Investigation of the factors influencing spinal manipulative therapy force transmission through the thorax: a cadaveric study

Chiropractic & Manual Therapies

Research

Martha Funabashi¹  Jérémie Mikhail²  Isabelle Pagé³  Stéphane Sobczak⁴  Martin Descarreaux⁵ 

[1] Department of Chiropractic, Université du Québec à Trois-Rivières, 3351 Boul. des Forges, G8Z 4M3, Trois-Rivières, QC, Canada;Canadian Memorial Chiropractic College, 6100 Leslie St, M2H 3J1, North York, ON, Canada;Department of Chiropractic, Université du Québec à Trois-Rivières, 3351 Boul. des Forges, G8Z 4M3, Trois-Rivières, QC, Canada;Research Group on Neuromusculoskeletal Disorders, Université du Québec à Trois-Rivières, 3351 Boul. des Forges, G8Z 4M3, Trois-Rivières, QC, Canada;Department of Chiropractic, Université du Québec à Trois-Rivières, 3351 Boul. des Forges, G8Z 4M3, Trois-Rivières, QC, Canada;Research Group on Neuromusculoskeletal Disorders, Université du Québec à Trois-Rivières, 3351 Boul. des Forges, G8Z 4M3, Trois-Rivières, QC, Canada;Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale (CIUSSS-CN), 525 Boul. Wilfrid-Hamel, G1M 2S8, Québec City, QC, Canada;Research Group on Neuromusculoskeletal Disorders, Université du Québec à Trois-Rivières, 3351 Boul. des Forges, G8Z 4M3, Trois-Rivières, QC, Canada;Department of Anatomy, Université du Québec à Trois-Rivières, 3351 Boul. des Forges, G8Z 4M3, Trois-Rivières, QC, Canada;Research Chair in Functional Anatomy, Université du Québec à Trois-Rivières, 3351 Boul. des Forges, G8Z 4M3, Trois-Rivières, QC, Canada;Research Group on Neuromusculoskeletal Disorders, Université du Québec à Trois-Rivières, 3351 Boul. des Forges, G8Z 4M3, Trois-Rivières, QC, Canada;Department of Human Kinetics, Université du Québec à Trois-Rivières, 3351 Boul. des Forges, G8Z 4M3, Trois-Rivières, QC, Canada;

关键词: Spinal manipulation;    Spinal mobilization;    Force–time characteristics;    Patient-table interface;    Clinician-patient interface;    Cadaveric study;    Kinetic;    Kinematic;   

DOI  :  10.1186/s12998-023-00493-1

 received in 2023-03-14, accepted in 2023-06-16,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundSpinal manipulative therapy (SMT) clinical effects are believed to be linked to its force–time profile characteristics. Previous studies have revealed that the force measured at the patient-table interface is most commonly greater than the one applied at the clinician-patient interface. The factors explaining this force amplification remains unclear.ObjectiveTo determine the difference between the force applied to a cadaveric specimen’s thoracic spine and the resulting force measured by a force-sensing table, as well as to evaluate the relationship between this difference and both the SMT force–time characteristics and the specimens’ characteristics.MethodsTwenty-five SMTs with different force–time profiles were delivered by an apparatus at the T7 vertebra of nine human cadaveric specimens lying prone on a treatment table equipped with a force plate. The difference between the force applied by the apparatus and the resulting force measured by the force plate was calculated in absolute force (Fdiff) and as the percentage of the applied force (Fdiff%). Kinematics markers were inserted into T6 to T8 spinous and transverse processes to evaluate vertebral displacements during the SMT thrusts. Mixed-effects linear models were run to evaluate the variance in Fdiff and Fdiff% explained by SMT characteristics (peak force, thrust duration and force application rate), T6 to T8 relative and total displacements, and specimens’ characteristics (BMI, height, weight, kyphosis angle, thoracic thickness).ResultsSixty percent of the trials showed lower force measured at the force plate than the one applied at T7. Fdiff¸ was significantly predicted (R2marginal = 0.54) by peak force, thrust duration, thoracic thickness and T6–T7 relative displacement in the z-axis (postero-anterior). Fdiff% was significantly predicted (R2marginal = 0.56) by force application rate, thoracic thickness and total T6 displacements. For both dependant variables, thoracic thickness showed the highest R2marginal out of all predictors.ConclusionDifference in force between the clinician-patient and the patient-table interfaces is influenced by SMT force–time characteristics and by thoracic thickness. How these differences in force are associated with vertebral displacements remains unclear. Although further studies are needed, clinicians should consider thorax thickness as a possible modulator of forces being transmitted through it during prone SMT procedures.

【 授权许可】

CC BY   
© Chiropractic and Osteopathic College of Australasia, European Academy of Chiropractic, The Royal College of Chiropractors, Nordic Institute of Chiropractic and Clinical Biomechanics and BioMed Central Ltd. 2023

【 图 表 】

40517_2023_266_Article_IEq19.gif

40517_2023_266_Article_IEq18.gif

Fig. 2

40517_2023_266_Article_IEq15.gif

40517_2023_266_Article_IEq14.gif

Fig. 2

40517_2023_266_Article_IEq12.gif

Fig. 3

12888_2023_5115_Article_IEq1.gif