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ABSTRACT: The lumbar facet joint capsule (FJC) is innervated with mechanically sensitive neurons and is thought to contribute to proprioception and pain. Biomechanical investigations of the FJC have commonly used human cadaveric spines, whereas combined biomechanical and neurophysiological studies have typically used nonhuman animal models. The purpose of this study was to develop mathematical relationships describing vertebral kinematics and FJC strain in cat and human lumbar spine specimens during physiological spinal motions to facilitate future efforts at understanding the mechanosensory role of the FJC.
Cat lumbar spine specimens were tested during extension, flexion, and lateral bending. Joint kinematics and FJC principal strain were measured optically. Facet joint capsule strain-intervertebral angle (IVA) regression relationships were established for the 3 most caudal lumbar joints using cat (current study) and human (prior study) data. The FJC strain-IVA relationships were used to estimate cat and human spine kinematics that corresponded to published sensory neuron response thresholds (5% and 10% strain) for low-threshold mechanoreceptors.
Significant linear relationships between IVA and strain were observed for both human and cat during motions that produced tension in the FJCs (P < .01). During motions that produced tension in the FJCs, the models predicted that FJC strain magnitudes corresponding to published sensory neuron response thresholds would be produced by IVA magnitudes within the physiological range of lumbar motion.
Data from the current study support the proprioceptive role of lumbar spine FJC and low-threshold mechanoreceptive afferents and can be used in interpreting combined neurophysiological and biomechanical studies of cat lumbar spines.
Journal of manipulative and physiological therapeutics 09/2011; 34(7):420-31. · 1.06 Impact Factor
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ABSTRACT: High-velocity, low-amplitude spinal manipulation (HVLA-SM) is an efficacious treatment for low back pain, although the physiological mechanisms underlying its effects remain elusive. The lumbar facet joint capsule (FJC) is innervated with mechanically sensitive neurons and it has been theorized that the neurophysiological benefits of HVLA-SM are partially induced by stimulation of FJC neurons. Biomechanical aspects of this theory have been investigated in humans while neurophysiological aspects have been investigated using cat models. The purpose of this study was to determine the relationship between human and cat lumbar spines during HVLA-SM. Cat lumbar spine specimens were mechanically tested, using a displacement-controlled apparatus, during simulated HVLA-SM applied at L5, L6, and L7 that produced preload forces of approximately 25% bodyweight for 0.5 s and peak forces that rose to 50-100% bodyweight within approximately 125 ms, similar to that delivered clinically. Joint kinematics and FJC strain were measured optically. Human FJC strain and kinematics data were taken from a prior study. Regression models were established for FJC strain magnitudes as functions of factors species, manipulation site, and interactions thereof. During simulated HVLA-SM, joint kinematics in cat spines were greater in magnitude compared with humans. Similar to human spines, site-specific HVLA-SM produced regional cat FJC strains at distant motion segments. Joint motions and FJC strain magnitudes for cat spines were larger than those for human spine specimens. Regression relationships demonstrated that species, HVLA-SM site, and interactions thereof were significantly and moderately well correlated for HVLA-SM that generated tensile strain in the FJC. The relationships established in the current study can be used in future neurophysiological studies conducted in cats to extrapolate how human FJC afferents might respond to HVLA-SM. The data from the current study warrant further investigation into the clinical relevance of site targeted HVLA-SM.
Journal of Biomechanical Engineering 07/2010; 132(7):071008. · 1.90 Impact Factor
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ABSTRACT: Muscle spindles provide essential information for appropriate motor control. In appendicular muscles, much is known about their position and movement sensitivities, but little is known about the axial muscles of the low back. We investigated the dynamic responsiveness of lumbar paraspinal muscle spindle afferents from L(6) dorsal root filaments during constant velocity movement of the L(6) vertebra (the feline has seven lumbar vertebrae) in Nembutal-anesthetized cats. Actuations of 1 mm applied at the L(6) spinous process were delivered at 0.5, 1.0 and 2.0 mm/s. The slow velocity component was measured as the slope of the relationship between displacement during the constant velocity ramp and instantaneous discharge frequency. The quick velocity component was the slope's intercept at zero displacement. The peak component was determined as the highest discharge rates occurring near the end of the ramp compared with control. The slow velocity component over the three increasing velocities was 23.9 (9.9), 21.6 (9.6) and 20.5 (9.5) imp/(s mm) [mean (SD)], respectively. The quick velocity component was 28.4 (8.6), 31.4 (9.8) and 35.8 (10.6) imp/s, respectively. These measures of dynamic responsiveness were at least 5-10 times higher compared with values reported for appendicular muscle spindles. The peak component's velocity sensitivity was 2.9 (imp/s)/(mm/s) [0.2, 5.5, lower, upper 95% confidence interval] similar to that for cervical paraspinal muscles as well as appendicular muscles. Increased dynamic responsiveness of lumbar paraspinal muscle spindles may insure central driving to insure control of intervertebral motion during changes in spinal orientation. It may also contribute to large, rapid and potentially injurious increases in paraspinal muscle activity during sudden and unexpected muscle stretch.
Experimental Brain Research 09/2009; 197(4):369-77. · 2.39 Impact Factor
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ABSTRACT: Muscle spindles contribute to sensorimotor control by supplying feedback regarding muscle length and consequently information about joint position. While substantial study has been devoted to determining the position sensitivity of spindles in limb muscles, there appears to be no data on their sensitivity in the low back. We determined the relationship between lumbar paraspinal muscle spindle discharge and paraspinal muscle lengthening estimated from controlled cranialward movement of the L(6) vertebra in anesthetized cats. Ramp (0.4 mm/s) and hold displacements (0.2, 0.4, 0.6, 0.8, and 1.2 mm for 2.5 s) were applied at the L(6) spinous process. Position sensitivity was defined as the slope of the relationship between the estimated increase in muscle length and mean instantaneous frequency at each length. To enable comparisons with appendicular muscle spindles where joint angle was measured, we also calculated sensitivity in terms of the L(6) and L(7) intervertebral flexion angle (IVA). This angle was estimated from measurements of facet joint capsule strain (FJC) based on a previously established relationship between IVA and FJC strain in the cat lumbar vertebral column during lumbar flexion. Single-unit recordings were obtained from 12 muscle spindle afferents. Longissimus and multifidus muscles contained the receptive field of 10 and 2 afferents, respectively. Mean position sensitivity was 16.3 imp.s(-1).mm(-1) [10.6-22.1, 95% confidence interval (CI), P < 0.001]. Mean angular sensitivity was 5.2 imp.s(-1). degrees (-1) (2.6-8.0, P < 0.003). These slope estimates were more than 3.5 times greater compared with appendicular muscle spindles, and their CIs did not contain previous slope estimates for the sensitivity of appendicular spindles from the literature. Potential reasons for and the significance of the apparently high position sensitivity in the lumbar spine are discussed.
Journal of Neurophysiology 01/2009; 101(4):1722-9. · 3.32 Impact Factor
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ABSTRACT: Quadruped animal models have been validated and used as biomechanical models for the lumbar spine. The biomechanics of the cat lumbar spine has not been well characterized, even though it is a common model used in neuromechanical studies.
Compare the physiological ranges of motion and determine torque-limits for cat and human lumbar spine specimens during physiological motions.
Biomechanics study.
Cat and human lumbar spine specimens.
Intervertebral angle (IVA), joint moment, yield point, torque-limit, and correlation coefficients.
Cat (L2-sacrum) and human (T12-sacrum) lumbar spine specimens were mechanically tested to failure during displacement-controlled extension (E), lateral bending (LB), and axial rotation (AR). Single trials consisted of 10 cycles (10mm/s or 5 degrees /s) to a target displacement where the magnitude of the target displacement was increased for subsequent trials until failure occurred. Whole-lumbar stiffness, torque at yield point, and joint stiffness were determined. Scaling relationships were established using equations analogous to those that describe the load response of elliptically shaped beams.
IVA magnitudes for cat and human lumbar spines were similar during physiological motions. Human whole-lumbar and joint stiffness magnitudes were significantly greater than those for cat spine specimens (p<.05). Torque-limits were also greater for humans compared with cats. Scaling relationships with high correlation (R(2) greater than 0.77) were established during later LB and AR.
The current study defined "physiological ranges of movement" for human and cat lumbar spine specimens during displacement-controlled testing, and should be observed in future biomechanical studies conducted under displacement control.
The spine journal: official journal of the North American Spine Society 11/2007; 9(1):77-86. · 2.90 Impact Factor
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ABSTRACT: There is a high incidence of low back pain (LBP) associated with occupations requiring sustained and/or repetitive lumbar flexion (SLF and RLF, respectively), which cause creep of the viscoelastic tissues. The purpose of this study was to determine the effect of creep on lumbar biomechanics and facet joint capsule (FJC) strain. Specimens were flexed for 10 cycles, to a maximum 10 Nm moment at L5-S1, before, immediately after, and 20 min after a 20-min sustained flexion at the same moment magnitude. The creep rates of SLF and RLF were also measured during each phase and compared to the creep rate predicted by the moment relaxation rate function of the lumbar spine. Both SLF and RLF resulted in significantly increased intervertebral motion, as well as significantly increased FJC strains at the L3-4 to L5-S1 joint levels. These parameters remained increased after the 20-min recovery. Creep during SLF occurred significantly faster than creep during RLF. The moment relaxation rate function was able to accurately predict the creep rate of the lumbar spine at the single moment tested. The data suggest that SLF and RLF result in immediate and residual laxity of the joint and stretch of the FJC, which could increase the potential for LBP.
Annals of Biomedical Engineering 04/2005; 33(3):391-401. · 2.37 Impact Factor
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ABSTRACT: The human facet joint capsule is one of the structures in the lumbar spine that constrains motions of vertebrae during global spine loading (e.g., physiological flexion). Computational models of the spine have not been able to include accurate nonlinear and viscoelastic material properties, as they have not previously been measured. Capsules were tested using a uniaxial ramp-hold protocol or a haversine displacement protocol using a commercially available materials testing device. Plane strain was measured optically. Capsules were tested both parallel and perpendicular to the dominant orientation of the collagen fibers in the capsules. Viscoelastic material properties were determined. Parallel to the dominant orientation of the collagen fibers, the complex modulus of elasticity was E*=1.63MPa, with a storage modulus of E'=1.25MPa and a loss modulus of: E" =0.39MPa. The mean stress relaxation rates for static and dynamic loading were best fit with first-order polynomials: B(epsilon) = 0.1110epsilon-0.0733 and B(epsilon)= -0.1249epsilon + 0.0190, respectively. Perpendicular to the collagen fiber orientation, the viscous and elastic secant moduli were 1.81 and 1.00 MPa, respectively. The mean stress relaxation rate for static loading was best fit with a first-order polynomial: B (epsilon) = -0.04epsilon - 0.06. Capsule strength parallel and perpendicular to collagen fiber orientation was 1.90 and 0.95 MPa, respectively, and extensibility was 0.65 and 0.60, respectively. Poisson's ratio parallel and perpendicular to fiber orientation was 0.299 and 0.488, respectively. The elasticity moduli were nonlinear and anisotropic, and capsule strength was larger aligned parallel to the collagen fibers. The phase lag between stress and strain increased with haversine frequency, but the storage modulus remained large relative to the complex modulus. The stress relaxation rate was strain dependent parallel to the collagen fibers, but was strain independent perpendicularly.
Journal of Biomechanical Engineering 03/2005; 127(1):15-24. · 1.90 Impact Factor
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ABSTRACT: Groups III and IV muscle mechano-nociceptors (MNs) can be stimulated during noxious stretch, as may occur during hyperextension of a joint. However, the mechanical state (characterized by stress and strain) encoded by MNs during stretch has not previously been determined. The current study used an ex vivo gracilis muscle-nerve preparation in a rat model to apply either a uniform uniaxial or pseudo-shear-loading paradigm. Single mechanically sensitive group III or IV MNs were mechanically stimulated while plane stress and strain were measured at the location of the MN's receptive field. Linear regression was used to evaluate the relationships between neural response and mechanical stress and strain. The mean neural response (threshold, 47.2 kPa; sensitivity, 0.05 Hz/kPa) was highly correlated to tensile stress, tensile strain, and in-plane compressive strain but was significantly and substantially less correlated with shear strain. Although the overall stress and strain relationship was nonlinear, it was reasonably linear (r2 = 0.92) for levels suprathreshold for MNs. Hence, at tensile loads sufficient to stimulate MNs, the muscle was acting as a pseudo-elastic tissue. Thus, muscle MNs encode noxious stretch differently than compression and exhibit different encoding of stretch than cutaneous MNs.
Muscle & Nerve 09/2004; 30(2):216-24. · 2.37 Impact Factor
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ABSTRACT: Groups III and IV muscle mechano-nociceptors (MNs) can be stimulated during noxious stretch, as may occur during hyperextension of a joint. However, the mechanical state (characterized by stress and strain) encoded by MNs during stretch has not previously been determined. The current study used an ex vivo gracilis muscle–nerve preparation in a rat model to apply either a uniform uniaxial or pseudo–shear-loading paradigm. Single mechanically sensitive group III or IV MNs were mechanically stimulated while plane stress and strain were measured at the location of the MN's receptive field. Linear regression was used to evaluate the relationships between neural response and mechanical stress and strain. The mean neural response (threshold, 47.2 kPa; sensitivity, 0.05 Hz/kPa) was highly correlated to tensile stress, tensile strain, and in-plane compressive strain but was significantly and substantially less correlated with shear strain. Although the overall stress and strain relationship was nonlinear, it was reasonably linear (r2 = 0.92) for levels suprathreshold for MNs. Hence, at tensile loads sufficient to stimulate MNs, the muscle was acting as a pseudo-elastic tissue. Thus, muscle MNs encode noxious stretch differently than compression and exhibit different encoding of stretch than cutaneous MNs. Muscle Nerve 30: 216–224, 2004
Muscle & Nerve 07/2004; 30(2):216 - 224. · 2.37 Impact Factor
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Partap S Khalsa
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ABSTRACT: Pain, due to mechanical stimuli, is a normal, indeed healthy, response of animals to potential or actual damage to tissues. Mammals in general, and humans in particular, have evolved a highly sophisticated system of pain perception, which is characterized in humans by complementary but distinct neural processing of the intensity and location of a noxious stimulus, and a motivational/emotional or affective response to the stimulus. The peripheral and central neurons that comprise this system, which has been called the 'neuromatrix', dynamically (temporally) respond and adapt to noxious biomechanical stimuli. However, phenotypic variability of the neuromatrix can be large, which can result in a host of musculoskeletal conditions that are characterized by altered pain perception, which can and often does alter the course of the condition. This neural plasticity has been well recognized in the central nervous system, but it has only more recently become known that peripheral nociceptors also adapt to their altered extracellular matrix environment. This work reviews the biomechanics of pain focusing on the relevant stimulus that initiates responses by nociceptors to the cognitive perception of pain.
Journal of Electromyography and Kinesiology 03/2004; 14(1):109-20. · 1.97 Impact Factor
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ABSTRACT: The mechanical state encoded by group III and IV muscle afferents, putative mechano-nociceptors, during indentation was examined using an isolated muscle-nerve preparation in a rat model. Gracilis muscle and its intact innervation were surgically removed from the medial thigh of the rat hindlimb and placed in a dish containing rodent synthetic interstitial fluid. The tendons of the muscle were coupled to an apparatus that could stretch and apply compression to the muscle. Using a standard teased-nerve preparation, the neural responses of single mechanically sensitive group III or IV afferents were identified. Afferents were classified as mechano-nociceptors on the basis of their graded response to noxious levels of compressive stress (or strain) as well as, in some cases, their polymodal response to noxious thermal stimuli. Mechano-nociceptors (n = 13) were stimulated using controlled compressive stress (10-30 kPa) or strain (40-80%) while simultaneously measuring displacement and force by compressing the muscle between a flat cylinder and a hard platform. Linear regression was used to evaluate the relationships between neural response and mechanical stress, force, strain, and displacement. The mean neural response (threshold: 1.1 +/- 0.4 kPa; sensitivity: 0.5 +/- 0.1 Hz/kPa; means +/- SE) was significantly and substantially more highly correlated with compressive stress than force, strain, or displacement. The data from this study support the hypothesis that muscle nociceptors stimulated by indentation encode compressive stress rather than force, strain, or displacement.
Journal of Neurophysiology 03/2003; 89(2):785-92. · 3.32 Impact Factor
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ABSTRACT: The mechanical state encoded by slowly adapting type 1 mechanoreceptors (SAI) during indentation was examined using an isolated preparation in a rat model. Skin and its intact innervation were harvested from the medial thigh of the rat hindlimb and placed in a dish, with the corium side down, containing synthetic interstitial fluid. The margins of the skin were coupled to an apparatus that could stretch and apply compression to the skin. Using a standard teased nerve preparation, the neural responses of single SAIs were identified. SAIs were stimulated, using controlled compressive stress while simultaneously measuring displacement, by compressing the skin between indenters (flat cylinders) of different diameters and a hard platform. SAIs were subcategorized according to whether their neural response saturated above or below 10 kPa compressive stress (SAI-H or SAI-L, respectively). Linear regression was used to evaluate the relationships between neuron response and stress and force and displacement. For all SAIs, the mean neural response was significantly and substantially more highly correlated with compressive stress than force or displacement. For the SAI-L subcategory, the mean correlation coefficient was significantly and substantially greater for stress than for force but not significantly different for displacement. The data from this study support the hypothesis that SAI mechanoreceptors stimulated by indentation encode compressive stress rather than force, displacement, or strain.
Journal of Neurophysiology 05/2002; 87(4):1686-93. · 3.32 Impact Factor
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ABSTRACT: The lumbar facet joint capsule is innervated with nociceptors and mechanoreceptors, and is thought to play a role in low back pain as well as to function proprioceptively.
In order to examine the facet capsule's potential proprioceptive role, relationships between intracapsular strain and relative spine position were examined.
Lumbar facet joint capsule strains were measured in human cadaveric specimens during displacement-controlled motions.
Ligamentous lumbar spine specimens (n=7) were potted and actuated without inducing a moment at the point of application. Spines were tested during physiological motions of extension, flexion, left and right lateral bending. Intervertebral angulations (IVA) were measured using biaxial inclinometers mounted on adjacent vertebrae. Joint moments were determined from the applied load at T12 and the respective moment arms. Capsule plane strains were measured by optically tracking the displacements of infrared reflective markers glued to capsule surfaces. Statistical differences (p<.05) in moment, IVA and strain were assessed across facet joint levels using analysis of variance and comparison of linear regressions.
The developed moments and IVAs increased monotonically with increasing displacements; the relationships were highly correlated for all four motion types. Although highly variable among specimens, principal strains also increased monotonically in magnitude with increasing displacements during extension and flexion, but were more complex during lateral bending. At a given joint level, the absolute magnitudes of principal strains and IVA were largest during the same motion type.
Distinct patterns in principal strains and IVA were identified during physiological motions, lending biomechanical support to the theory that lumbar facet joint capsules could function proprioceptively.
The Spine Journal 4(2):141-52. · 3.29 Impact Factor
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ABSTRACT: In cases of low back pain associated with biomechanical lumbar instability, anterior interbody fixation can be used as a surgical treatment, but its affect on facet joint capsule strains is unknown.
To determine the effect of a single-level anterolateral interbody fixation, the changes in lumbar facet joint capsule strains at the level of and adjacent to the fixation were evaluated.
Human cadaveric lumbar spine specimens were tested under displacement control before and after the addition of a single anterior thoracolumbar plate (ATLP) on the L4-L5 motion body.
Ligamentous lumbar spine specimens (n=7) were potted and actuated before and after fixation of the L4-L5 motion segment with an ATLP in motions of extension, flexion, left and right bending. Joint moments were calculated from the applied load and respective moment arms. Intervertebral angulation was measured using biaxial inclinometers mounted onto adjacent vertebrae. Plane strains of the capsules were measured by optically tracking the displacements of small, infrared reflective markers glued to capsule surfaces. Statistical differences (p<.05) in moment, intervertebral angle and capsular strain were assessed using analysis of variance and comparison of linear regression lines.
Fixation resulted in an increase in moment at the three vertebral levels for all motions. There was also an increase in intervertebral angle at L3-L4 and L5-S1, and a decrease in intervertebral angle at L4-L5 for all motions. Plane strains in the L3-L4 and L5-S1 facet capsules increased as a result of the fixation. L4-L5 facet capsules experienced decreased and increased strains ipsilateral and contralateral, respectively, to the instrumentation.
Restriction of a vertebral motion segment using a single ATLP increased adjacent capsular strains, which if suprathreshold for capsule nociceptors, could play a role in low back pain.
The Spine Journal 4(2):153-62. · 3.29 Impact Factor
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ABSTRACT: Cervical flexion teardrop fractures (CFTF) are highly unstable injuries, and the optimal internal fixation construct is not always clearly indicated.
The purpose of the current study was to determine whether the type of fixation construct (anterior, posterior, or combined) or number of joint levels involved in fixation (one or two) affected the relative stability of a CFTF injury at C5-C6.
Human cadaveric cervical spine specimens were mechanically tested under displacement control in the intact state and after creation of CFTF at C5-C6 with stabilization using five different instrumentation constructs. Joint stiffness and intervertebral translation of the constructs were compared with the intact state and normalized (instrumented/intact) to assess relative differences across the five constructs.
Spine specimens were mechanically tested in the intact state during flexion, extension, lateral bending, and axial rotation. CFTF was created at C5-C6 by creating an osteotomy at C5 and transecting the posterior ligaments and intervertebral disc. Specimens were tested with anterior, posterior, and combined single-level constructs (C5-C6). Then, a corpectomy was performed at C5, and specimens were retested with the two-level constructs (C4-C6; anterior and anterior-posterior). Joint stiffness and intervertebral translations were computed.
All five fixation constructs resulted in joint stability that was as good as or better than that of the intact specimens. Relative stiffness of the constructs differed depending upon the motion type considered, though the two-level anterior-posterior construct typically provided the greatest stability. Intervertebral translation along the major axis was reduced the most for both of the combined instrumentation systems, although there were few changes in total intervertebral translation across the five constructs.
All five constructs restored stability comparable to that of the intact specimens. The significance of the relative differences in constructs for the in vivo spine is unclear and warrants further clinical investigation.
The Spine Journal 6(5):514-23. · 3.29 Impact Factor
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ABSTRACT: Lumbar spinal manipulation (SM) is a popular, effective treatment for low back pain but the physiological mechanisms remain elusive. During SM, mechanoreceptors innervating the facet joint capsule (FJC) may receive a novel stimulus, contributing to the neurophysiological benefits of SM. The biomechanics of SM and physiological axial rotations were compared to determine whether speed or loading site affected FJC strain magnitudes or patterns.
Human lumbar spine specimens were tested during physiological rotations and simulated SM while measuring applied torque, vertebral motion, and FJC strain. During physiological rotations, specimens were actuated at T12 to 20 degrees left and right axial rotation at 2 degrees to 125 degrees per second. During SM simulations, a 7-mm impulse displacement was applied to L3, L4, or L5 at 5 to 50 mm per second.
Physiological rotations. Increasing displacement rate resulted in significantly larger torque magnitudes (P < .001), whereas vertebral kinematics and FJC strain magnitudes were unchanged (P > .05). Physiological rotations vs SM. Applied torque and vertebral rotation magnitudes were similar across speed and vertebral level. Total vertebral translations were slightly larger during physiological rotations vs SM at a given loading rate (P < .05). Patterns of vertebral motions and FJC strain during SM and physiological rotations varied significantly with loading rate (P < .05) but not with actuation site (P > .15).
The similar patterns observed in vertebral motion and FJC strain across actuation sites during SM and physiological rotations suggest that site specificity of SM may have minimal clinical relevance. High loading rates during lumbar SM resulted in unique patterns in FJC strain, which may result in unique patterns of FJC mechanoreceptor response.
Journal of manipulative and physiological therapeutics 28(9):673-87. · 1.06 Impact Factor
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ABSTRACT: Spinal manipulation (SM) is an effective treatment for low back pain (LBP), and it has been theorized that SM induces a beneficial neurophysiological effect by stimulating mechanically sensitive neurons in the lumbar facet joint capsule (FJC).
The purpose of this study was to determine whether human lumbar FJC strains during simulated SM were different from those that occur during physiological motions.
Lumbar FJC strains were measured in human cadaveric spine specimens during physiological motions and simulated SM in a laboratory setting.
Specimens were tested during displacement-controlled physiological motions of flexion, extension, lateral bending, and axial rotations. SM was simulated using combinations of manipulation site (L3, L4, and L5), impulse speed (5, 20, and 50 mm/s), and pre-torque magnitude (applied at T12 to simulate patient position; 0, 5, 10 Nm). FJC strains and vertebral motions (using six degrees of freedom) were measured during both loading protocols.
During SM, the applied loads were within the range measured during SM in vivo. Vertebral translations occurred primarily in the direction of the applied load, and were similar in magnitude regardless of manipulation site. Vertebral rotations and FJC strain magnitudes during SM were within the range that occurred during physiological motions. At a given FJC, manipulations delivered distally induced capsule strains similar in magnitude to those that occurred when the manipulation was applied proximally.
FJC strain magnitudes during SM were within the physiological range, suggesting that SM is biomechanically safe. Successful treatment of patients with LBP using SM may not require precise segmental specificity, because the strain magnitudes at a given FJC during SM do not depend upon manipulation site.
The Spine Journal 5(3):277-90. · 3.29 Impact Factor
