Neurophysiologic effects of spinal manipulation in patients with chronic low back pain

BMC Musculoskeletal Disorders

James S Thomas²  Andrew Ross²  Richard L Hoffman³  Stevan Walkowski⁴  David A Goss³  Brian C Clark¹ 

[1] Department of Biomedical Sciences, Ohio University Heritage College of Osteopathic Medicine, 228 Irvine Hall, Athens, OH 45701, USA;School of Rehabilitation and Communication Sciences, Grover Center, Ohio University, Athens, OH 45701 USA;Ohio Musculoskeletal and Neurological Institute (OMNI), Ohio University, 236 Irvine Hall, Athens, OH 45701, USA;Department of Family Medicine, Ohio University Heritage College of Osteopathic Medicine, Grosvenor Hall, Athens, OH 45701, USA

关键词: audible release;    osteopathic;    chiropractic;    transcranial magnetic stimulation;    stretch reflex;    muscle;    low back pain;    manual therapies;    Spinal manipulation;   

Others  :  1152615
DOI  :  10.1186/1471-2474-12-170

 received in 2011-03-31, accepted in 2011-07-22,  发布年份 2011

【 摘 要 】

Background

While there is growing evidence for the efficacy of SM to treat LBP, little is known on the mechanisms and physiologic effects of these treatments. Accordingly, the purpose of this study was to determine whether SM alters the amplitude of the motor evoked potential (MEP) or the short-latency stretch reflex of the erector spinae muscles, and whether these physiologic responses depend on whether SM causes an audible joint sound.

Methods

We used transcranial magnetic stimulation to elicit MEPs and electromechanical tapping to elicit short-latency stretch reflexes in 10 patients with chronic LBP and 10 asymptomatic controls. Neurophysiologic outcomes were measured before and after SM. Changes in MEP and stretch reflex amplitude were examined based on patient grouping (LBP vs. controls), and whether SM caused an audible joint sound.

Results

SM did not alter the erector spinae MEP amplitude in patients with LBP (0.80 ± 0.33 vs. 0.80 ± 0.30 μV) or in asymptomatic controls (0.56 ± 0.09 vs. 0.57 ± 0.06 μV). Similarly, SM did not alter the erector spinae stretch reflex amplitude in patients with LBP (0.66 ± 0.12 vs. 0.66 ± 0.15 μV) or in asymptomatic controls (0.60 ± 0.09 vs. 0.55 ± 0.08 μV). Interestingly, study participants exhibiting an audible response exhibited a 20% decrease in the stretch reflex (p < 0.05).

Conclusions

These findings suggest that a single SM treatment does not systematically alter corticospinal or stretch reflex excitability of the erector spinae muscles (when assessed ~ 10-minutes following SM); however, they do indicate that the stretch reflex is attenuated when SM causes an audible response. This finding provides insight into the mechanisms of SM, and suggests that SM that produces an audible response may mechanistically act to decrease the sensitivity of the muscle spindles and/or the various segmental sites of the Ia reflex pathway.

【 授权许可】

   
2011 Clark et al; licensee BioMed Central Ltd.

【 图 表 】

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