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The objective of this study was to perform an investigation evaluating if cervical spinal manipulative therapy (SMT) can increase grip strength on judo athletes in a top 10 national-ranked team. A single-blinded, prospective, comparative, pilot, randomized, clinical trial was performed with 18 athletes of both sexes from a judo team currently competing on a national level. The athletes were randomly assigned to 2 groups: chiropractic SMT and sham. Three interventions were performed on each of the athletes at different time points. Force measurements were obtained by a hydraulic dynamometer immediately before and after each intervention at the same period before training up to 3 weeks with at least 36 hours between interventions. Analysis of grip strength data revealed a statistically significant increase in strength within the treatment group after the first intervention (6.95% right, 12.61% left) as compared with the second (11.53% right, 17.02% left) and the third interventions (10.53% right, 16.81% left). No statistically significant differences were found in grip strength comparison within the sham group. Overall differences in strength were consistently significant between the study groups (P = .0025). The present study suggests that the grip strength of national level judo athletes receiving chiropractic SMT improved compared to those receiving sham.
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WFC 2011 AWARD WINNING PAPER
EFFECT OF CERVICAL SPINE MANIPULATIVE THERAPY ON
JUDO ATHLETES'GRIP STRENGTH
Marcelo B. Botelho, DC,
a
and Bruno B. Andrade, MD, PhD
b
ABSTRACT
Objective: The objective of this study was to perform an investigation evaluating if cervical spinal manipulative
therapy (SMT) can increase grip strength on judo athletes in a top 10 national-ranked team.
Methods: A single-blinded, prospective, comparative, pilot, randomized, clinical trial was performed with 18 athletes
of both sexes from a judo team currently competing on a national level. The athletes were randomly assigned to 2
groups: chiropractic SMT and sham. Three interventions were performed on each of the athletes at different time
points. Force measurements were obtained by a hydraulic dynamometer immediately before and after each
intervention at the same period before training up to 3 weeks with at least 36 hours between interventions.
Results: Analysis of grip strength data revealed a statistically significant increase in strength within the treatment
group after the first intervention (6.95% right, 12.61% left) as compared with the second (11.53% right, 17.02% left)
and the third interventions (10.53% right, 16.81% left). No statistically significant differences were found in grip
strength comparison within the sham group. Overall differences in strength were consistently significant between the
study groups (P= .0025).
Conclusion: The present study suggests that the grip strength of national level judo athletes receiving chiropractic
SMT improved compared to those receiving sham. (J Manipulative Physiol Ther 2012;35:38-44)
Key Indexing Terms: Martial Arts; Manipulation, Spinal; Chiropractic; Athletic Performance
The competitive and dynamic atmosphere of profes-
sional sports generates a wide field in which new
therapeutic techniques have a great potential for
growth and development once their efficacy is showed to
optimize sports performance.
1
Complementary/alternative
and traditional medicine (CAM/TM) usage among athletes
has been poorly studied, and recent investigations have
been focused on the prevalence of their use and other
descriptive approaches.
1-3
In a Hawaiian university, 56% of
athletes had reported the use of 1 or more types of CAM/
TM. The 2 major types of CAM/TM used in this setting
seem to be massage (prevalence of 38%) and chiropractic
(prevalence of 29%).
2
When wide-ranging populations are considered, the
usage of CAM/TM has increased in the last decade in
various countries.
4
The chiropractic profession is consid-
ered as one of the most important CAM/TM professions,
with use rates in the general population ranging from 6% to
12%, with spinal manipulative therapy (SMT) as its most
commonly used therapeutic approach.
5,6
Spinal manipula-
tive therapy is considered an effective and safe therapy for
musculoskeletal disorders
7
with significant results in both
short and long term.
8-14
It is consisted of a specific high-
velocity, low-amplitude application of force beyond the end
of passive range of motion and inside the zone known as
paraphysiological space.
5
Several studies have evaluated
adverse effects and potential severe outcomes from
SMT, and the results indicate that SMT is comparatively
a safe procedure when performed with patients without
contraindications.
4,15-19
Spinal manipulative therapy generates neuromuscular
reflex responses in a surface electromyography in patients
with low back pain,
22
increases quadriceps' strength after
manipulation of the ipsilateral sacroiliac joint,
23
and causes
temporary excitatory inhibition of lumbar and cervical
motoneurons.
26
Spinal manipulative therapy has influenced
a significant reduction of tumor necrosis factor αand
a
Chiropractor, Private Practice, Salvador, BA/Brazil.
b
Clinical Research Fellow, National Institutes of Health,
Bethesda, MD.
Submit requests for reprints to: Marcelo B. Botelho, DC, Av
Oceanica, 3731, Rio Vermelho, Salvador, BA, CEP:41950-000,
Brazil (e-mail: Quiropraxia@hotmail.com).
Paper submitted April 20, 2011; in revised form July 1, 2011;
accepted July 14, 2011.
0161-4754/$36.00
Copyright © 2012 by National University of Health Sciences.
doi:10.1016/j.jmpt.2011.09.005
38
interleukin 1β(proinflammatory cytokines) production when
compared with placebo and other control groups
24
and has
also induced a significant reduction of pain and hyperalgesia
in an experimental study with SMT instrument-assisted
(Activator Methods International, Ltd, Phoenix, Arizona)
performed in rats.
25
In the current study, the hypothesis that
cervical SMT would increase grip strength when performed
in national level judo athletes was tested.
The United States has officially used chiropractic care in
the Olympic Games since 1980.
1
The Brazilian Olympic
Committee has been using sports chiropractic care since
2000 in their major competitions such as the Olympics and
Pan American Games. During the 2007 Pan American
Games in Rio de Janeiro, 209 chiropractic-based treatments
were performed for 95 athletes within a total of 660
Brazilian competitors (14.40%). At the 1995 All African
Games, 1135 athletes were treated by doctors of chiroprac-
tic within 6000 athletes, with a total of 1957 chiropractic
treatments being performed. Most of the treatments were
performed on track and field athletes (38%) followed by
fighting sports (14.7%).
20
Another study revealed that 77%
of the coaches from the American National Football League
refer athletes to chiropractic care, and 31% of the teams
officially have a chiropractor as part of their medical team.
1
Thus, there is a precedence for inclusion of chiropractic care
for high-performance athletes.
Judo is an intense martial art sport that can potentially
cause injuries that may result in loss of strength, which is
detrimental to sports performance. A recent study analyzing
3 consecutive judo championships revealed an increase of
13.5% in the incidence of injuries, with no differences
between sex or weight categories of the athletes. The most
common location in men were at the fingers, whereas the
shoulders were more commonly associated with injury
among women.
21
These findings suggest that judo may be a
sport in which the impact of chiropractic therapies on the
athletic performance can be tested.
Spinal manipulative therapy is growing in sports
treatment, and when performed by a highly trained
professional,
4
it can serve as a useful therapeutic option
for the treatment of joint biomechanical dysfunctions,
especially of the spine.
22-25
However, this technique has
primarily been used with therapeutic aims, and little is
known if it can be used as a potential sports perform-
ance enhancer.
Therefore, this study evaluated the effects of chiropractic
cervical SMT
4,5
on grip force among Brazilian judo
athletes who were competing on a national level.
METHODS
Trial Design
A pilot clinical trial, with balanced randomization (1:1),
single blind, and placebo controlled, was performed to test
the influence of SMT on grip strength of judo athletes of a
top 10 national-ranked judo team.
Subjects
Brazilian athletes from a national competing level judo
team volunteered to the study. This group includes athletes
from both sexes with a 5-day training program per week. The
group was approached, and the athletes were interviewed to
verify inclusion and exclusion criteria. Eighteen individuals
were recruited (72% of the total invited). The participants
were randomly assigned into 2 groups of 9 subjects each, with
group 1 receiving SMT and with group 2 getting sham
procedures. The study was registered under the International
Standard Randomised Controlled Trials Number (ISRCTN)
38228413. The study was approved by the ethics committee
of the Faculdade de Tecnologia e Ciências, Salvador, Brazil
(register no. 904). All participants or their legal guardians
signed informed consent before enrollment in the study.
Inclusion and Exclusion Criteria
The inclusion criteria were age ranging from 15 to 30
years, regular attendance to training and competing sessions
for at least 4 days a week, never receiving chiropractic care,
possessing no prior knowledge of chiropractic procedures,
and no change of medical or physical routine because of the
addition of the new procedures.
The exclusion criteria were spine anomalies, such as
hypoplasia or instability of the odontoid process; acute
fracture or infections; cancer; local hematoma; signs of
progressive neurologic deficit; Arnold-Chiari malforma-
tion; vertebral dislocation; signs of meningeal irritation; and
signs of joint instability.
4,15,16
Study Design and Setting
The study took place at the team training facilities in
Salvador, BA/Brazil in June 2009. All athletes answered a
survey before the randomization and then were randomly
assigned following simple randomization procedures (flip
of a coin) to 2 groups. The subjects allocated in the group 1
(n = 9) were treated with standard chiropractic cervical
diversified technique SMT, and group 2 (n = 9) had
received a standardized sham intervention.
Spinal manipulative therapy intervention consisted of
static and motion cervical joints analysis, with the patient
lying supine, and areas of motion restriction received
specific contact high-velocity, low-amplitude manipulation
consisting of standard chiropractic diversified techniques to
the cervical spine.
Sham intervention was performed using the head piece
drop mechanism of a Thuli Table (Thuli Tables Inc,
Dodgeville, WI). This procedure consisted of having the
patient lying prone, and the drop mechanism was performed
3 to 5 consecutive times, having the contact force of the
39
Botelho and AndradeJournal of Manipulative and Physiological Therapeutics
Judo Athlete's Grip StrengthVolume 35, Number 1
chiropractor applied directed to the head piece and not
contacting the subject neck.
The study evaluated grip strength variations after 3 SMT
interventions or sham procedures. Data were analyzed for
SMT effect when comparing strength baseline values and
after interventions within the same group (treatment or
sham intervention) and also between groups.
Three interventions were performed in each group in a
maximum time frame of 3 weeks with a minimum interval
of 36 hours between sessions. Both groups had also received
in a similar way the same amount of time expended in each
intervention including patient education regarding the
treatment and its potential side effects. The same chiroprac-
tor performed all interventions on all athletes for both the
treatment and sham groups. The chiropractic practitioner
was experienced, having a bachelor's degree in chiropractic
with at least 3 years of clinical practice.
4
A trained
technician performed the strength measurements without
knowing which group each subject was assigned.
Strength measurement was done in both groups before
and at least 20 seconds after each intervention using a
JAMAR 5030J1 hydraulic dynamometer (Sammons Preston
Inc, Bolingbrook, IL).
26
Data were taken in a more natural
position for judo demands, with the subject standing, arms
close to the trunk, 90° of elbow flexion, and internal rotation
of 45° of the wrist and hand. Athletes were then asked to
have a maximum isometric grip contraction, 1 side each
time, for 3 consecutive times, with a 20-second interval
between measurements.
26
For analysis purpose, the arith-
metic mean of all 3 measurements was taken.
Data were recorded in differently colored files for
before- or after-intervention measurements in kilograms/
force. Discrepancy between measurements higher than 3
dynamometer measurement units (that represents 2 kg each
or 6 kg on total) was considered invalid, and all 3 strength
data were collected again. Measurements that had been
higher than 1 dynamometer measurement unit (2 kg)
without reaching the next unit were considered as the value
of the exceeded one. The very same procedure was also
performed in the superior limb of the opposite side.
All interventions and measurements were performed
before training sessions between 14:30 and 16:00 hours,
with the purpose of minimizing training lesions interference
and the hormone effects of the circadian cycle and its
potential effects on athletes muscle strength.
27
Subjects
were asked to not comment among them what were the
characteristics of the procedure they were submitted to.
Statistical Analysis
Data analysis was performed with GraphPad Prism
software 5.0 (GraphPad Inc, La Jolla, CA). For baseline
questionnaires' analysis, Fisher exact test was used, and no
significant differences were founded between groups,
showing adequation of the randomization process allowing
both groups to have similar characteristics.
Despite the small sample size, the data distribution re-
garding the strength measurements among groups displayed
Gaussian distribution (Lilliefors test), and paired ttest was
chosen for strength variations statistical analysis. We also
compared percentile measurements variations between
groups, as displayed in Tables 4 and 5, which had also
displayed Gaussian distribution, and paired ttest was used
with Welch test correction (Table 6).
RESULTS
Survey data analysis revealed that randomization
process was successful, and both groups ended up having
subjects with the same characteristics. Male sex was
observed in 55.5% (n = 5) of the sham group (group 2)
and in 44.4% (n = 4) of the SMT group (group 1). Other
important variables were age, judo experience, chiropractic
previous knowledge, current level of tournament dispute,
and actual and previous pain episodes (summarized in
Table 1), with no statistical significant differences between
groups (Fisher exact test). None of the athletes in both
groups had been previously submitted to chiropractic care.
A total of 55 cervical biomechanical adjustments were
performed using SMT of the 27 interventions in the 9
athletes from group 1. More commonly affected joints were
C1 and C2 (n = 27), representing 49.09% of total
adjustments, with 7.27% of C3 and C4 (n = 4), 25.45%
of C5 and C6 (n = 14), 12.72% of C6 and C7 (n = 7), and
5.45% of C7 to T1. No adjustments were performed at the
C2 and C3 and C4 and C5 joints. Two side-effect episodes
at SMT group (group 1) was recorded: a mild neck pain and
a mild headache were reported after 3 to 6 hours after
adjustments lasting less than 12 hours each. There was no
Table 1. Baseline characteristics of the study subjects
Variable
Sham
(n = 9)
SMT
(n = 9) Pvalue,
Fisher
exact testf (%) f (%)
Male sex 5 55.5 4 44.4 1.00
Age, y .33
15-20 4 44.5 7 77.8
N20 5 55.5 2 22.2
Judo experience, y 1.00
0-10 5 55.5 5 55.5
N10 4 44.5 4 44.5
Previous chiropractic knowledge 1.00
Yes 2 22.2 1 11.1
No 7 77.8 8 88.9
Currently disputed tournament level 1.00
National 9 100 8 88.9
International 0 0 1 11.1
Actual pain episode 1.00
Yes 9 100 9 100
No 0 0 0 0
No. of previous pain episodes .33
0-3 7 77.8 4 44.5
N3 2 22.2 5 55.5
40 Journal of Manipulative and Physiological TherapeuticsBotelho and Andrade
January 2012Judo Athlete's Grip Strength
report of side effects on group 2 (sham intervention).
Strength measurement data from both groups were recorded
on Tables 2 and 3.
Analysis of the SMT group revealed a statistically
significant increase of grip strength in both hands after the
first intervention (mean increase of 6.95% at the right hand
and 12.61% on the left one). Significant differences were also
found when baseline (before first intervention) was compared
with strength data registered after the second and third
interventions, revealing a final increase 10.53% on the right
side and 16.82% on the left hand after the third intervention.
No significant statistical differences were founded when
comparing strength measurements immediately before and
after the second and third interventions (Table 4).
Group 2 (sham intervention) data analysis revealed no
statistically significant differences among grip strength
measurements in all interventions and when they were
combined (Table 5).
Table 3. Strength measurements for the sham intervention group in kilograms/force
PRE 1R PRE 1L PRE 2R PRE 2L PRE 3R PRE 3L POST 1R POST 1L POST 2R POST 2L POST 3R POST 3L
1 28.7 29.3 27.3 31.3 27.3 32.7 29.3 34.0 30.7 32.0 31.3 32.7
2 30.0 26.0 23.3 26.0 26.7 28.7 31.3 28.7 22.0 24.0 28.7 29.3
3 50.0 48.7 45.3 47.3 51.3 49.3 51.3 52.0 48.7 46.0 50.7 48.7
4 43.3 43.3 56.7 48.7 47.3 44.0 44.7 40.0 54.7 44.7 52.7 44.0
5 45.3 49.3 48.0 48.0 46.7 50.7 48.7 48.7 48.0 50.0 49.3 50.0
6 56.7 54.7 54.0 52.0 62.7 58.0 58.0 54.7 58.0 56.7 61.3 55.3
7 26.7 21.3 28.7 27.3 28.0 28.7 26.0 24.0 28.0 28.0 28.0 27.3
8 22.0 23.3 23.3 24.7 22.0 22.7 23.3 24.7 23.3 24.0 22.7 21.3
9 48.0 42.0 59.3 50.7 50.0 48.0 46.0 35.3 54.7 47.3 46.0 44.0
Mean 39.0 37.6 40.7 39.6 40.2 40.3 39.8 38.0 40.9 39.2 41.2 39.2
SD 12.3 12.6 14.9 11.8 14.3 12.3 12.5 11.6 14.7 12.3 13.6 11.8
There was no significant discrepancy between strength measurements from different arms before and after each intervention (paired ttest).
L, left; R, right; PRE, pre intervention; POST, post intervention.
Table 2. Strength measurements for SMT group in kilograms/force
PRE 1R PRE 1L PRE 2R PRE 2L PRE 3R PRE 3L POST 1R POST 1L POST 2R POST 2L POST 3R POST 3L
1 32.0 32.7 31.3 33.3 39.3 36.7 32.7 35.3 41.3 40.7 42.7 39.3
2 26.7 28.7 28.0 30.7 293 26.7 29.3 29.3 30.7 30.0 28.7 26.0
3 24.7 22.7 23.3 21.3 25.3 25.3 28.0 26.0 25.3 24.7 28.0 27.3
4 40.0 40.7 48.0 50.7 36.0 43.3 44.7 51.3 49.3 53.3 42.7 46.0
5 46.0 43.3 55.3 50.0 52.7 52.7 47.3 45.3 52.7 47.3 58.7 54.7
6 30.7 29.3 29.3 31.3 35.3 34.7 34.7 32.0 32.0 34.0 32.7 34.0
7 34.0 30.7 32.0 31.3 34.0 32.0 33.3 31.3 33.3 34.0 32.7 33.3
8 52.0 43.3 55.3 50.0 60.7 57.3 55.3 48.7 56.7 55.3 57.3 56.0
9 49.3 46.0 50.7 53.3 49.3 50.7 53.3 58.0 52.7 52.0 47.3 54.0
Mean 37.3 35.3 39.3 39.1 40.2 39.9 39.8 39.7 41.6 41.3 41.2 41.2
SD 10.0 8.2 12.8 11.8 11.6 11.6 10.4 11.3 11.6 11.2 11.6 11.9
There was no significant discrepancy between strength measurements from different arms before and after each intervention (paired ttest).
L, left; R, right; PRE, pre intervention; POST, post intervention.
Table 4. Strength comparisons immediately before and after interventions in the SMT group
Intervention
Mean Before and after mean
difference (%) PPrior mean kg/force Post mean kg/force
First intervention R 37.256 39.847 6.954 .002
First intervention L 35.254 39.701 12.614 .013
Second intervention R 39.256 41.551 5.846 .070
Second intervention L 39.107 41.256 5.495 .079
Third intervention R 40.218 41.180 2.391 .468
Third intervention L 39.921 41.183 3.161 .058
First × second intervention R 37.256 41.551 11.528 .007
First × second intervention L 35.254 41.256 17.025 .002
First × third intervention R 37.256 41.180 10.532 .047
First × third intervention L 35.254 41.183 16.817 .005
Data were compared using paired ttest.
L, left; R, right.
41Botelho and AndradeJournal of Manipulative and Physiological Therapeutics
Judo Athlete's Grip StrengthVolume 35, Number 1
Furthermore, a graphic analysis was performed, on Figures
1and2, to compare grip strength variation between SMT
group (group 1) and sham (group 2). A consistent increase in
these values can be observed in group 1 when compared with
group 2, and 2 strength reductions can be registered at the left
hand after the second and third interventions in group 2. These
nonstatistically significant results found were not observed in
anystrengthdatarecordedingroup1.
A greater increase on the grip strength at the left hand was
observed when compared with the right one among subjects
who received SMT (group 1) in all measurements, except for
the second one, which had similar end points. This
difference was compared and revealed to be nonsignificant
(P= .6777). When discrepancies were analyzed between the
left and right hand on group 2 (sham), a greater strength
increase at the right hand in all interventions measurements
was found. All variations observed between hand sides in
both groups were not statistically significant, which means
that they occurred by chance.
Percentile measurements variations between groups, as
described in Tables 4 and 5, were also analyzed according
to Table 6, revealing a Pvalue of .0025.
DISCUSSION
Both nonprofessional and high-performance sports
involve a high demand for athletic performance enhance-
ment. A better athletic performance can be achieved by
shortening recovery time and lesion incidence and by
improving specific athletic function. This peculiar charac-
teristic impulses a high demand for quality research
focusing on performance enhancement.
1,5
There are few studies that evaluate the effects of SMT in
athletes, and we could not find similar studies performed
within judo athletes in the literature. The present study adds
important insights to the field, pointing the SMT as a
promising approach to enhance grip strength in judo athletes.
The statistically significant increase in the grip strength
observed in both hands on group 1 might be due to the
already-observed SMT effects in inducing vertebral motion
with concomitant spine nerve root responses and increase
in muscle strength.
28,23
In our study, the primary in-
volved nerves targeted using the SMT approach are
Table 5. Strength comparisons immediately before and after in athletes receiving sham therapy
Intervention
Mean Before and after mean
difference (%) PPrior mean kg/force Post mean kg/force
First intervention R 38.960 39.848 2.279 .111
First intervention L 37.552 37.996 1.182 .720
Second intervention R 40.663 40.885 0.545 .822
Second intervention L 39.552 39.183 0.932 .694
Third intervention R 40.218 41.181 2.394 .344
Third intervention L 40.292 39.182 2.754 .051
First × second intervention R 38.960 40.885 4.940 .304
First × second intervention L 37.552 39.183 4.343 .146
First × third intervention R 38.960 41.181 5.700 .091
First × third intervention L 37.552 39.182 4.340 .070
Data were compared using paired ttest.
L, left; R, right.
Fig 1. Percentage of strength variation after each intervention.
Data represent the percentage of strength variation after each
intervention for both arms of the athletes.
Fig 2. Spinal manipulative therapy optimizes grip strength in judo
athletes. Data represent the percentage of strength variation after
each intervention compared with baseline (prefirst intervention)
for both arms of the athletes.
42 Journal of Manipulative and Physiological TherapeuticsBotelho and Andrade
January 2012Judo Athlete's Grip Strength
musculocutaneous (cervical roots C5, C6, and C7), which
innervates biceps muscle; median (C5, C6, and C7 roots),
which innervates forearm anterior muscles and thumb short
muscles; and ulnar nerve (C8 and T1), which supplies ulnar
carpal flexor, the ulnar half of the deep finger flexors,
thumb adductor, and the deep part of its short flexor.
29
Other previously related SMT effects include quadriceps
strength increase,
23
neuromuscular reflex response in surface
electromyography,
22
lumbar and cervical motoneuron tem-
porary inhibition,
26
and modulation of proinflammatory
cytokines (tumor necrosis factor αand interleukin 1β).
24
An important positive aspect concerns the chosen
methodological rigidity to obtain strength measurements
using only 1 dynamometer, always performed immediately
before and after each intervention and before training
sessions in the same period and in a small time frame of 3
weeks. We believe that this had a positive influence in
minimizing effects of the circadian cycle hormonal
influence and possible microtrauma and tissue fatigue due
to training and competition.
27
Another favorable point on
sample uniformity is the regular daily training basis of the
team and the high level of athlete competition (national) of
all the study subjects.
Limitations
Potential limitations of present study include the small
sample size, great difference among interventions character-
istics, athlete communication regarding applied procedures,
and its potential interference on placebo effect. On the other
hand, none of the subjects had been previously treated by
chiropractic, and knowing that 77.8% of all individuals of the
sham group (group 2) and 88.9% of the treatment group
(group 1) had never heard the term chiropractic makes it
unlikely to infer that they knew what type of procedure they
were being subjected to (sham or treatment) and its potential
negative influence over the placebo effect.
Another aspect when dealing with high-performance
teams is the constant pressure and demand on the health
care personal for a quickly return to play and urgent
implementation of any potential performance enhancer to
all athletes. The way we have found to be beneficial in
dealing with this outward pressure and properly conduct a
randomized clinical trial is to do it in a small limited time (3
weeks) and letting the team understand the importance of
studies such as that for future greater sports development.
Other potential limitation appears when the athletes
change their usual training and treatment routine because of
the addition of new procedures. That can lead to study bias
and outcome changes. We have stated to all team members
to not change their routine, as the purpose was to add
additional interventions and not to replace them. As far as
we could observe, the athlete routine was kept similar
before, after, and at the end of the study.
Future Studies
The findings of this study add important insights to the
sports performance field because it shows a marked grip
strength increase in elite judo athletes after being submitted
to cervical SMT. It can be translated as a potential marked
performance enhancer once grip strength is a vital aspect of
judo combats.
In that way, it is important to do similar studies in
larger judo athlete samples and in other high-performance
level athletes of different sports, trying to observe if
SMT can also have a positive influence on performance in
other modalities.
CONCLUSIONS
The present study tested the effect of chiropractic SMT
on elite judo athletes' grip strength and found a significant
increase in grip strength for those submitted to the SMT
compared with those getting sham interventions. In
addition, subjects in the SMT group had achieved
significant and progressive enhancement of the grip
strength with the first, second, and third interventions.
Future studies are encouraged to validate our results in
larger samples of high-performance athletes.
FUNDING SOURCES AND POTENTIAL CONFLICTS OF INTEREST
No funding sources or conflicts of interest were reported
for this study.
Table 6. Percentile variation comparisons between groups as
described in Tables 4 and 5
Before and after interventions
difference, SMT group (%)
Before and after interventions
difference, sham group (%)
6.95 2.28
12.61 1.18
5.85 0.55
5.50 0.93
2.39 2.39
3.16 2.75
11.53 4.94
17.03 4.34
10.53 5.70
16.82 4.34
Mean percentile differences were compared between the groups using
paired ttest with Welch correction, P= .0025.
Practical Applications
This study showed that cervical SMT increased
elite judo athletes' grip strength.
This study suggests that chiropractic SMT may
affect athletic performance.
43
Botelho and AndradeJournal of Manipulative and Physiological Therapeutics
Judo Athlete's Grip StrengthVolume 35, Number 1
REFERENCES
1. Stump JL, Redwood D. The use and role of sport chiropractors
in the National Football League: a short report. J Manipulative
Physiol Ther 2002;25:1-4.
2. Nichols AW, Harrigan R. Complementary and alternative
medicine usage by intercollegiate athletes. Clin J Sport Med
2006;16:232-7.
3. Kazemi M, Sherer H. Chiropractic utilization in Taekwondo
athletes. J Can Chiropr Assoc 2008;52:96-102.
4. Al Bedah A, Amigoni M, Caizzi, et al. Diretrizes da OMS
sobre a formação básica e a segurança em Quiropraxia.
Genebra: Organizacao Mundial de Saude/Feevale; 2006.
5. Chapman-smith D. Quiropraxia uma profissão na área da
saúde. Anhembi Morumbi: São Paulo; 2001.
6. Lawrence DJ, Meeker WC. Chiropractic and CAM utilization:
a descriptive review. Chirop and Ostopa 2007;15:2.
7. Bigos S, Bower O, Braen G, et al. Acute low back problems in
adults. Clinical practice guideline, number 14. Rockeville,
MD: US department of Health and Human Services, Public
Health Service, Agency for Helth Care Policy and Research;
1994 [AHCPR Publication No. 95-0642].
8. Wilkey A, Gregory M, Byfield D, McCarthy PW. A
comparison between chiropractic management and pain clinic
management for chronic low-back pain in a national health
service outpatient clinic. J Altern Complement Med 2008;14:
465-73.
9. Santilli V, Beghi E, Finucci S. Chiropractic manipulation in
the treatment of acute back pain and sciatica with disc
protusion: a randomized double-blind clinical trial of active
and simulated spinal manipulations. Spine J 2006;6:131-7.
10. Hoiriis KT, Pfleger B, McDuffie FC, et al. A randomized
clinical trial comparing chiropractic adjustments to muscle
relaxants for subacute low back pain. J Manipulative Physiol
Ther 2004;27:388-98.
11. Giles LG, Muller R. Chronic spinal pain: a randomized
clinical trial comparing medication, acupuncture, and spinal
manipulation. Spine 2003;28:1490-502.
12. Giles LG, Muller R. Chronic spinal pain syndromes: a clinical
pilot trial comparing acupuncture, a nonsteroidal anti-
inflammatory drug, and spinal manipulation. J Manipulative
Physiol Ther 1999;22:376-81.
13. Meade TW, Dyer S, Browne W, et al. Low back pain of
mechanical origin: randomized comparison of chiropractic
and hospital outpatient treatment. J Orthop Sports Phys Ther
1991;13:278-87.
14. Hurwitz EL, Morgenstern H, Harber P, Kominski GF, Belin
TR, Yu F, et al; University of California-Los Angeles. A
randomized clinical trial of medical care with and without
physical therapy and chiropractic care with and without
physical modalities for patients with low back pain: 6-month
follow-up outcomes from the UCLA low back pain study.
Spine 2002;27:2193-204.
15. Rubinstein SM, Leboeuf-Yde C, Koekkoek TE, et al.
Predictors of adverse events following chiropractic care for
patients with neck pain. J Manipulative Physiol Ther 2008;31:
94-103.
16. Rubinstein SM, Peerdeman SM, Van Tulder MW, et al. A
systematic review of the risk factors for cervical artery
dissection. Stroke 2005;36:1575-80.
17. Haldeman S, Kohlbeck FJ, McGregor M. Stroke, cerebral
artery dissection, and cervical spine manipulation therapy.
J neurol 2002;249:1098-104.
18. Carstensen M. Letters to the editor. J Manipulative Physiol
Ther 2004;27:69-70.
19. Rothwell PM, Norris JW. Cerebrovascular complications of
therapeutic neck manipulation the need for reliable data on
risks and risks factors. J Neurol 2002;249:1105-6.
20. Nook BC, Nook DD. Demographics of athletes and support
personnel who used chiropractic physicians at the 6th all
African games. J Sports Chirop Rehabil 1997;11:136-9.
21. Green CM, Petrou MJ, Fogarty-Hover ML, Rolf CG. Injuries
among judokas during competition. Scand J Med Sci Sports
2007;17:205-10.
22. Colloca CJ, Keller TS. Electromyographic reflex responses to
mechanical force, manually assisted spinal manipulative
therapy. Spine 2001;26:1117-24.
23. Hillerman B, Gomes AN, Korporaal C, et al. A pilot study
comparing the effects of spinal manipulative therapy with
those of extra-spinal manipulative therapy on quadriceps
muscle strength. J Manipulative Physiol Ther 2006;29:145-9.
24. Teodorczyk-Injeyan JA, Injeyan S, Ruegg R. Spinal manip-
ulative therapy reduces inflammatory cytokines but not
substance P production in normal subjects. J Manipulative
Physiol Ther 2006;26:14-21.
25. Song X, Gan Q, Cao J, et al. Spinal manipulation reduces pain
and hyperalgesia after lumbar intervertebral foramen inflam-
mation in the rat. J Manipulative Physiol Ther 2006;29:5-13.
26. Dishman JD, Burke J. Spinal reflex excitability changes after
cervical and lumbar spinal manipulation: a comparative study.
Spine J 2003;3:204-12.
27. Sedliak M, Finni T, Cheng S, et al. Diurnal variation in
maximal and submaximal strength, power and neural
activation of leg extensors in men: multiple sampling across
two consecutive days. Intern J Sports Med 2008;29:217-24.
28. Colloca CJ, Keller TS, Gunzburg R. Biomechanical and
neurophysiological responses to spinal manipulation in
patients with lumbar radiculopathy. J Manipulative Physiol
Ther 2004;27:1-15.
29. Netter FH. Atlas de anatomia humana. 2nd ed. Artmed:
Porto Alegre; 2000.
44 Journal of Manipulative and Physiological TherapeuticsBotelho and Andrade
January 2012Judo Athlete's Grip Strength
... The ability of spinal adjustments or spinal manipulation to alter corticomotor excitability is supported by multiple studies that have shown changes in force output or background muscle activity following single or repeated sessions of spinal adjustments or manipulations (see Table 1) (Christiansen et al. 2018;Haavik et al. 2016aHaavik et al. , b, 2018aNiazi et al. 2015Niazi et al. , 2020Dunning and Rushton 2009;Cleland et al. 2004;Holt et al. 2019;Botelho and Andrade 2012;Hillermann et al. 2006;Vining et al. 2020;Keller and Colloca 2000;Humphries et al. 2013;Grindstaff et al. 2009;Fernandez-Carnero et al. 2008;Galindez-Ibarbengoetxea et al. 2017;Lo et al. 2019). As mentioned earlier (and highlighted in Table 1) the various authors of these publications may or may not have used the terminology 'central segmental motor control (CSMC) problems' to describe any dysfunctional spinal segments. ...
... Studies that found no change in outcome measures have been highlighted in grey. EMG electromyography, HVLA high-velocity low-amplitude thrust, CSMC problems central segmental motor control problems single session of spinal adjustments of CSMC problems has also been shown to alter handgrip strength measured using a hydraulic hand dynamometer (Botelho and Andrade 2012). This significant increase in handgrip strength was found in a group of judo athletes (Botelho and Andrade 2012). ...
... EMG electromyography, HVLA high-velocity low-amplitude thrust, CSMC problems central segmental motor control problems single session of spinal adjustments of CSMC problems has also been shown to alter handgrip strength measured using a hydraulic hand dynamometer (Botelho and Andrade 2012). This significant increase in handgrip strength was found in a group of judo athletes (Botelho and Andrade 2012). In people with mechanical neck pain, hand grip strength on the contralateral side to adjustment was noted after an instrument-assisted adjustment combined with stretching (Gorrell et al. 2016). ...
Article
Full-text available
Purpose There is growing evidence that vertebral column function and dysfunction play a vital role in neuromuscular control. This invited review summarises the evidence about how vertebral column dysfunction, known as a central segmental motor control (CSMC) problem, alters neuromuscular function and how spinal adjustments (high-velocity, low-amplitude or HVLA thrusts directed at a CSMC problem) and spinal manipulation (HVLA thrusts directed at segments of the vertebral column that may not have clinical indicators of a CSMC problem) alters neuromuscular function. Methods The current review elucidates the peripheral mechanisms by which CSMC problems, the spinal adjustment or spinal manipulation alter the afferent input from the paravertebral tissues. It summarises the contemporary model that provides a biologically plausible explanation for CSMC problems, the manipulable spinal lesion. This review also summarises the contemporary, biologically plausible understanding about how spinal adjustments enable more efficient production of muscular force. The evidence showing how spinal dysfunction, spinal manipulation and spinal adjustments alter central multimodal integration and motor control centres will be covered in a second invited review. Results Many studies have shown spinal adjustments increase voluntary force and prevent fatigue, which mainly occurs due to altered supraspinal excitability and multimodal integration. The literature suggests physical injury, pain, inflammation, and acute or chronic physiological or psychological stress can alter the vertebral column’s central neural motor control, leading to a CSMC problem. The many gaps in the literature have been identified, along with suggestions for future studies. Conclusion Spinal adjustments of CSMC problems impact motor control in a variety of ways. These include increasing muscle force and preventing fatigue. These changes in neuromuscular function most likely occur due to changes in supraspinal excitability. The current contemporary model of the CSMC problem, and our understanding of the mechanisms of spinal adjustments, provide a biologically plausible explanation for how the vertebral column’s central neural motor control can dysfunction, can lead to a self-perpetuating central segmental motor control problem, and how HVLA spinal adjustments can improve neuromuscular function.
... The rapidly evolving professional sports sector creates a wide field in which new therapeutic techniques have great potential for growth and development, provided their effectiveness on sports performance has been proven. [1] In western medicine, there has been a specialization of general practitioners in sports in recent years. ...
... Literature research resulted in 8 articles on the subject ofit 3 systematic reviews [5 -7] and 5 randomized clinical trials [1, 8 -10]. One study was withdrawn [1]. Four studies were finally used to analyse the topic [1, 8 -10] (see Figure 1 in the Appendix). ...
... Four evaluable RCT studies were available to evaluate the topic of chiropractic in sports. One study on performance enhancement [1,2] on injury and rehabilitation [8,9] and another study on evaluation of performance reduction through jetlag or jetlag improvement [10] through chiropractic treatment. In the area of performance improvement by increasing the grip strength in judo athletes [1] as well as in injuries and rehabilitation measures [8,9], the results could be significantly improved by the use of chiropractic treatments. ...
Article
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Background: Since 1980, chiropractic has been used at the Olympic Games to accompany the USA's top athletes therapeutically. The rapidly developing professional sports sector offers great scope for new therapeutic support for athletes in the areas of prevention, performance improvement, injury treatment and medical rehabilitation. The aim of this systematic review is to analyse the latest scientific findings, which can be evaluated on the basis of existing clinical controlled studies. The present article deals with the question: How efficient is the use of chiropractic in sports in the above-mentioned areas? Methods: The research is carried out in the PubMed database. The evidence level of the individual studies is determined using the PEDro scale. The studies with evidence class I are evaluated in tabular form according to the PICO model. Endpoints assessed are grip strength in judo athletes, ankle injuries, medical rehabilitation with recurrent ankle sprains, jet lag symptoms. Results: The literature review include 232 researched articles 8 on the subject, including 3 systematic reviews and 5 randomized clinical trials, of which 4 include evaluable results. Overall, in 3 studies, outcomes in the intervention group for performance enhancement, injury treatment and medical rehabilitation are significantly improved by the use of chiropractic care. The jet lag treatment show no differences compared to the control group. Conclusion: In 3 out of 4 studies, there are significant improvements with the use of chiropractic in therapy. Thus, it can be concluded, that the use of chiropractic in sports can improve performance and reduce injury times in medical rehabilitation. Chiropractic in sports is therefore quite efficient.
... Several of the neurophysiological effects of SMT that have been demonstrated in studies could theoretically in uence sports performance. These include changes in surface electromyographic activity [18,19], corticospinal [20][21][22] and spinal cord [22][23][24] excitability, muscle strength [7,25,26], muscle inhibition [27,28], expression of proin ammatory cytokines [29], pain sensation [30][31][32][33][34][35][36][37][38], and prevention of muscle fatigue [39]. ...
... Further, there are studies which have demonstrated that SMT' may in uence and improve aspects of sports performance. These aspects include increased full-swing for golfers [40], increased judoka grip strength [25], and increased ball kicking speed for soccer players [41]. However there are few studies in this eld, and there is a lack of data regarding the in uence of SMT on sports performance from laboratory studies, eld tests, or real events. ...
... A similar placebo intervention has been used in a previous study. [25] Outcomes The outcome tests (30-meter sprint run with a 10-meter split, and the COD test) were performed after a standard and simultaneous warm-up by all subjects, and immediately prior to the interventions and after approximately 3 hours. The subjects were placed in a line and consecutively performed the tests using the same track line and measurement devices. ...
Preprint
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Background Asymptomatic spinal biomechanical alterations may generate impaired central nervous system proprioceptive input, and motor control, and central processing deficits, which could impair sports performance. Several of the demonstrated neurophysiological effects of spinal manipulative therapy (SMT) could theoretically influence sports performance. Further, some studies have demonstrated that SMT' may improve aspects of sports performance. These include improved full-swing in golfers, judoka grip strength, taekwondo muscle strength, and ball kicking speed in soccer. The purpose of this study was to assess the effect on the performance of elite athletes of one session of SMT to correct asymptomatic, biomechanical dysfunction, using professional soccer players and sprint and change of direction (COD) tests. Also, the proposed placebo intervention was tested for efficacy in achieving blinding. Methods A parallel-randomized, controlled, clinical trial was performed with 20 elite soccer players who were randomly assigned to one of two groups by a coin flip: one receiving SMT (n=10) and the other a placebo intervention (n=10). All players were from the same team, and were injury free and naive to SMT. Data were collected at the team training facility. Measured outcome tests (30-meter sprint run with a 10-meter split and COD test) were performed at the same time by all subjects immediately prior to and after interventions. Photocell devices were used for data acquisition. Participants and those assessing outcomes were blinded to group assignment. Care givers were not able to be blinded. Results 20 participants were analyzed, 10 in each group. There were no changes to the sprint (10m and 30m) and COD test results immediately following either of the interventions. All subjects (SMT and placebo) answered YES to a question after the intervention asking if they were treated by SMT. No adverse events were reported. Conclusion Spinal manipulative therapy to correct asymptomatic, biomechanical dysfunction in the spine and pelvis did not have any immediate effect on the performance of elite soccer players as measured by 10- and 30-meters sprint times and COD sprint times. Additionally, the proposed placebo strategy was successful in blinding these athletes. Trial registration ISRCTN29691307. Retrospectively registered in 07/02/2018. http://www.isrctn.com/ISRCTN29691307.
... This increase in lower extremity muscle activation may be exploited to improve exercise capacity, function, and sports performance. Spinal manipulation has been shown to increase running speed, grip strength, golf ball driving distance, and increased ball velocity while kicking a soccer ball [20][21][22][23]; however, the performance-related outcome of spinal manipulation can be debated [24]. The effectiveness of joint manipulation may be related to non-specific effects, such as placebo effects. ...
... Chiropractors and athletes report the benefit of pre-competition spinal manipulation (SM) on performance, regardless of their clinical presentation or pain status (4). Studies investigating the effects of SM on performance outcomes have previously reported small effect sizes in running and cycling sprint times, grip strength, free throw accuracy, golf ball driving distance, and hip flexor flexibility (6,11,24,28,30). Although these changes were not statistically significant, small sample sizes and unresponsive outcome measures may limit the detectable changes. ...
Article
Corso, M, Liang, L, Tran, S, Howitt, S, Srbely, J, and Mior, SA. The immediate effect of spinal manipulation on ball velocity and neuromuscular function during an instep kick in former Varsity soccer players: a feasibility study. J Strength Cond Res XX(X): 000-000, 2020-Spinal manipulation (SM) has been shown to increase ball velocity (BV) in soccer players. Evidence suggests that SM modulates responses at spinal or cortical levels to enhance force production in asymptomatic populations. No studies have explored the underlying neuromuscular mechanisms contributing to changes in BV post-SM in soccer players. We assessed the feasibility of measuring change in BV and neuromuscular function after SM in former Varsity level soccer players with a pre-post study design. Three to 5 maximal instep kicks were performed before and after SM at the L3-5 level. Ball velocity was measured using high-speed camera. Activation of lower limb and trunk musculature was recorded with electromyography. Outcomes included ease of recruitment, scheduling and data capture, as well as expectation and perception of SM effect and adverse events (AE). Fifteen potential subjects were recruited over 1.5 months. Eleven were scheduled (24-31 years; 8 females, 3 males). Two subjects reported mild AE after maximal voluntary isometric contraction testing. A significant increase in BV (mean change: 1.75 m·s [95% confidence interval: 0.5-3.0]) and a trend to increased peak-activation of knee extensors (90.7%) were observed post-SM. Findings suggest that our recruitment strategy and methodology are feasible in a larger trial with some modifications. Our preliminary findings support previous research by suggesting that increased BV may be mediated through increased activation of knee extensors during the kick. Our findings may offer additional insight into the underlying neuromuscular mechanisms contributing to immediate change in BV post-SM.
Article
Objective The purpose of this study was to assess the feasibility of the procedures’ routine, the recruiting rate, the presence of any significant detrimental impact on the players’ training routine, and the sham efficacy in achieving blinding. Methods A parallel randomized controlled clinical trial was performed with 20 elite soccer players who were randomly assigned to 1 of 2 groups: spinal manipulative therapy (SMT) and sham SMT. All players were from the same team, were injury free, and were naive to SMT. Measured outcome tests (30-m sprint run with a 10-m split and change of direction [COD] test) were performed at the same time by all participants immediately before and after interventions. Photocell devices were used for data acquisition. Results Twenty participants were analyzed (10 in each group). There were no changes to the sprint (10 m and 30 m) and COD test results immediately after either of the interventions. All participants in both groups (SMT and sham SMT) answered “yes” to a question after the intervention asking if they were treated by SMT. No adverse effects or training routine impairment were reported. Conclusion This pilot study protocol showed it was an appropriate design for a confirmatory clinical trial. The study had minimal effect on the team training routine, and the recruitment rate was excellent. The proposed sham SMT strategy was successful in blinding the players. In this sample, SMT did not have any immediate effect on the performance of these elite soccer players, as measured by 10- and 30-m sprint times and COD sprint times.
Article
Introduction The most frequent injuries in professional soccer players are those pertinent to the lower limbs. In particular, strains of the hamstrings and ligamentous injuries of the knee. Therefore, preventive measures are aimed to reduce such events. We aimed to investigate if an osteopathic manipulative treatment (OMT) of the pivots could improve lower limb function in young professional football players. Methods Thirty-eight young male professional football players were recruited (mean age 17.8 ± 0.44 years). These were randomly assigned to an OMT or control group (n = 20 and 18, respectively). Both groups underwent osteopathic evaluation. A sit-and-reach test, a vertical jump test, a hand-grip strength test, a cervical ROM test and a balance evaluation were also performed. Results A significant improvement (p < 0.01) was observed between pre and post measures in the OMT for dysfunctional assessment of the pivots. However, only L3 and C2 also differed from the control group post evaluation (p < 0.0001). No differences were present for any functional measure in the control group. Only the sit-&-reach of the OMT increased significantly (p < 0.001). Static balance with open eyes in the OMT, but not in the control group, improved during post evaluation (p < 0.01). Conclusion The OMT of the pivots was able to increase the sit-and-reach measure, improve postural control with open eyes and improve dysfunctional patterns of the lumbosacral and upper cervical spine in young professional football players.
Conference Paper
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INVESTIGATION OF THE EFFICACY OF CHIROPRACTIC MANIPULATION THERAPY IN SPORTS PERFORMANCE
Article
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Reprinted with permission from the British Medical Journal 300:1431-1437.1990. Objective - To compare chiropractic and hospital outpatient treatment for managing low back pain of mechanical origin.Design - Randomized controlled trial. Allocation to chiropractic or hospital management by minimization to establish groups for analysis of results according to initial referral clinic, length of current episode, history, and severity of back pain. Patients were followed up for up to two years.Setting - Chiropractic and hospital outpatient clinics in 11 centers.Patients - 741 patients aged 18-65 who had no contraindications to manipulation and who had not been treated within the past month.Interventions - Treatment at the discretion of the chiropractors, who used chiropractic manipulation in most patients, or of the hospital staff, who most commonly used Maitland mobilization or manipulation, or both.Main outcome measures - Changes in the score on the Oswestry pain disability questionnaire and in the results of tests of straight leg raising and lumbar flexion.Results - Chiropractic treatment was more effective than hospital outpatient management, mainly for patients with chronic or severe back pain. A benefit of about 7 percent points on the Oswestry scale was seen at two years. The benefit of chiropractic treatment became more evident throughout the follow-up period. Secondary outcome measures also showed that chiropractic was more beneficial.Conclusions - For patients with low back pain in whom manipulation is not contraindicated, chiropractic almost certainly confers worthwhile, long-term benefit in comparison with hospital outpatient management. The benefit is seen mainly in those with chronic or severe pain. Introducing chiropractic into NHS practice should be considered.J Orthop Sports Phys Ther 1991;13(6):278-287.
Article
Full-text available
To compare chiropractic and hospital outpatient treatment for managing low back pain of mechanical origin. Randomised controlled trial. Allocation to chiropractic or hospital management by minimisation to establish groups for analysis of results according to initial referral clinic, length of current episode, history, and severity of back pain. Patients were followed up for up two years. Chiropractic and hospital outpatient clinics in 11 centres. 741 Patients aged 18-65 who had no contraindications to manipulation and who had not been treated within the past month. Treatment at the discretion of the chiropractors, who used chiropractic manipulation in most patients, or of the hospital staff, who most commonly used Maitland mobilisation or manipulation, or both. Changes in the score on the Oswestry pain disability questionnaire and in the results of tests of straight leg raising and lumbar flexion. Chiropractic treatment was more effective than hospital outpatient management, mainly for patients with chronic or severe back pain. A benefit of about 7% points on the Oswestry scale was seen at two years. The benefit of chiropractic treatment became more evident throughout the follow up period. Secondary outcome measures also showed that chiropractic was more beneficial. For patients with low back pain in whom manipulation is not contraindicated chiropractic almost certainly confers worthwhile, long term benefit in comparison with hospital outpatient management. The benefit is seen mainly in those with chronic or severe pain. Introducing chiropractic into NHS practice should be considered.
Article
Demographic statistics were collected at the international sporting event the 6th All African Games in Harare, Zimbabwe, September 12-23, 1992. The Federation International de Chiropractique Sportive (FICS) sent 30 volunteer chiropractors from 6 different nations to treat the athletes and support personnel present at these games. Treatment data was collected that demonstrated 1957 treatments in the 10 days of competition. Patients were seem from 47 of the 48 nations present at the games. The data show which countries and sports made use of the chiropractic physician. This information demonstrates the need for chiropractic physicians at such national and international events. We will discuss how this information can be used to promote the use of sports chiropractic at sporting events.
Article
1. I examine several of them in an article entitled "A Reply to Dwight Ingle" in The Mankind Quarterly, IV, 1, July-September, 1963.
Article
To compare needle acupuncture, medication (tenoxicam with ranitidine), and spinal manipulation for managing chronic (>13 weeks duration) spinal pain syndromes. Prospective, randomized, independently assessed preintervention and postintervention clinical pilot trial. Specialized spinal pain syndrome out-patient unit at Townsville General Hospital, Queensland, Australia. Seventy-seven patients (without contraindication to manipulation or medication) were recruited. One of three separate, clearly defined intervention protocols: needle acupuncture, nonsteroidal anti-inflammatory medication, or chiropractic spinal manipulation. Main outcome measures were changes (4 weeks vs. initial visit) in the scores of the (1) Oswestry Back Pain Disability Index, (2) Neck Disability Index, and (3) three visual analogue scales of local pain intensity. Randomization was successful. After a median intervention period of 30 days, spinal manipulation was the only intervention that achieved statistically significant improvements (all expressed as percentages of the original scores) with (1) a reduction of 30.7% on the Oswestry scale, (2) an improvement of 25% on the neck disability index, and (3) reductions on the visual analogue scale of 50% for low back pain, 46% for upper back pain, and 33% for neck pain (all P<.001). Neither of the other interventions showed any significant improvement on any of the outcome measures. The consistency of the results provides, in spite of several discussed shortcomings of this pilot study, evidence that in patients with chronic spinal pain syndromes spinal manipulation, if not contraindicated, results in greater improvement than acupuncture and medicine.
Article
Surface electromyographic reflex responses associated with mechanical force, manually assisted (MFMA) spinal manipulative therapy were analyzed in this prospective clinical investigation of 20 consecutive patients with low back pain. To characterize and determine the magnitude of electromyographic reflex responses in human paraspinal muscles during high loading rate mechanical force, manually assisted spinal manipulative therapy of the thoracolumbar spine and sacroiliac joints. Spinal manipulative therapy has been investigated for its effectiveness in the treatment of patients with low back pain, but its physiologic mechanisms are not well understood. Noteworthy is the fact that spinal manipulative therapy has been demonstrated to produce consistent reflex responses in the back musculature; however, no study has examined the extent of reflex responses in patients with low back pain. Twenty patients (10 male and 10 female, mean age 43.0 years) underwent standard physical examination on presentation to an outpatient chiropractic clinic. After repeated isometric trunk extension strength tests, short duration (<5 msec), localized posteroanterior manipulative thrusts were delivered to the sacroiliac joints, and L5, L4, L2, T12, and T8 spinous processes and transverse processes. Surface, linear-enveloped electromyographic (sEMG) recordings were obtained from electrodes located bilaterally over the L5 and L3 erector spinae musculature. Force-time and sEMG time histories were recorded simultaneously to quantify the association between spinal manipulative therapy mechanical and electromyographic response. A total of 1600 sEMG recordings were analyzed from 20 spinal manipulative therapy treatments, and comparisons were made between segmental level, segmental contact point (spinous vs. transverse processes), and magnitude of the reflex response (peak-peak [p-p] ratio and relative mean sEMG). Positive sEMG responses were defined as >2.5 p-p baseline sEMG output (>3.5% relative mean sEMG output). SEMG threshold was further assessed for correlation of patient self-reported pain and disability. Consistent, but relatively localized, reflex responses occurred in response to the localized, brief duration MFMA thrusts delivered to the thoracolumbar spine and SI joints. The time to peak tension (sEMG magnitude) ranged from 50 to 200 msec, and the reflex response times ranged from 2 to 4 msec, the latter consistent with intraspinal conduction times. Overall, the 20 treatments produced systematic and significantly different L5 and L3 sEMG responses, particularly for thrusts delivered to the lumbosacral spine. Thrusts applied over the transverse processes produced more positive sEMG responses (25.4%) in comparison with thrusts applied over the spinous processes (20.6%). Left side thrusts and right side thrusts over the transverse processes elicited positive contralateral L5 and L3 sEMG responses. When the data were examined across both treatment level and electrode site (L5 or L3, L or R), 95% of patients showed positive sEMG response to MFMA thrusts. Patients with frequent to constant low back pain symptoms tended to have a more marked sEMG response in comparison with patients with occasional to intermittent low back pain. This is the first study demonstrating neuromuscular reflex responses associated with MFMA spinal manipulative therapy in patients with low back pain. Noteworthy was the finding that such mechanical stimulation of both the paraspinal musculature (transverse processes) and spinous processes produced consistent, generally localized sEMG responses. Identification of neuromuscular characteristics, together with a comprehensive assessment of patient clinical status, may provide for clarification of the significance of spinal manipulative therapy in eliciting putative conservative therapeutic benefits in patients with pain of musculoskeletal origin.
Article
To analyze chiropractic utilization on National Football League (NFL) medical teams and the role played by chiropractors. Postal survey of head athletic trainers of the 36 teams. Survey questions were developed from responses to a questionnaire submitted to a pilot group of 30 sport chiropractors and a panel of 20 postdoctoral faculty of the sport chiropractic program of the American Chiropractic Board of Sport Physicians, as well as a representative from the University of South Alabama. Twenty-two of 36 questionnaires were returned for a return rate of 66%. Of the trainers who did respond, 45% have personally been treated by a chiropractor, and 55% have not. Seventy-seven percent of the trainers have referred to a chiropractor for evaluation or treatment, and 23% have not. Thirty-one percent of NFL teams use a chiropractor in an official capacity on their staffs, and 69% do not. When asked to identify conditions appropriate for referral to a chiropractor, the respondents identified low back pain (61%), "stingers" and "burners" usually associated with neck injury (31%), headaches (8%), asthma or other visceral disorders (0%). All respondents (100%) agree that some players use chiropractic care without referral from team medical staff. There is significant chiropractic participation in US professional football. Certified athletic trainers see a role for the sport chiropractor in the NFL, primarily as a spinal specialist treating low back and other musculoskeletal injuries. A substantial majority of NFL trainers have developed cooperative relationships with chiropractors, with 77% having referred a player to a chiropractor. Thirty-one percent of NFL teams have a chiropractor officially on staff, and an additional 12% of teams refer players to chiropractors but do not directly retain these chiropractors.