Short-Term Effects of Thoracic Spine Manipulation on the Biomechanical Organisation of Gait Initiation: A Randomized Pilot Study

Abstract

Speed performance during gait initiation is known to be dependent on the capacity of the central nervous system to generate efficient anticipatory postural adjustments (APA). According to the posturo-kinetic capacity (PKC) concept, any factor enhancing postural chain mobility and especially spine mobility, may facilitate the development of APA and thus speed performance. “Spinal Manipulative Therapy High-Velocity, Low-Amplitude” (SMT-HVLA) is a healing technique applied to the spine which is routinely used by healthcare practitioners to improve spine mobility. As such, it may have a positive effect on the PKC and therefore facilitate gait initiation. The present study aimed to investigate the short-term effect of thoracic SMT-HVLA on spine mobility, APA and speed performance during gait initiation. Healthy young adults (n = 22) performed a series of gait initiation trials on a force plate before (“pre-manipulation” condition) and after (“post-manipulation” condition) a sham manipulation or an HVLA manipulation applied to the ninth thoracic vertebrae (T9). Participants were randomly assigned to the sham (n = 11) or the HVLA group (n = 11).The spine range of motion (ROM) was assessed in each participant immediately after the sham or HVLA manipulations using inclinometers. The results showed that the maximal thoracic flexion increased in the HVLA group after the manipulation, which was not the case in the sham group. In the HVLA group, results further showed that each of the following gait initiation variables reached a significantly lower mean value in the post-manipulation condition as compared to the pre-manipulation condition: APA duration, peak of anticipatory backward center of pressure displacement, center of gravity velocity at foot-off, mechanical efficiency of APA, peak of center of gravity velocity and step length. In contrast, for the sham group, results showed that none of the gait initiation variables significantly differed between the pre- and post-manipulation conditions. It is concluded that HVLA manipulation applied to T9 has an immediate beneficial effect on spine mobility but a detrimental effect on APA development and speed performance during gait initiation. We suggest that a neural effect induced by SMT-HVLA, possibly mediated by a transient alteration in the early sensory-motor integration, might have masked the potential mechanical benefits associated with increased spine mobility.

Acute Effects of Whole-Body Vibration on the Postural Organization of Gait Initiation in Young Adults and Elderly: A Randomized Sham Intervention Study

“…The stabilizing function of APA was thus improved by acute WBV application. The spatiotemporal parameters of APA are also known to be dependent on the somatosensory inputs arising from the lower limbs and trunk (52)(53)(54)(55)(74)(75)(76)(77)(78). One can therefore wonder whether the positive effect on APA amplitude reported in this study could be ascribed to a change in the somatosensory inputs induced by the WBV application.…”

The effects of spinal manipulation on performance-related outcomes in healthy asymptomatic adult population: a systematic review of best evidence

“…Methodological weaknesses in these studies included no disclosure of concealment methodology ( n = 12), lack of participant or investigator blinding ( n = 7), similarities at baseline (n = 1) (Table 4). We calculated between group mean change and 95% CI for all but four studies [33, 34, 38, 41].…”

“…We included 20 articles with a low risk of bias, of which seven were randomized controlled crossover studies [30, 31, 35, 41–43, 46], 10 were randomized controlled trials (RCT) [13, 14, 32–34, 37–39, 44, 47] and three were RCT pilot studies [36, 40, 45].…”

“…Four studies reported on adverse events [30, 36, 40, 44]. Four studies reported on physiological outcomes [30, 33, 42, 47], 16 studies reported on biomechanical outcomes [13, 14, 31, 34–46], three of which also reported on sport-specific outcomes [40, 42, 45], and one additional study reported on performance variables for specific sports [32, 42].…”

“…n = 34Immediately after intervention.Cervical ROM (flexion, extension, bilateral lateral flexion and rotation) (°).S.S. group x time interaction: cervical extension ROM and bilateral lateral flexion.Extension ROM:SMT-Control: 3.76° (− 0.37, 7.15)SMT-Stretch: − 4.29° (− 7.72, − 0.86)Control-Stretch: − 8.05° (− 11.42, − 4.68)L lateral flexion ROM:SMT-Control: 2.82° (0.18, 5.46)SMT-Stretch: 0.35° (− 2.06, 2.76)Control-Stretch: − 2.47° (− 5.26, 0.32)R lateral flexion ROM:SMT-Control: 3.76° (0.94, 6.58)SMT-Stretch: − 0.47° (− 3.31, 2.37)Control-Stretch: − 4.23° (− 7.26, − 1.20)Cervical flexion ROM:SMT-Control: 3.61° (0.16, 7.06)SMT-Stretch: − 0.65° (− 3.86, 2.56)Control-Stretch: − 4.26° (− 7.58, − 0.94)Left cervical rotation ROM:SMT-Control: 3.0° (0.38, 5.62)SMT-Stretch: 0.53° (− 1.70, 2.76)Control-Stretch: − 2.47° (− 5.04, − 0.10)Right cervical rotation ROM:SMT-Control: 1.88° (− 0.70, 4.46)SMT-Stretch: 0.88° (− 1.23, 2.99)Control-Stretch: − 1.0° (− 3.77, 1.77)Biomechanical Outcomes: Other Ditcharles et al, 2017 [34]Right-handed young healthy adults; 24–32 years; France; n = 22; Randomized controlled trial.Standing “lift-off” technique HVLA SMT to T9. n = 11Sham: same experimental protocol as HVLA group using “light touch methodology”, without compression or traction.…”