Do Participants With Low Back Pain Who Respond to Spinal Manipulative Therapy Differ Biomechanically From Nonresponders, Untreated Controls or Asymptomatic Controls?

Wong, Arnold Y. L.; Parent, Éric; Dhillon, Sukhvinder; Prasad, Narasimha; Kawchuk, Gregory N.

doi:10.1097/brs.0000000000000981

Cited by 66 publications

(84 citation statements)

References 32 publications

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“…Indirect support for this idea comes from prior studies showing that SMT creates unique strain patterns in facet joints compared to physiological axial rotation44, and that specific tissue properties change in those who are SMT responders234. Similarly, particular spines, spinal conditions, or tissues (e.g., degenerative spine or tissues) may not be impacted by these same loads which may help to explain SMT non-responders or when adverse events occur following SMT.…”

Section: Discussionmentioning

confidence: 99%

“…Toward understanding this discrepancy, recent studies have suggested that some forms of low back pain respond to SMT while others do not. Specifically, SMT creates significant changes in spinal stiffness, muscle response and disc diffusion in SMT responders while these same changes are not observed in SMT non-responders234. In addition, approximately 30–50% of persons who receive SMT experience some kind of benign adverse event that typically self-resolves in 24–48 hours567, with a minority of patients experiencing serious adverse events8910.…”

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confidence: 99%

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Tissue loading created during spinal manipulation in comparison to loading created by passive spinal movements

Funabashi

Kawchuk

Vette

et al. 2016

Sci Rep

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Spinal manipulative therapy (SMT) creates health benefits for some while for others, no benefit or even adverse events. Understanding these differential responses is important to optimize patient care and safety. Toward this, characterizing how loads created by SMT relate to those created by typical motions is fundamental. Using robotic testing, it is now possible to make these comparisons to determine if SMT generates unique loading scenarios. In 12 porcine cadavers, SMT and passive motions were applied to the L3/L4 segment and the resulting kinematics tracked. The L3/L4 segment was removed, mounted in a parallel robot and kinematics of SMT and passive movements replayed robotically. The resulting forces experienced by L3/L4 were collected. Overall, SMT created both significantly greater and smaller loads compared to passive motions, with SMT generating greater anterioposterior peak force (the direction of force application) compared to all passive motions. In some comparisons, SMT did not create significantly different loads in the intact specimen, but did so in specific spinal tissues. Despite methodological differences between studies, SMT forces and loading rates fell below published injury values. Future studies are warranted to understand if loading scenarios unique to SMT confer its differential therapeutic effects.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Tissue loading created during spinal manipulation in comparison to loading created by passive spinal movements

Funabashi

Kawchuk

Vette

et al. 2016

Sci Rep

Self Cite

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show abstract

“…For example, ultrasonography may be used to quantify atrophy of lumbar multifidus that can guide clinical treatments (e.g., spinal stabilization exercises). Likewise, computerized spinal stiffness tests can be used to identify patients with LBP who are likely to benefit from spinal manipulation [309]. Novel yet more sensitive imaging, such as chemical exchange saturation transfer, T2 mapping, T1-rho, ultra-short time-to-echo and sodium MRI, may identify the pain-generating source allowing for more targeted therapies [50, 310].…”

Section: Introductionmentioning

confidence: 99%

Low back pain in older adults: risk factors, management options and future directions

2017

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Low back pain (LBP) is one of the major disabling health conditions among older adults aged 60 years or older. While most causes of LBP among older adults are non-specific and self-limiting, seniors are prone to develop certain LBP pathologies and/or chronic LBP given their age-related physical and psychosocial changes. Unfortunately, no review has previously summarized/discussed various factors that may affect the effective LBP management among older adults. Accordingly, the objectives of the current narrative review were to comprehensively summarize common causes and risk factors (modifiable and non-modifiable) of developing severe/chronic LBP in older adults, to highlight specific issues in assessing and treating seniors with LBP, and to discuss future research directions. Existing evidence suggests that prevalence rates of severe and chronic LBP increase with older age. As compared to working-age adults, older adults are more likely to develop certain LBP pathologies (e.g., osteoporotic vertebral fractures, tumors, spinal infection, and lumbar spinal stenosis). Importantly, various age-related physical, psychological, and mental changes (e.g., spinal degeneration, comorbidities, physical inactivity, age-related changes in central pain processing, and dementia), as well as multiple risk factors (e.g., genetic, gender, and ethnicity), may affect the prognosis and management of LBP in older adults. Collectively, by understanding the impacts of various factors on the assessment and treatment of older adults with LBP, both clinicians and researchers can work toward the direction of more cost-effective and personalized LBP management for older people.

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“…Of various physical examination procedures, posteroanterior (PA) segmental spinal stiffness assessment is a routine measurement adopted by practitioners of spinal manipulative therapy [5]. Notably, this assessment has face validity to evaluate changes of spinal biomechanics after manual therapy [8,9] and to guide treatment options based on spinal mobility [7]. To examine spinal stiffness, a clinician applies a manual PA force to the lumbar spine in general or to a spinal landmark (eg, spinous process).…”

Section: Introductionmentioning

confidence: 99%

The Clinical Value of Assessing Lumbar Posteroanterior Segmental Stiffness: A Narrative Review of Manual and Instrumented Methods

Wong

Kawchuk

2016

PM&R

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Do Participants With Low Back Pain Who Respond to Spinal Manipulative Therapy Differ Biomechanically From Nonresponders, Untreated Controls or Asymptomatic Controls?

Abstract: 3.

Cited by 66 publications

References 32 publications

Tissue loading created during spinal manipulation in comparison to loading created by passive spinal movements

Tissue loading created during spinal manipulation in comparison to loading created by passive spinal movements

Low back pain in older adults: risk factors, management options and future directions

The Clinical Value of Assessing Lumbar Posteroanterior Segmental Stiffness: A Narrative Review of Manual and Instrumented Methods

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