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. 2020 Jan 24;28:5.
doi: 10.1186/s12998-019-0290-7. eCollection 2020.

Does Manual Therapy Affect Functional and Biomechanical Outcomes of a Sit-To-Stand Task in a Population With Low Back Pain? A Preliminary Analysis

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Free PMC article

Does Manual Therapy Affect Functional and Biomechanical Outcomes of a Sit-To-Stand Task in a Population With Low Back Pain? A Preliminary Analysis

Giancarlo Carpino et al. Chiropr Man Therap. .
Free PMC article

Abstract

Introduction: Manual therapy (MT) hypothetically affects discrepant neuromuscular control and movement observed in populations with low back pain (LBP). Previous studies have demonstrated the limited influence of MT on movement, predominately during range of motion (ROM) testing. It remains unclear if MT affects neuromuscular control in mobility-based activities of daily living (ADLs). The sit-to-stand (STS) task represents a commonly-performed ADL that is used in a variety of clinical settings to assess functional and biomechanical performance.

Objective: To determine whether MT affects functional performance and biomechanical performance during a STS task in a population with LBP.

Methods: Kinematic data were recorded from the pelvis and thorax of participants with LBP, using an optoelectronic motion capture system as they performed a STS task before and after MT from November 2011 to August 2014. MT for each participant consisted of two high-velocity low-amplitude spinal manipulations, as well as two grade IV mobilizations of the lumbar spine and pelvis targeted toward the third lumbar vertebra and sacroiliac joint in a side-lying position; the order of these treatments was randomized. Pelvis and thorax kinematic data were used to derive the time-varying lumbar angle in the sagittal plane for each STS trial. The difference between the maximum and minimum lumbar angles during the STS trial determined the sagittal ROM that was used as the biomechanical outcome. Time to complete each STS trial was used as a functional measure of performance. Pre-MT and post-MT values for the lumbar sagittal ROM and time to completion were statistically analysed using paired samples t-tests.

Results: Data were obtained from 40 participants with 35 useful datasets (NRS = 3.3 ± 1.2; 32.4 ± 9.8 years; 16 females, 19 males). After MT, lumbar sagittal ROM increased by 2.7 ± 5.5 degrees (p = 0.007). Time to complete the STS test decreased by 0.4 ± 0.4 s (p < 0.001).

Discussion: These findings provide preliminary evidence that MT might influence the biomechanical and functional performance of an STS task in populations with LBP. The MT intervention in this study involved a combination of spinal manipulations and mobilizations. Future work will expand upon these data as a basis for targeted investigations on the effects of either spinal manipulation and mobilization on neuromuscular control and movement in populations with LBP.

Keywords: Activities of daily living; Kinematics; Lumbar spine; Mobilisation; Neuromuscular control; Spinal manipulation.

Conflict of interest statement

Competing interestsThe authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Anterior view of placement for kinematic instrumentation used to monitor pelvis and thorax movements during the sit-to-stand task
Fig. 2
Fig. 2
Positioning of the chiropractor and the participant during the MT interventions
Fig. 3
Fig. 3
Sample time-series data of the spine angular position (black solid line) and velocity (gray solid line) in the sagittal plane during a single trial of the sit-to-stand task. Vertical gray dashed lines denote the identified instants for initiation and termination of the sit-to-stand task. Task completion time was the difference between the termination and initiation timepoints. Horizontal gray dashed lines denote the maximum and minimum sagittal plane spine angles that occurred during the sit-to-stand task. Total spine range of motion was determined as the difference between the identified maximum and minimum spine angles
Fig. 4
Fig. 4
Change in time to complete the sit-to-stand task following the manual therapy intervention for individual participants. Closed circles represent acute low back pain participants, and the open circles represent chronic low back pain participants. The dashed lines represent integer multiples of approximations of the standard error of measurement from a 5 cycle sit-to-stand test: 0.5 s each
Fig. 5
Fig. 5
Change in utilised sagittal plane lumbar spine range of motion (ROM) during the sit-to-stand task following the manual therapy intervention for individual participants. Closed circles represent acute low back pain participants, and the open circles represent chronic low back pain participants. The dashed lines are integer multiples of approximations of the standard error of measurement that were obtained from the literature: 3.4 degrees each

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