Patients With Magnetic Resonance Imaging–Verified Lumbar Disk Herniations Benefit From Chiropractic High-Velocity, Low-Amplitude Spinal Manipulative Therapy

BackgroundLumbar disk degeneration (LDD) has been related to heavy physical loading. However, the quantification of the exposure has been controversial, and the dose-response relationship with the LDD has not been established.ObjectiveThe purpose of this study was to investigate the dose-response relationship between lifetime cumulative lifting load and LDD.DesignThis was a cross-sectional study.MethodsEvery participant received assessments with a questionnaire, magnetic resonance imaging (MRI) of the lumbar spine, and estimation of lumbar disk compression load. The MRI assessments included assessment of disk dehydration, annulus tear, disk height narrowing, bulging, protrusion, extrusion, sequestration, degenerative and spondylolytic spondylolisthesis, foramina narrowing, and nerve root compression on each lumbar disk level. The compression load was predicted using a biomechanical software system.ResultsA total of 553 participants were recruited in this study and categorized into tertiles by cumulative lifting load (ie, <4.0 × 105, 4.0 × 105 to 8.9 × 106, and ≥8.9 × 106 Nh). The risk of LDD increased with cumulative lifting load. The best dose-response relationships were found at the L5–S1 disk level, in which high cumulative lifting load was associated with elevated odds ratios of 2.5 (95% confidence interval [95% CI]=1.5, 4.1) for dehydration and 4.1 (95% CI=1.9, 10.1) for disk height narrowing compared with low lifting load. Participants exposed to intermediate lifting load had an increased odds ratio of 2.1 (95% CI=1.3, 3.3) for bulging compared with low lifting load. The tests for trend were significant.LimitationsThere is no “gold standard” assessment tool for measuring the lumbar compression load.ConclusionsThe results suggest a dose-response relationship between cumulative lifting load and LDD.

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Magnetic resonance imaging in the evaluation of a high-velocity gunshot wound to the thigh

British Journal of Surgery ◽

10.1002/bjs.1800840823 ◽

1997 ◽

Vol 84 (8) ◽

pp. 1119-1119 ◽

Cited By ~ 3

Author(s):

S. J. Parker ◽

L. J. Jarvis ◽

R. F. Dale

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

High Velocity ◽

Gunshot Wound ◽

Resonance Imaging

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Prediction of Lumbar Disk Herniation and Clinical Outcome Using Quantitative Magnetic Resonance Imaging

Investigative Radiology ◽

10.1097/rli.0000000000000527 ◽

2019 ◽

Vol 54 (3) ◽

pp. 183-189 ◽

Cited By ~ 2

Author(s):

Marcus Raudner ◽

Markus M. Schreiner ◽

Vladimir Juras ◽

Michael Weber ◽

David Stelzeneder ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Clinical Outcome ◽

Resonance Imaging ◽

Disk Herniation ◽

Quantitative Magnetic Resonance Imaging ◽

Lumbar Disk Herniation ◽

Lumbar Disk ◽

Quantitative Magnetic Resonance

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Differences in force-time parameters and electromyographic characteristics of two high-velocity, low-amplitude spinal manipulations following one another in quick succession

Chiropractic & Manual Therapies ◽

10.1186/s12998-020-00355-0 ◽

2020 ◽

Vol 28 (1) ◽

Author(s):

Lindsay M. Gorrell ◽

Philip J. Conway ◽

Walter Herzog

Keyword(s):

High Velocity ◽

Spinal Manipulative Therapy ◽

Peak Force ◽

Manipulative Therapy ◽

Force Application ◽

Thoracic Spinal ◽

Time Parameters ◽

Force Time ◽

Upper Thoracic ◽

Low Amplitude

Abstract Background Spinal manipulative therapy is an effective treatment for neck pain. However, the mechanisms underlying its clinical efficacy are not fully understood. Previous studies have not systematically compared force-time parameters and electromyographic responses associated with spinal manipulation. In this study, force-time parameters and electromyographic characteristics associated with multiple manual high-velocity, low-amplitude cervical and upper thoracic spinal manipulations were investigated. The purpose of this analysis was to compare the force-time parameters and electromyographic characteristics between two spinal manipulations delivered following one another in quick succession if the first thrust was not associated with an audible cavitation. Methods Nine asymptomatic and eighteen symptomatic participants received six Diversified-style spinal manipulations to the cervical and upper thoracic spines during data collected February 2018 to September 2019. Peak force, rate of force application and thrust duration were measured using a pressure pad. Bipolar surface electrodes were used to measure the electromyographic responses and reflex delay times in sixteen neck, back and limb outlet muscles bilaterally. Differences in force-time parameters and electromyographic data were analyzed between the first and second thrust. Results Fifty-two spinal manipulations were included in this analysis. Peak force was greater (p < 0.001) and rate of force application faster (p < 0.001) in the second thrust. Furthermore, peak electromyographic responses were higher following the second thrust in asymptomatic (p < 0.001) and symptomatic (p < 0.001) subjects. Also, electromyographic delays were shorter in the symptomatic compared to the asymptomatic participants for the second thrust (p = 0.039). There were no adverse patient events. Conclusion When a second manipulation was delivered because there was not audible cavitation during the first thrust, the second thrust was associated with greater treatment forces and faster thrust rates. Peak electromyographic responses were greater following the second thrust.

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