Investigation of Abdominal Muscle Thickness Changes After Spinal Manipulation in Patients Who Meet a Clinical Prediction Rule for Lumbar Stabilization

Konitzer, Lisa N.; Gill, Norman W.; Koppenhaver, Shane

doi:10.2519/jospt.2011.3685

Cited by 18 publications

(16 citation statements)

References 56 publications

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“…Most recently we have found changes in contracted LM thickness were associated with improved LBP-related disability one week after SMT (Koppenhaver et al, 2011). Together these findings lend support to the hypothesis that SMT may provide a facilitatory stimulus (“jump start”) to the LM muscle, which may help initiate clinical recovery from LBP (Gill et al, 2007; Konitzer et al, 2011). Of interest, the changes that were observed in contracted LM thickness after SMT were not seen in all patients with LBP; rather the direction and extent of change was highly variable and dependent upon the individual (Koppenhaver et al, 2011).…”

Section: Introductionsupporting

confidence: 68%

“…Having acute rather than chronic LBP, no pain with PA pressure to L5, a positive ASLR test, and symptoms that centralize rather than peripheralize with repeated lumbar extension were associated with larger increases in contracted LM thickness. Knowing these variables may help us determine what type of patient with LBP might be expected to benefit from a combination of SMT and LSE as well as lend support to the hypothesis that SMT may “jump start” the LM muscle in these individuals (Gill et al, 2007; Konitzer et al, 2011). …”

Section: Discussionmentioning

confidence: 99%

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Association between history and physical examination factors and change in lumbar multifidus muscle thickness after spinal manipulation in patients with low back pain

Koppenhaver

Fritz

Hébert

et al. 2012

Journal of Electromyography and Kinesiology

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Understanding the clinical characteristics of patients with low back pain (LBP) who display improved lumbar multifidus (LM) muscle function after spinal manipulative therapy (SMT) may provide insight into a potentially synergistic interaction between SMT and exercise. Therefore, the purpose of this study was to identify the baseline historical and physical examination factors associated with increased contracted LM muscle thickness one week after SMT. Eighty-one participants with LBP underwent a baseline physical examination and ultrasound imaging assessment of the LM muscle during submaximal contraction before and one week after SMT. The relationship between baseline examination variables and 1-week change in contracted LM thickness was assessed using correlation analysis and hierarchical multiple linear regression. Four variables best predicted the magnitude of increases in contracted LM muscle thickness after SMT. When combined, these variables suggest that patients with LBP, (1) that are fairly acute, (2) have at least a moderately good prognosis without focal and irritable symptoms, and (3) exhibit signs of spinal instability, may be the best candidates for a combined SMT and LSE treatment approach.

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Section: Introductionsupporting

confidence: 68%

Section: Discussionmentioning

confidence: 99%

Association between history and physical examination factors and change in lumbar multifidus muscle thickness after spinal manipulation in patients with low back pain

Koppenhaver

Fritz

Hébert

et al. 2012

Journal of Electromyography and Kinesiology

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“…42,61 It is possible, therefore, that the manipulation techniques included in the MT intervention contributed to facilitation of the deep spinal musculature and, consequently, exerted an effect similar to that attributed to LSE. Be that as it may, when spinal manipulation has been previously performed specifically on patients who meet the stabilization CPR, 41 no effects were observed on the activation of the transversus abdominis or internal oblique, and the clinical effects (pain and disability) did not exceed the minimal clinically important threshold. 41 Furthermore, another study indicated that none of the variables comprising the stabilization CPR was associated with increased activation of the lumbar multifidus following spinal manipulation.…”

Section: Discussionmentioning

confidence: 99%

“…Be that as it may, when spinal manipulation has been previously performed specifically on patients who meet the stabilization CPR, 41 no effects were observed on the activation of the transversus abdominis or internal oblique, and the clinical effects (pain and disability) did not exceed the minimal clinically important threshold. 41 Furthermore, another study indicated that none of the variables comprising the stabilization CPR was associated with increased activation of the lumbar multifidus following spinal manipulation. 43 Finally, any changes in activation of the lumbar multifidus that were observed immediately after manipulation did not seem to be consistently sustained 3 to 4 days after the application of the technique.…”

Section: Discussionmentioning

confidence: 99%

A Clinical Prediction Rule to Identify Patients With Low Back Pain Who Are Likely to Experience Short-Term Success Following Lumbar Stabilization Exercises: A Randomized Controlled Validation Study

Rabin¹,

Shashua²,

Pizem³

et al. 2014

J Orthop Sports Phys Ther

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“…Although achieving 100% sensitivity and specificity in a classification algorithm is unrealistic, caution must be taken when using a classification algorithm that lacks mutual exclusivity too prematurely, as there is a risk of reaching incorrect conclusions regarding the effectiveness of the treatment tested 28 and the clinical features that determine patient subgrouping. Our results suggest that additional refinement may be necessary for the stabilization category to distinguish the clinical features associated with stabilization treatment success from those of the specific exercise or manipulation categories.…”

Section: Patterns Of Classification Disagreementsmentioning

confidence: 99%

Reliability of a Treatment-Based Classification System for Subgrouping People With Low Back Pain

Henry¹,

Fritz²,

Trombley³

et al. 2012

J Orthop Sports Phys Ther

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[ research report ] D espite the high cost associated with the fluctuating clinical course of low back pain (LBP), no treatment strategy surgical or conservative has been shown to be consistently effective in reducing the often persistent symptoms, functional limitations, and disability associated with this condition. The lack of beneficial effects of conservative treatments for LBP may be due to the lack of a pathoanatomy-specific diagnosis, 27,30,31 as fewer than 20% of individuals with LBP can be given a specific, structurally based diagnosis. 22In the absence of a specific pathoanatomical diagnosis and to better direct treatment, a number of research and clinical groups have suggested that there is a need for a system that classifies individuals with LBP based on key clinical symptoms and multidimensional features of the LBP presentation. [1][2][3]8,9,14,29,35 The basis for this suggestion is that people with LBP represent a heterogeneous group, consisting of several smaller homogeneous subgroups. Logically, if the subgroups of patients were classified based on criteria relevant to their specific symptoms, these more homogeneous subgroups would have a higher likelihood of responding to matched treatment approaches. Such a classification system could be useful both in prognosis and treatment, rendering the development and testing of classification systems of LBP a top priority. 3,8,35 Numerous classification systems have been described for patients with LBP.34 Delitto and colleagues 11 described a treatment-based classification (TBC) system and used information gathered from the patient history and physical examination to place a patient into 1 of 4 classification categories that directed patient treatment: manipulation, specific exercise, stabilization, and traction. The T T STUDY DESIGN: Observational, cross-sectional reliability study. T T OBJECTIVES:To examine the interrater reliability of novice raters in their use of the treatmentbased classification (TBC) system for low back pain and to explore the patterns of disagreement in classification errors. T T BACKGROUND:Although the interrater reliability of individual test items in the TBC system is moderate to good, some error persists in classification decision making. Understanding which classification errors are common could direct further refinement of the TBC system. T T METHODS:Using previously recorded patient data (n = 24), 12 novice raters classified patients according to the TBC schema. These classification results were combined with those of 7 other raters, allowing examination of the overall agreement using the kappa statistic, as well as agreement/ disagreement among pairwise comparisons in classification assignments. A chi-square test examined differences in percent agreement between the novice and more experienced raters and differences in classification distributions between these 2 groups of raters. T T RESULTS:Among 12 novice raters, there was 80.9% agreement in the pairs of classification (κ = 0.62; 95% confidence interval: 0.59, 0.65) an...

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Investigation of Abdominal Muscle Thickness Changes After Spinal Manipulation in Patients Who Meet a Clinical Prediction Rule for Lumbar Stabilization

Cited by 18 publications

References 56 publications

Association between history and physical examination factors and change in lumbar multifidus muscle thickness after spinal manipulation in patients with low back pain

Association between history and physical examination factors and change in lumbar multifidus muscle thickness after spinal manipulation in patients with low back pain

A Clinical Prediction Rule to Identify Patients With Low Back Pain Who Are Likely to Experience Short-Term Success Following Lumbar Stabilization Exercises: A Randomized Controlled Validation Study

Reliability of a Treatment-Based Classification System for Subgrouping People With Low Back Pain

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