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Subluxation of Joint of Lumbar SpineNCT02848456

The Effects of Spinal Manipulation on Central Nervous System Activity Measured by Reflexive Calf Muscle Recruitment

A study testing Spinal Manipulation, Max Voluntary Isometric Contraction and SM+MVIC in people with Subluxation of Joint of Lumbar Spine, run by Grant Sanders at 1 site in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

This study investigated the effects of spinal manipulation on central nervous system activity. The presence of postactivation potentiation, an increase in muscular force production following prior muscular contractions, was measured with electromyography and the muscular force production during electrically-induced… Read more about this study

Who is it for?
Ages 20 to 35 yearsHealthy volunteers can take part
Conditions the study is for
Subluxation of Joint of Lumbar Spine
What is being tested?
Spinal Manipulation, Max Voluntary Isometric Contraction and SM+MVIC
Type of treatment
Surgery or procedure
Could I receive a placebo?
No, everyone receives an active treatment
How many people
20 participants
Where
1 siteUnited States
Study dates
Aug 2014to Oct 2014
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 20 to 35 years
  • All sexes
  • Healthy volunteers accepted
  • Adult

Who may be able to join

  • At least one year of resistance training experience and current completion of at least three training sessions per week
  • Males needed to be able to back squat a minimum load of 1.5 x body weight
  • Females needed to be able to back squat 1 x body weight

Who cannot join

  • Any pain in the lower back, abdomen or legs and/or surgeries performed in these regions

Trial locations and contacts

1 site in 1 country.

United States1 site
  • College of Education, Department of Kinesiology and Health Promotion, University of Kentucky, Lexington, KY

    Lexington, Kentucky, 40506

Other trials in United States

About this study

Official title: The Effects of Spinal Manipulative Therapy on Postactivation Potentiation

This study investigated the effects of spinal manipulation on central nervous system activity. The presence of postactivation potentiation, an increase in muscular force production following prior muscular contractions, was measured with electromyography and the muscular force production during electrically-induced calf muscle reflexes. It was hypothesized that significantly greater potentiation would be stimulated by a calf muscle contraction with spinal manipulation delivered immediately beforehand than the potentiation arising from the contraction only.

Read the detailed description

A randomized, controlled, single-blind crossover study design was utilized, and the three independent variables were spinal manipulative therapy (SMT), a 10 second plantar flexion maximal voluntary isometric contraction (MVIC) or SMT immediately preceding the MVIC (SMT + MVIC). The treatment order was randomized for each of the three sessions before the tibial nerve Hmax/Mmax stimulation protocol.

Each of the four dependent variables were evoked during the tibial nerve H-reflex stimulation protocol at the conclusion of each session, and included the Hmax/Mmax ratio (%) of the gastrocnemius and soleus muscles and the isometric twitch torque occurring at Hmax and at Mmax. Hmax, the highest H-reflex amplitude, is an indication of the greatest possible reflex activation; as such, it is an estimate of the number of motor neurons a subject is capable of activating in a given state. Further increases in the stimulation intensity cause the subsequent M-wave to reach its highest amplitude, Mmax. Mmax is a compound muscle action potential (CMAP) which represents full muscle activation. Specific to the current investigation, Mmax indicated activation of the total volume of the gastrocnemius/soleus motor neuron (MN) pool.

Given that Hmax is an inference of the number of MNs being recruited, and Mmax constitutes the entire motor neuron pool, the proportion of the entire MN pool capable of being recruited can be estimated with the Hmax/Mmax ratio. The Hmax/Mmax ratio was determined by division of the EMG peak-to-peak amplitudes (mV) evoked at Hmax by the preceding Mmax EMG peak-to-peak amplitudes. Differences in each of the four dependent variables (Hmax/Mmax ratios of the gastrocnemius and soleus and the peak twitch torques evoked at Hmax and Mmax) following each treatment form of SMT, MVIC or SMT+MVIC delivered during the three data collection sessions on three separate days were determined with a two-way (treatment × time point) repeated measures ANOVA. Percent changes from baseline were also calculated for each of the dependent variables, and the same type of ANOVA was used to determine differences in the within-subjects effects of each treatment.

Being tested
Spinal Manipulation, Max Voluntary Isometric Contraction, SM+MVIC
Keywords
Manipulation, Spinal, H-Reflex, Muscle Contraction, Muscle Strength Dynamometer

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Spinal ManipulationProcedure or surgery

    Manual, side-posture, high-velocity low-amplitude spinal manipulation targeting the lower lumbar spine and sacroiliac joints

  • Max Voluntary Isometric ContractionProcedure or surgery

    A 10 second plantar flexion maximal voluntary isometric contraction

  • SM+MVICProcedure or surgery

    The spinal manipulation immediately preceding the maximal voluntary isometric contraction

Study groups in NCT02848456
Study groupRoleWhat they receive
Spinal Manipulation SMActive comparatorIn a repeated measures, crossover design, all subjects received one of three randomized treatments during three separate sessions: SM; a 10 second plantar flexion maximal voluntary isometric contraction (MVIC) or the manipulation immediately preceding the contraction (SM+MVIC).
Receives: Procedure: Spinal Manipulation
Max Voluntary Isometric Contraction MVICActive comparatorIn a repeated measures, crossover design, all subjects received one of three randomized treatments during three separate sessions: SM; a 10 second plantar flexion maximal voluntary isometric contraction (MVIC) or the manipulation immediately preceding the contraction (SM+MVIC).
Receives: Procedure: Max Voluntary Isometric Contraction
SM+MVICActive comparatorIn a repeated measures, crossover design, all subjects received one of three randomized treatments during three separate sessions: SM; a 10 second plantar flexion maximal voluntary isometric contraction (MVIC) or the manipulation immediately preceding the contraction (SM+MVIC).
Receives: Procedure: SM+MVIC

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Changes in H-reflex amplitudes of the gastrocnemius and soleus muscles compared to baseline

    Peak-to-peak EMG amplitudes (mV) at Hmax of the gastrocnemius and soleus were recorded before and immediately following the three separate treatments

    Measured: Data were collected at 17 time points during a 20-minute tibial nerve electrical stimulation protocol post-treatment: 20 seconds, 40 seconds, 1:00, 2:00, 3:00, 4:00, 5:00, 6:00, 7:00, 8:00, 9:00, 10:00, 12:00, 14:00, 16:00, 18:00 and 20:00 minutes

  2. Changes in isometric twitch torques of the gastrocnemius and soleus muscles compared to baseline

    Twitch torques (Nm) of the gastrocnemius and soleus at Mmax were recorded before and immediately following the three separate treatments

    Measured: Data were collected at 17 time points during a 20-minute tibial nerve electrical stimulation protocol post-treatment: 10 seconds, 30 seconds, 50 seconds, 1:30, 2:30, 3:30, 4:30, 5:30, 6:30, 7:30, 8:30, 9:30, 11:00, 13:00, 15:00, 17:00 and 19:00 minutes

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted28 Jul 2016 (estimated)
  2. Study startAug 2014
  3. Primary completionOct 2014
  4. Study completionOct 2014

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Basic science
Allocation
Randomised
Intervention model
Factorial
Masking
Single blind
Who is masked
Participant
Enrolment
20 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02848456
Sponsor's protocol ID
14-0507-F6A
Status last verified
Apr 2017
First submitted
13 Jul 2016
Last updated
19 Apr 2017
Results posted
No
Data monitoring committee
No
Individual data sharing
Yes: Shared data include the subjects' reflexive EMG amplitudes and peak torques of the gastrocnemius and soleus during the Hoffmann Reflex electrical stimulation protocol at the conclusion of each data collection session. These raw data are available in Appendix K of the PI's dissertation, which may be obtained at http://uknowledge.uky.edu/khp\_etds/27/

Publications

  • Hurwitz EL. Epidemiology: spinal manipulation utilization. J Electromyogr Kinesiol. 2012 Oct;22(5):648-54. doi: 10.1016/j.jelekin.2012.01.006. Epub 2012 Jan 29.

    PubMed 22289432
  • Michaleff ZA, Lin CW, Maher CG, van Tulder MW. Spinal manipulation epidemiology: systematic review of cost effectiveness studies. J Electromyogr Kinesiol. 2012 Oct;22(5):655-62. doi: 10.1016/j.jelekin.2012.02.011. Epub 2012 Mar 18.

    PubMed 22429823
  • Goertz CM, Long CR, Hondras MA, Petri R, Delgado R, Lawrence DJ, Owens EF, Meeker WC. Adding chiropractic manipulative therapy to standard medical care for patients with acute low back pain: results of a pragmatic randomized comparative effectiveness study. Spine (Phila Pa 1976). 2013 Apr 15;38(8):627-34. doi: 10.1097/BRS.0b013e31827733e7.

    PubMed 23060056
  • Goertz CM, Pohlman KA, Vining RD, Brantingham JW, Long CR. Patient-centered outcomes of high-velocity, low-amplitude spinal manipulation for low back pain: a systematic review. J Electromyogr Kinesiol. 2012 Oct;22(5):670-91. doi: 10.1016/j.jelekin.2012.03.006. Epub 2012 Apr 24.

    PubMed 22534288
  • von Heymann WJ, Schloemer P, Timm J, Muehlbauer B. Spinal high-velocity low amplitude manipulation in acute nonspecific low back pain: a double-blinded randomized controlled trial in comparison with diclofenac and placebo. Spine (Phila Pa 1976). 2013 Apr 1;38(7):540-8. doi: 10.1097/BRS.0b013e318275d09c.

    PubMed 23026869
  • Boline PD, Kassak K, Bronfort G, Nelson C, Anderson AV. Spinal manipulation vs. amitriptyline for the treatment of chronic tension-type headaches: a randomized clinical trial. J Manipulative Physiol Ther. 1995 Mar-Apr;18(3):148-54.

    PubMed 7790794
  • Nelson CF, Bronfort G, Evans R, Boline P, Goldsmith C, Anderson AV. The efficacy of spinal manipulation, amitriptyline and the combination of both therapies for the prophylaxis of migraine headache. J Manipulative Physiol Ther. 1998 Oct;21(8):511-9.

    PubMed 9798179
  • Burton AK, Tillotson KM, Cleary J. Single-blind randomised controlled trial of chemonucleolysis and manipulation in the treatment of symptomatic lumbar disc herniation. Eur Spine J. 2000 Jun;9(3):202-7. doi: 10.1007/s005869900113.

    PubMed 10905437
  • Haas M, Sharma R, Stano M. Cost-effectiveness of medical and chiropractic care for acute and chronic low back pain. J Manipulative Physiol Ther. 2005 Oct;28(8):555-63. doi: 10.1016/j.jmpt.2005.08.006.

    PubMed 16226622
  • Korthals-de Bos IB, Hoving JL, van Tulder MW, Rutten-van Molken MP, Ader HJ, de Vet HC, Koes BW, Vondeling H, Bouter LM. Cost effectiveness of physiotherapy, manual therapy, and general practitioner care for neck pain: economic evaluation alongside a randomised controlled trial. BMJ. 2003 Apr 26;326(7395):911. doi: 10.1136/bmj.326.7395.911.

    PubMed 12714472
  • Gunnar Brolinson P, McGinley SM, Kerger S. Osteopathic manipulative medicine and the athlete. Curr Sports Med Rep. 2008 Feb;7(1):49-56. doi: 10.1097/01.CSMR.0000308664.13278.a7.

    PubMed 18296946
  • Julian C, Hoskins W, Vitiello AL. Sports chiropractic management at the World Ice Hockey Championships. Chiropr Osteopat. 2010 Dec 3;18:32. doi: 10.1186/1746-1340-18-32.

    PubMed 21129212
  • Nook DD, Nook BC. A report of the 2009 World Games injury surveillance of individuals who voluntarily used the International Federation of Sports Chiropractic delegation. J Manipulative Physiol Ther. 2011 Jan;34(1):54-61. doi: 10.1016/j.jmpt.2010.11.003.

    PubMed 21237408
  • Uchacz GP. 2010 olympic winter games chiropractic: the making of history. J Can Chiropr Assoc. 2010 Mar;54(1):14-6. No abstract available.

    PubMed 20195421
  • Miners AL. Chiropractic treatment and the enhancement of sport performance: a narrative literature review. J Can Chiropr Assoc. 2010 Dec;54(4):210-21.

    PubMed 21120012

Questions about this trial

What is this clinical trial studying?

A study testing Spinal Manipulation, Max Voluntary Isometric Contraction and SM+MVIC in people with Subluxation of Joint of Lumbar Spine, run by Grant Sanders at 1 site in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 3 inclusion and 1 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 19 Apr 2017. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Changes in H-reflex amplitudes of the gastrocnemius and soleus muscles compared to baseline (time frame: Data were collected at 17 time points during a 20-minute tibial nerve electrical stimulation protocol post-treatment: 20 seconds, 40 seconds, 1:00, 2:00, 3:00, 4:00, 5:00, 6:00, 7:00, 8:00, 9:00, 10:00, 12:00, 14:00, 16:00, 18:00 and 20:00 minutes). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT02848456, which also lists 48 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 19 Apr 2017.

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