. There were 14 trials of three symmetry tests for each participant, for a total of 560 trials.

Results: Lumbar SMT produced immediate effects in symmetry in the static position; however, the same effects were not found in squat and CMJ on symmetry 1. Therefore, our results showed a significant difference in pre- (mean 16.3%) and post-lumbar SMT (mean 3.7%) in static symmetry. However, symmetry 2 showed no statistical significant differences for any of the tests and intervention groups. No statistically significant effects in symmetry pre- to post-SHAM were found in any of the tests.

Conclusions: Statistically significant differences were found in lumbar SMT, but only for static symmetry. These findings suggest that SMT was effective in producing immediate effects in symmetry in the static position, but none in dynamic tests. Future studies could address our study's limitations.

Clinical trials register number: NCT03361592.

Keywords: biomechanics; exercise testing; lumbar spine; randomised controlled trial; rehabilitation; symmetry index.

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
CONSORT flow-chart describing the randomised controlled study protocol. SMT, spinal manipulative therapy.
Figure 2
Figure 2
Study protocol, presenting physical performance tests symmetry (static position, free squat and countermovementjump) sequence, pre- and post-SMT and SHAM interventions.
Figure 3
Figure 3
(A) View of the participant receiving lumbar spinal manipulative therapy (SMT) intervention. (B) View of the participant receiving SHAM pre-positioning lumbar SMT intervention.
Figure 4
Figure 4
Vectors for the Euclidean distances computed during the right side and during the left side, for the linear global symmetry index (LGSI%) calculations.
Figure 5
Figure 5
Visual representation of total symmetry values from both groups. Box-plot: the small black lines represent the interquartile, superior and inferior limit; the blue box represents the minimal and maximal values; the red line represents the groups means; and the red cross signals outliers, indicating variability. Both indexes (symmetry 1 and symmetry 2) show variability values of the physical performance tests (static, squat and counter movement jump). LGSI, linear global symmetry index; SI, symmetry index; SMT, spinal manipulative therapy.

References

    1. Miners AL, Degraauw C. A survey of Fellows in the College of Chiropractic Sports Sciences (Canada): their intervention practices and intended therapeutic outcomes when treating athletes. J Can Chiropr Assoc 2010;54:282–92.
    1. Julian C, Hoskins W, Vitiello AL. Sports chiropractic management at the world ice hockey championships. Chiropr Osteopat 2010;18:32 10.1186/1746-1340-18-32
    1. World Health Organization WHO guidelines on basic training and safety in chiropractic. Geneva: World Health Organization, 2005.
    1. Stump JL, Redwood D. The use and role of sport chiropractors in the national football league: a short report. J Manipulative Physiol Ther 2002;25:A2–5. 10.1067/mmt.2002.122326
    1. Guideline CP. Council on chiropractic practice guideline. Vertebral subluxation in chiropractic practice, 1998: 0–5.
    1. Hannon SM. Objective physiologic changes and associated health benefits of chiropractic adjustments in asymptomatic subjects: a review of the literature. JVSR 2004;26:1–9.
    1. Robinson RO, Herzog W, Nigg BM. Use of force platform variables to quantify the effects of chiropractic manipulation on gait symmetry. J Manipulative Physiol Ther 1987;10:172–6.
    1. Herzog W, Nigg BM, Read LJ, et al. . Asymmetries in ground reaction force patterns in normal human gait. Med Sci Sports Exerc 1989;21:110–4. 10.1249/00005768-198902000-00020
    1. Ga J, Herzog W, Kawchuk G. Biomechanical studies of spinal manipulative therapy (SMT): quantifying the movements of vertebral bodies during SMT. J Can Chiropr Assoc 1994;38:11–24.
    1. Tomkinson GR, Popović N, Martin M. Bilateral symmetry and the competitive standard attained in elite and sub-elite sport. J Sports Sci 2003;21:201–11. 10.1080/0264041031000071029a
    1. Bishop C, Turner A, Read P. Effects of inter-limb asymmetries on physical and sports performance: a systematic review. J Sports Sci 2018;36:1135–44. 10.1080/02640414.2017.1361894
    1. Tomkinson GR, Olds TS. Physiological correlates of bilateral symmetry in humans. Int J Sports Med 2000;21:545–50. 10.1055/s-2000-8479
    1. Nigg BM, Herzog W. Biomechanics of the musculo-skeletal system. UK: Willey & Sons, Chichester, 1994.
    1. Pollard HWG, Pollard H, Ward G. Strength change of quadriceps femoris following a single manipulation of the L3/4 vertebral motion segment; a preliminary investigation. JNS 1996;4:137–44.
    1. Grindstaff TL, Hertel J, Beazell JR, et al. . Effects of lumbopelvic joint manipulation on quadriceps activation and strength in healthy individuals. Man Ther 2009;14:415–20. 10.1016/j.math.2008.06.005
    1. Sports Biomechanics. Bartlett R. Reducing injury and improving performance 2005:1–293.
    1. Hoskins W, Pollard H. The effect of a sports chiropractic manual therapy intervention on the prevention of back pain, hamstring and lower limb injuries in semi-elite Australian Rules footballers: a randomized controlled trial. BMC Musculoskelet Disord 2010;11:64 10.1186/1471-2474-11-64
    1. Botelho MB, Alvarenga BAP, Molina N. Spinal manipulative therapy and sports performance : a systematic review. J Manipulative Physiol Ther 2017;40:535–43. 10.1016/j.jmpt.2017.03.014
    1. Chapman-Smith D. Chiropractic: A profession in the field of health. Publisher Anhembi Morumbi, 2001.
    1. Haldeman S. Spinal manipulative therapy in sports medicine. Clin Sports Med 1986;5:277–93.
    1. Herzog W, Walter Herzog PD, et al. . Clinical biomechanics of spinal manipulation . The mechanical, neuromuscular, and physiologic effects produced by spinal manipulation. Philadelphia: Churchill Livingstone, 2000: 206.
    1. Pickar JG. Neurophysiological effects of spinal manipulation. Spine J 2002;2:357–71. 10.1016/S1529-9430(02)00400-X
    1. Haldeman S. Neurological effects of the adjustment. J Manipulative Physiol Ther 2000;23:112–4. 10.1016/S0161-4754(00)90078-2
    1. Mansholt BA, Stites JS, Derby DC, et al. . Essential literature for the chiropractic profession: a survey of chiropractic research leaders. Chiropr Man Therap 2013;21:33 10.1186/2045-709X-21-33
    1. Forrester SE. Selecting the number of trials in experimental biomechanics studies. International Biomechanics 2015;2:62–72. 10.1080/23335432.2015.1049296
    1. Mullineaux DR, Bartlett RM, Bennett S. Research design and statistics in biomechanics and motor control. J Sports Sci 2001;19:739–60. 10.1080/026404101317015410
    1. Eldridge SM, Chan CL. CONSORT 2010 statement: extension to randomised pilot and feasibility trials. Pilot Feasibility Stud. 2016, 2010.
    1. International physical activity questionnaire (IPAQ) Guidelines for data processing and analysis– Short and Long Forms, 2005: 1–15.
    1. Kankaanpää M, Taimela S, Laaksonen D, et al. . Back and hip extensor fatigability in chronic low back pain patients and controls. Arch Phys Med Rehabil 1998;79:412–7. 10.1016/S0003-9993(98)90142-3
    1. Kawchuk GN, Haugen R, Fritz J. A true blind for subjects who receive spinal manipulation therapy. Arch Phys Med Rehabil 2009;90:366–8. 10.1016/j.apmr.2008.08.213
    1. Lund ME, Andersen MS, de Zee M, et al. . Scaling of musculoskeletal models from static and dynamic trials. International Biomechanics 2015;2:1–11. 10.1080/23335432.2014.993706
    1. Cappozzo A, Catani F, Leardini A, et al. . Position and orientation in space of bones during movement: experimental artefacts. Clin Biomech 1996;11:90–100. 10.1016/0268-0033(95)00046-1
    1. Seay J, Selbie WS, Hamill J. In vivo lumbo-sacral forces and moments during constant speed running at different stride lengths. J Sports Sci 2008;26:1519–29. 10.1080/02640410802298235
    1. Antunes N, Medeiros FB, Alvares De CA. Analysis of the reliability of two force platforms for the simultaneous collection of kinetic variables. 33rd International Conference of Biomechanics in Sports 2015:1999–4168.
    1. Bergmann TF PD, technique C. Principles and procedures. Philadelphia: Elsevier Mosby, 2010.
    1. Cabral S, Fernandes R, Selbie WS, et al. . Inter-session agreement and reliability of the Global Gait Asymmetry index in healthy adults. Gait Posture 2017;51:20–4. 10.1016/j.gaitpost.2016.09.014
    1. Nigg S, Vienneau J, Maurer C, et al. . Development of a symmetry index using discrete variables. Gait Posture 2013;38:115–9. 10.1016/j.gaitpost.2012.10.024
    1. Almeida PDO, Prudente GFG, De Sá FE, et al. . Postural and load distribution asymmetries in preschoolers. Motricidade 2016;11:58 10.6063/motricidade.4033
    1. Menzel HJ, Chagas MH, Szmuchrowski LA, et al. . Analysis of lower limb asymmetries by isokinetic and vertical jump tests in soccer players. J Strength Cond Res 2013;27:1370–7. 10.1519/JSC.0b013e318265a3c8
    1. McGrath TM, Waddington G, Scarvell JM, et al. . The effect of limb dominance on lower limb functional performance–a systematic review. J Sports Sci 2016;34:1–14. 10.1080/02640414.2015.1050601
    1. Impellizzeri FM, Rampinini E, Maffiuletti N, et al. . A vertical jump force test for assessing bilateral strength asymmetry in athletes. Med Sci Sports Exerc 2007;39:2044–50. 10.1249/mss.0b013e31814fb55c
    1. Fousekis K, Tsepis E, Vagenas G. Lower limb strength in professional soccer players: profile, asymmetry, and training age. J Sports Sci Med 2010;9:364–73.
    1. Linthorne NP. Analysis of standing vertical jumps using a force platform. Am J Phys 2001;69:1198–204. 10.1119/1.1397460
    1. Noyes FR, Barber SD, Mangine RE. Abnormal lower limb symmetry determined by function hop tests after anterior cruciate ligament rupture. Am J Sports Med 1991;19:513–8. 10.1177/036354659101900518

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