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

Marie-Pierre Harvey, Martin Descarreaux, Marie-Pierre Harvey, Martin Descarreaux

Abstract

Background: Low 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).

Methods: Sixty 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.

Results: Participants 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.

Conclusion: Changes 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.

Figures

Figure 1
Figure 1
Representation of the experimental setup, including 8 infrared LEDs and EMG electrodes at L2 and L5 (erector spinae).
Figure 2
Figure 2
Mean baseline and post spinal manipulation pain scores (VAS = 0–100) for both the control and experimental groups. *Pain in the control group significantly increased at the 5 min and 30 assessments when compared to baseline value. Whiskers indicate standard deviation.
Figure 3
Figure 3
Mean baseline and post spinal manipulation L2 paraspinal normalized RMS values (EMG) for both the control and experimental groups during the flexion phase of the task. *RMS values in the control group significantly increased during the last block of trials. Whiskers indicate standard deviation.
Figure 4
Figure 4
Mean baseline and post spinal manipulation L2 paraspinal normalized RMS values (EMG) for both the control and experimental groups during the full flexion phase of the task. *RMS values in the control group significantly increased during the last block of trials. Whiskers indicate standard deviation.

References

    1. Woolf AD, Pfleger B. Burden of major musculoskeletal conditions. Bull World Health Organ. 2003;81(9):646–656.
    1. Dunn KM, Croft PR. Epidemiology and natural history of low back pain. Eura Medicophys. 2004;40(1):9–13.
    1. Kent PM, Keating JL. The epidemiology of low back pain in primary care. Chiropr Osteopat. 2005;13:13. doi: 10.1186/1746-1340-13-13.
    1. Walker BF. The prevalence of low back pain: a systematic review of the literature from 1966 to 1998. J Spinal Disord. 2000;13(3):205–217. doi: 10.1097/00002517-200006000-00003.
    1. Cassidy JD, Cote P, Carroll LJ, Kristman V. Incidence and course of low back pain episodes in the general population. Spine (Phila Pa 1976) 2005;30(24):2817–2823. doi: 10.1097/01.brs.0000190448.69091.53.
    1. O'Sullivan P. Diagnosis and classification of chronic low back pain disorders: maladaptive movement and motor control impairments as underlying mechanism. Man Ther. 2005;10(4):242–255. doi: 10.1016/j.math.2005.07.001.
    1. Delitto A, George SZ, Van Dillen LR, Whitman JM, Sowa G, Shekelle P, Denninger TR, Godges JJ. Low back pain. J Orthop Sports Phys Ther. 2012;42(4):A1–A57.
    1. Dagenais S, Caro J, Haldeman S. A systematic review of low back pain cost of illness studies in the United States and internationally. Spine J. 2008;8(1):8–20. doi: 10.1016/j.spinee.2007.10.005.
    1. Chou R, Qaseem A, Snow V, Casey D, Cross JT Jr, Shekelle P, Owens DK. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med. 2007;147(7):478–491.
    1. Pickar JG, Bolton PS. Spinal manipulative therapy and somatosensory activation. J Electromyogr Kinesiol. 2012;22(5):785–794. doi: 10.1016/j.jelekin.2012.01.015.
    1. Haavik H, Murphy B. The role of spinal manipulation in addressing disordered sensorimotor integration and altered motor control. J Electromyogr Kinesiol. 2012;22(5):768–776. doi: 10.1016/j.jelekin.2012.02.012.
    1. Herzog W, Scheele D, Conway PJ. Electromyographic responses of back and limb muscles associated with spinal manipulative therapy. Spine (Phila Pa 1976) 1999;24(2):146–152. doi: 10.1097/00007632-199901150-00012. discussion 153.
    1. Symons BP, Herzog W, Leonard T, Nguyen H. Reflex responses associated with activator treatment. J Manipulative Physiol Ther. 2000;23(3):155–159. doi: 10.1016/S0161-4754(00)90244-6.
    1. DeVocht JW, Pickar JG, Wilder DG. Spinal manipulation alters electromyographic activity of paraspinal muscles: a descriptive study. J Manipulative Physiol Ther. 2005;28(7):465–471. doi: 10.1016/j.jmpt.2005.07.002.
    1. Lalanne K, Lafond D, Descarreaux M. Modulation of the flexion-relaxation response by spinal manipulative therapy: a control group study. J Manipulative Physiol Ther. 2009;32(3):203–209. doi: 10.1016/j.jmpt.2009.02.010.
    1. Bicalho E, Setti JA, Macagnan J, Cano JL, Manffra EF. Immediate effects of a high-velocity spine manipulation in paraspinal muscles activity of nonspecific chronic low-back pain subjects. Man Ther. 2010;15(5):469–475. doi: 10.1016/j.math.2010.03.012.
    1. Murphy B, Taylor HH, Marshall P. The effect of spinal manipulation on the efficacy of a rehabilitation protocol for patients with chronic neck pain: a pilot study. J Manipulative Physiol Ther. 2010;33(3):168–177. doi: 10.1016/j.jmpt.2010.01.014.
    1. Indahl A, Kaigle AM, Reikeras O, Holm SH. Interaction between the porcine lumbar intervertebral disc, zygapophysial joints, and paraspinal muscles. Spine (Phila Pa 1976) 1997;22(24):2834–2840. doi: 10.1097/00007632-199712150-00006.
    1. Peterson DH, Bergmann TF. Chiropractic technique: principles and procedures. 2. St. Louis: Churchill Livingstone; 2002.
    1. Dubois JD, Piche M, Cantin V, Descarreaux M. Effect of experimental low back pain on neuromuscular control of the trunk in healthy volunteers and patients with chronic low back pain. J Electromyogr Kinesiol. 2011;21(5):774–781. doi: 10.1016/j.jelekin.2011.05.004.
    1. Descarreaux M, Lafond D, Cantin V. Changes in the flexion-relaxation response induced by hip extensor and erector spinae muscle fatigue. BMC Musculoskelet Disord. 2010;11:112. doi: 10.1186/1471-2474-11-112.
    1. Esola MA, McClure PW, Fitzgerald GK, Siegler S. Analysis of lumbar spine and hip motion during forward bending in subjects with and without a history of low back pain. Spine (Phila Pa 1976) 1996;21(1):71–78. doi: 10.1097/00007632-199601010-00017.
    1. Millan M, Leboeuf-Yde C, Budgell B, Descarreaux M, Amorim MA. The effect of spinal manipulative therapy on spinal range of motion: a systematic literature review. Chiropr Man Therap. 2012;20(1):23. doi: 10.1186/2045-709X-20-23.
    1. Millan M, Leboeuf-Yde C, Budgell B, Amorim MA. The effect of spinal manipulative therapy on experimentally induced pain: a systematic literature review. Chiropr Man Therap. 2012;20(1):26. doi: 10.1186/2045-709X-20-26.
    1. Olson MW, Li L, Solomonow M. Flexion-relaxation response to cyclic lumbar flexion. Clin Biomech (Bristol, Avon) 2004;19(8):769–776. doi: 10.1016/j.clinbiomech.2004.05.007.
    1. Solomonow M, Baratta RV, Banks A, Freudenberger C, Zhou BH. Flexion-relaxation response to static lumbar flexion in males and females. Clin Biomech (Bristol, Avon) 2003;18(4):273–279. doi: 10.1016/S0268-0033(03)00024-X.
    1. O'Sullivan P, Dankaerts W, Burnett A, Chen D, Booth R, Carlsen C, Schultz A. Evaluation of the flexion relaxation phenomenon of the trunk muscles in sitting. Spine (Phila Pa 1976) 2006;31(17):2009–2016. doi: 10.1097/01.brs.0000228845.27561.e0.
    1. Kawchuk GN, Prasad NG, McLeod RC, Liddle T, Li T, Zhu Q. Variability of force magnitude and force duration in manual and instrument-based manipulation techniques. J Manipulative Physiol Ther. 2006;29(8):611–618. doi: 10.1016/j.jmpt.2006.08.013.
    1. Millan M, Leboeuf-Yde C, Budgell B, Amorim MA. The effect of spinal manipulative therapy on experimentally induced pain: a systematic literature review. Chirop Man Ther. 2012;20(1):26. doi: 10.1186/2045-709X-20-26.
    1. Ge HY, Nie H, Graven-Nielsen T, Danneskiold-Samsoe B, Arendt-Nielsen L. Descending pain modulation and its interaction with peripheral sensitization following sustained isometric muscle contraction in fibromyalgia. Eur J Pain. 2012;16(2):196–203. doi: 10.1016/j.ejpain.2011.06.008.

Source: PubMed

Sponsor e collaboratori

Condizioni mediche

Interventi farmacologici

3
Sottoscrivi