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Effect of Spinal Manipulation on Corticospinal and Stretch Reflex Excitability in Patients With Chronic Low Back Pain

Journal: The Journal of the American Osteopathic Association Date: 2011/01, 111(1):Pages: 55. doi: Subito , type of study: pretest posttest design

Full text    (https://www.degruyter.com/document/doi/10.7556/jaoa.2011.111.1.54/html)

Keywords:

chronic pain [296]
low back pain [500]
high velocity low amplitude [56]
HVLA [50]
pilot study [194]
pretest posttest design [217]

Abstract:

Objective: The purpose of this pilot study was to examine the effects of a high-velocity, low-amplitude (HVLA) spinal manipulation on corticospinal and stretch reflex excitability of the lumbar paraspinal muscles in adults with and without chronic low back pain (LBP). Methods: Ten adults with chronic LBP (>12 weeks) and 10 healthy adults without LBP participated in this study. All subjects received HVLA spinal manipulation. Before and immediately after the manipulation, we used transcranial magnetic stimulation to assess corticospinal excitability by quantifying the motor evoked potential (MEP) amplitude of the erector spinae (ES) muscles. We also used an electromechanical tapping device to elicit short-latency stretch reflexes from the ES. Results: Spinal manipulation did not alter the mean (standard deviation [SD]) MEP amplitude of the ES in patients with chronic LBP (0.80 [0.33] uV vs 0.80 [0.30] uV) or in healthy individuals without LBP (0.56 [0.09] uV vs 0.57 [0.06] uV). Likewise, spinal manipulation did not alter the short-latency stretch reflex amplitude of the ES in patients with chronic LBP (0.66 [0.12] uV vs 0.66 [0.15] uV) or in healthy individuals without LBP (0.60 [0.09] uV vs 0.55 [0.08] uV). Interestingly, we observed that subjects who exhibited an audible response to spinal manipulation had a 25.7% decrease in the stretch reflex whereas subjects who did not exhibit an audible response had a nominal 3.9% increase. Conclusions: These preliminary findings suggest that a single spinal manipulative treatment does not systematically alter corticospinal or stretch reflex excitability of the ES muscles in asymptomatic controls or individuals with chronic LBP. However, these findings suggest that the stretch reflex is attenuated when spinal manipulation results in an audible response. This study was approved by the Ohio University Institutional Review Board (#09F064). This work was supported by a research grant from the Osteopathic Heritage Foundations.


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