Effect of spinal manipulation on sensorimotor functions in back pain patients: study protocol for a randomised controlled trial

Abstract

BackgroundLow back pain (LBP) is a recognized public health problem, impacting up to 80% of US adults at some point in their lives. Patients with LBP are utilizing integrative health care such as spinal manipulation (SM). SM is the therapeutic application of a load to specific body tissues or structures and can be divided into two broad categories: SM with a high-velocity low-amplitude load, or an impulse "thrust", (HVLA-SM) and SM with a low-velocity variable-amplitude load (LVVA-SM). There is evidence that sensorimotor function in people with LBP is altered. This study evaluates the sensorimotor function in the lumbopelvic region, as measured by postural sway, response to sudden load and repositioning accuracy, following SM to the lumbar and pelvic region when compared to a sham treatment.Methods/DesignA total of 219 participants with acute, subacute or chronic low back pain are being recruited from the Quad Cities area located in Iowa and Illinois. They are allocated through a minimization algorithm in a 1:1:1 ratio to receive either 13 HVLA-SM treatments over 6 weeks, 13 LVVA-SM treatments over 6 weeks or 2 weeks of a sham treatment followed by 4 weeks of full spine "doctor's choice" SM. Sensorimotor function tests are performed before and immediately after treatment at baseline, week 2 and week 6. Self-report outcome assessments are also collected. The primary aims of this study are to 1) determine immediate pre to post changes in sensorimotor function as measured by postural sway following delivery of a single HVLA-SM or LVVA-SM treatment when compared to a sham treatment and 2) to determine changes from baseline to 2 weeks (4 treatments) of HVLA-SM or LVVA-SM compared to a sham treatment. Secondary aims include changes in response to sudden loads and lumbar repositioning accuracy at these endpoints, estimating sensorimotor function in the SM groups after 6 weeks of treatment, and exploring if changes in sensorimotor function are associated with changes in self-report outcome assessments.DiscussionThis study may provide clues to the sensorimotor mechanisms that explain observed functional deficits associated with LBP, as well as the mechanism of action of SM.Trial registrationThis trial is registered in ClinicalTrials.gov, with the ID number of NCT00830596, registered on January 27, 2009. The first participant was allocated on 30 January 2009 and the final participant was allocated on 17 March 2011.

Effects of spinal manipulation on sensorimotor function in low back pain patients – A randomised controlled trial

“…Exclusion criteria included: 1) safety concerns for receiving SM or biomechanical testing; 2) compliance; 3) ongoing treatment for LBP by other health care providers; 4) severe osteoporosis; 5) prior spinal surgery; 6) tumor; and 7) pain from a visceral source(s). A more detailed description of the recruitment process, screening procedures, inclusion/exclusion criteria, as well as the rationale for each criterion, can be found in the study protocol (Wilder et al, 2011). The study protocol and informed consent documents were approved by the institutional review board (IRB# 2007M093) and the study was monitored by an independent Data and Safety Monitoring Committee as well as a National Institutes of Health-appointed External Advisory Committee.…”

“…The light effleurage had a load limit of 30N to avoid stimulating deeper tissues that are targeted by HVLA-SM and LVVA-SM (Gandevia et al, 1992; Morelli et al, 1999; Sullivan et al, 1991). More detailed descriptions of the SM techniques and the sham control have been presented previously (Wilder et al, 2011). Two of the 5 treatment visits were video-recorded (TVs 1 and 5).…”

Chiropractic Care of Acute Low Back Pain and Incidental Spina Bifida Occulta: A Case Report

“…18 Addition of strength exercises and ergonomic correction with the HVLA chiropractic adjustment helps eliminate lower back pain. 19 High-velocity low-amplitude has been shown to improve postural sway and accuracy in patients with low back pain, although it is unknown if the same results would be produced in patients with SBO and lower back pain. 19 Spina bifida occulta has been described as a promoter of lower back pain because of increased stress on vertebral structures due to hypoplastic formation.…”

“…19 High-velocity low-amplitude has been shown to improve postural sway and accuracy in patients with low back pain, although it is unknown if the same results would be produced in patients with SBO and lower back pain. 19 Spina bifida occulta has been described as a promoter of lower back pain because of increased stress on vertebral structures due to hypoplastic formation. 20 With nonunion of a vertebral spinous process, possible stress may be placed on the pars interarticularis.…”

Prevalence of Radiographic Findings in Individuals With Chronic Low Back Pain Screened for a Randomized Controlled Trial: Secondary Analysis and Clinical Implications

“…(50) The current study was approved by the Palmer College of Chiropractic institutional review board. All participants provided consent.…”