Chiropractic Research

Auckland, New Zealand

The role of spinal manipulation

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The role of spinal manipulation in addressing disordered sensorimotor integration and altered motor control

Heidi Haavik, Bernadette Murphy

Abstract: This review provides an overview of some of the growing body of research on the effects of spinal manipulation on sensory processing, motor output, functional performance and sensorimotor integration. It describes a body of work using somatosensory evoked potentials (SEPs), transcranial magnetic nerve stimulation, and electromyographic techniques to demonstrate neurophysiological changes following spinal manipulation. This work contributes to the understanding of how an initial episode(s) of back or neck pain may lead to ongoing changes in input from the spine which over time lead to altered sensorimotor integration of input from the spine and limbs.

The effects of manual therapy on balance and falls

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The effects of manual therapy on balance and falls: a systematic review

Kelly R. Holt, BSc (Chiro), PGDipHSc, Heidi Haavik, BSc (Chiro), PhD, and C. Raina Elley, MBChB, PhD

Objective: The purpose of this study was to review the scientific literature on the effects of manual therapy interventions on falls and balance.

Methods: This systematic review included randomized and quasi-randomized controlled trials that investigated the effects of manual therapy interventions on falls or balance. Outcomes of interest were rate of falls, number of fallers reported, and measures of postural stability. Data sources included searches through June 2011 of Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, MEDLINE, EMBASE, CINAHL, PsycINFO, Allied and Complimentary Medicine, Current Controlled Trials, Manual Alternative and Natural Therapy Index System, Index to the Chiropractic Literature, National Institutes of Health (USA), and Google Scholar.

Results: Eleven trials were identified that met the inclusion criteria. Most trials had poor to fair methodological quality. All included trials reported outcomes of functional balance tests or tests that used a computerized balance platform. Nine of the 11 trials reported some statistically significant improvements relating to balance after an intervention that included a manual therapy component. The ability to draw conclusions from a number of the studies was limited by poor methodological quality or very low participant numbers. A meta-analysis was not performed due to heterogeneity of interventions and outcomes. Only 2 small trials included falls as an outcome measure, but as a feasibility study and a pilot study, no meaningful conclusions could be drawn about the effects of the intervention on falls.

Conclusion: A limited amount of research has been published that supports a role for manual therapy in improving postural stability and balance. More well-designed controlled trials with sufficient participant numbers are required to draw meaningful clinical conclusions about the role that manual therapies may play in preventing falls or improving postural stability and balance. (J Manipulative Physiol Ther 2012;35:227-234)

Fall risk profile

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Fall risk profile and quality-of-life status of older chiropractic patients

Kelly R. Holt, BSc (Chiro), PGDipHSc, Paul L. Noone, B.App.Sci (Chiro), PhD, Krystal Short, B.N RcpN,C. Raina Elley, MBChB, PhD, and Heidi Haavik, BSc (Chiro), PhD

Objectives: The primary aim of this study was to estimate the prevalence of fall risk factors in older chiropractic patients. The secondary aim was to investigate the quality-of-life status of older chiropractic patients and to see whether a history of falling was related to quality-of-life status.

Methods: A cross-sectional study was conducted at 12 chiropractic practices throughout Auckland, New Zealand, and Melbourne, Australia. The study involved gaining a profile of health status, fall history, and fall risk from active chiropractic patients who were 65 years or older.

Results:One hundred ten older chiropractic patients were approached, and 101 agreed to participate in this study (response rate, 91.8%). Thirty-five percent of participants had experienced at least 1 fall in the previous 12 months. Of those that had fallen, 80% had at least a minor injury, with 37% of fallers requiring medical attention and 6% suffering a serious injury. The prevalence of most fall risk factors was consistent with published data for communitydwelling older adults. Quality of life of older chiropractic patients appeared to be good, but fallers reported a lower physical component summary score compared with nonfallers (P = .04).

Conclusions: A portion of the older chiropractic patients sampled in this study had a substantial risk of falling. This risk could be assessed on a regular basis for the presence of modifiable fall risk

Subclinical neck pain

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Subclinical neck pain and the effects of cervical manipulation on elbow joint position sense

Heidi Haavik, PhD, BSc (Chiro), and Bernadette Murphy, PhD

Objective: The objectives of this study were to investigate whether elbow joint position sense (JPS) accuracy differs between participants with a history of subclinical neck pain (SCNP) and those with no neck complaints and to determine whether adjusting dysfunctional cervical segments in the SCNP group improves their JPS accuracy.

Method: Twenty-five SCNP participants and 18 control participants took part in this pre-post experimental study. Elbow JPS was measured using an electrogoniometer (MLTS700, ADInstruments, New Zealand). Participants reproduced a previously presented angle of the elbow joint with their neck in 4 positions: neutral, flexion, rotation, and combined flexion/rotation. The experimental intervention was high-velocity, low-amplitude cervical adjustments, and the control intervention was a 5-minute rest period. Group JPS data were compared, and it was assessed pre and post interventions using 3 parameters: absolute, constant, and variable errors.

Results: At baseline, the control group was significantly better at reproducing the elbow target angle. The SCNP group’s absolute error significantly improved after the cervical adjustments when the participants’ heads were in the neutral and left-rotation positions. They displayed a significant overall decrease in variable error after the cervical adjustments. The control group participants’ JPS accuracy was worse after the control intervention, with a significant overall effect in absolute and variable errors. No other significant effects were detected.

Conclusion: These results suggest that asymptomatic people with a history of SCNP have reduced elbow JPS accuracy compared to those with no history of any neck complaints. Furthermore, the results suggest that adjusting dysfunctional cervical segments in people with SCNP can improve their upper limb JPS accuracy. (J Manipulative Physiol Ther 2011;34:88-97)

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