Chiropractic adjustments improve smoothness of intervertebral motion, acceleration, & angular velocity of lumbar motion segments


Lumbar motion changes in chronic low back pain patients.
Mieritz RM, DC, PhD, Bronfort G, DC, PhD et al. Spine J 2014; 14:xxxepub ahead of print.

Comments: This 2014 paper uses a high tech” piece of equipment (Spine Motion Analyzer) to quantify not only the overall range of motion (ROM), but the quality of motion based on angular velocity, acceleration, & smoothness of motion (aka jerk index) which is based on the number of changes in acceleration throughout a particular ROM. The results document that chiropractic adjustments improved all measurements of improved quality of motion, but several exercise programs which were also evaluated improved only half of the measurements. Importantly, this study is the first to document that chiropractic adjustments improved smoothness of motion but the exercises did not. The paper notes that simply measuring end range of motion and not quality of motion is not sensitive enough to detect important clinical improvements of motion that occur with chiropractic adjustments.

Methods: :This study assesses changes in lumbar regional motion in 199 LBP Pts (>6 wks to 12 wks) with (w) or w/o leg pain &/or neurological signs (18-65 yrs) over 12 wks of care. Lumbar spine kinematics were determined using a high tech instrumented spatial linkage system (CA 6000 Spine Motion Analyzer; OSI, Union City, CA, USA) to measure angular velocity, acceleration & smoothness of motion at 2 pre-Tx visits & 1 F-U visit after 12 wks of treatment. ‘Low tech’ ROM measurements describe functional range but little about the quality of the motion. Simple ROM has limited use as a measure of Tx outcomes or as a stand-alone measure of disability. Addressing the patterns & quality of the motion rather than just the end ROM may be more responsive measures. ‘High tech’ 3D spinal motion analysis may aid in describing Pt movement & changes w various Tx& remedy deficiencies in the quantification of LBP impairment.
    The lumbar region spinal motion data were analyzed relative to 3 treatment modalities:
      1. High-dose, supervised exercise (20 supervised sessions of high reps of core exercises)
      2. Low-tech trunk exercise (2 supervised sessions w PT training & advice & then exercise on their own)
      3.Spinal Manipulation (SM) (2 visits/wk for 12 wks of HVLA side-posture).
Results:Lumbar region motion parameters were altered over 12 wks in all groups, but only the SM grp changed significantly in all outcomes, and the exercise groups in half of the motion parameters analyzed. SM grp changed to a smoother motion pattern of motion but the exercise groups did not. The hypothesis that LBP Pts would move more smoothly after SM was confirmed.

Conclusion: This study provides evidence that spinal motion changes can occur in CLBP Pts over a 12-week period and that these changes are associated with the type of Tx.