Neuromechanical response to spinal manipulation therapy: effects of a constant rate of force application

François Nougarou, Isabelle Pagé, Michel Loranger, Claude Dugas, Martin Descarreaux, François Nougarou, Isabelle Pagé, Michel Loranger, Claude Dugas, Martin Descarreaux

Abstract

Background: Neuromechanical responses to spinal manipulation therapy (SMT) have been shown to be modulated through the variation of SMT biomechanical parameters: peak force, time to peak force, and preload force. Although rate of force application was modulated by the variation of these parameters, the assumption that neuromuscular responses are modulated by the rate of force application remains to be confirmed. Therefore, the purpose of the present study was to evaluate the effect of a constant rate of force application in neuromechanical responses to SMT in healthy adults.

Methods: Four SMT force-time profiles presenting different time to peak force and peak force, but with a constant rate of force application were applied on 25 healthy participants' T7 transverse processes. Muscular responses were recorded through surface electromyography electrodes (T6 and T8 levels), while vertebral displacements were assessed through pasted kinematic markers on T6 to T8 spinous processes. Effects of SMT force-time profiles on neuromechanical responses were assessed using repeated-measures ANOVAs.

Results: There was no main effect of SMT force-time profile modulation on muscular responses (ps > .05) except for the left T8 (F (3, 72) = 3.23, p = .03) and left T6 (F (3, 72) = 2.94, p = .04). Muscular responses were significantly lower for the lowest peak force condition than the highest (for T8) or second highest (for T6). Analysis showed that increasing the SMT peak force (and concomitantly time to peak force) led to a significant vertebral displacement increase for the contacted vertebra (F T7 (1, 17) = 354.80, p < .001) and both adjacent vertebras (F T6 (1, 12) = 104.71, p < .001 and F T8 (1, 19) = 468.68, p < .001).

Conclusion: This study showed that peak force modulation using constant rate of force application leads to similar neuromuscular responses. Coupled with previous investigations of SMT peak force and duration effects, the results suggest that neuromuscular responses to SMT are mostly influenced by the rate of force application, while peak force modulation yields changes in the vertebral displacement. Rate of force application should therefore be defined in future studies. Clinical implications of various SMT dosages in patients with spine related pain should also be investigated.

Trial registration: ClinicalTrials.gov NCT02550132 . Registered 8 September 2015.

Keywords: Biomechanical phenomena; Dose-response relationship; Electromyography; Musculoskeletal manipulations; Spinal manipulation.

Figures

Fig. 1
Fig. 1
Modulation of SMT preload force, peak force, and time to peak force. These studies revealed an increase in muscle response amplitudes with increasing rate of force application by either increasing peak force, decreasing preload force, or decreasing time to peak force. SMT: spinal manipulation therapy
Fig. 2
Fig. 2
a Typical SMT force-time profile with time-windows, and (b) typical sEMG and kinematic responses. The rate of force application (N/s) is equal to the force applied (peak force – preload force) divided by the time to peak force. SMT: spinal manipulation therapy
Fig. 3
Fig. 3
Normalized RMS during (a) “Thrust phase” and (b) “Post-SMT1”, and (c) absolute vertebral displacements during “Thrust phase”. Muscular activity values (normalized RMS) are presented for the four applied SMT force-time profiles and all electrodes. Vertebral displacements are shown for all markers and SMT force-time profiles.* refers to p < .05

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Source: PubMed

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