Document Type : Original Article

Authors

1 School of Rehabilitation Sciences, Department of Physical Therapy, Iran University of Medical Sciences, Tehran, Iran

2 School of Public Health, Department of Kinesiology, Indiana University, Bloomington, United State of America

Abstract

Background: Lumbar motion analysis is used as a clinical method in the diagnosis and treatment of low back pain (LBP). So far, no studies have shown if manipulating the sacroiliac joint (SIJ) will change spinal kinematics.
Objective: The main objectives of this study were to investigate the effects of SIJ manipulation on the lumbar kinematics in subjects with innominate rotation and to compare lumbar kinematics among experiment and control groups.
Material and Methods: This study was a quasi-experiment-control trial study. 21 LBP patients with anterior or posterior innominate rotations in experiment group and 22 asymptomatic subjects in control group were evaluated. Lumbar kinematic variables (LKV) include lumbar range of motion (ROM) and speed, lumbar lateral flexion and rotation asymmetry were evaluated using Qualysis Track Manager (QTM) twice within two days in control group, and these parameters with pelvic asymmetry and disability were tested before and after intervention in the experiment group.
Results: While pre-intervention experiment group exhibited significantly lower lumbar lateral flexion (p=0.0001), rotation (p=0.008) ROM and lower lateral flexion speed (p=0.014), post-intervention experiment group exhibited significantly lower lumbar lateral flexion (p=0.01) ROM in comparison with control group. Pelvic asymmetry (p=0.049) and disability (p=0.01) significantly decreased in the experiment group after manipulation, but LKV did not change significantly after the intervention (p˃0.05).
Conclusion: Experiment groups had different lumbar kinematics in comparison with control group before and after SIJ manipulation. Despite the changes in pelvic asymmetry and disability, intervention had no effect on lumbar kinematics.

Keywords

  1. Danneels LA, Cools AM, Vanderstraeten GG, Cambier DC, Witvrouw EE, Bourgois J, et al. The effects of three different training modalities on the cross-sectional area of the paravertebral muscles. Scand J Med Sci Sports. 2001;11:335-41. doi.org/10.1034/j.1600-0838.2001.110604.x. PubMed PMID: 11782265.
  2. George SZ, Childs JD, Teyhen DS, Wu SS, Wright AC, Dugan JL, et al. Rationale, design, and protocol for the prevention of low back pain in the military (POLM) trial (NCT00373009). BMC Musculoskelet Disord. 2007;8:92. doi.org/10.1186/1471-2474-8-92. PubMed PMID: 17868436. PubMed PMCID: 2034557.
  3. Koumantakis GA, Watson PJ, Oldham JA. Trunk muscle stabilization training plus general exercise versus general exercise only: randomized controlled trial of patients with recurrent low back pain. Phys Ther. 2005;85:209-25. PubMed PMID: 15733046.
  4. Al-Eisa E, Egan D, Deluzio K, Wassersug R. Effects of pelvic skeletal asymmetry on trunk movement: three-dimensional analysis in healthy individuals versus patients with mechanical low back pain. Spine (Phila Pa 1976). 2006;31:E71-9. doi.org/10.1097/01.brs.0000197665.93559.04. PubMed PMID: 16449891.
  5. Gomez TT. Symmetry of lumbar rotation and lateral flexion range of motion and isometric strength in subjects with and without low back pain. J Orthop Sports Phys Ther. 1994;19:42-8. doi.org/10.2519/jospt.1994.19.1.42. PubMed PMID: 8156063.
  6. Haas M, Peterson D. A roentgenological evaluation of the relationship between segmental motion and malalignment in lateral bending. J Manipulative Physiol Ther. 1992;15:350-60. PubMed PMID: 1431618.
  7. Mellin G, Harkapaa K, Hurri H. Asymmetry of lumbar lateral flexion and treatment outcome in chronic low-back pain patients. J Spinal Disord. 1995;8:15-9. doi.org/10.1097/00002517-199502000-00003. PubMed PMID: 7711365.
  8. Tenhula JA, Rose SJ, Delitto A. Association between direction of lateral lumbar shift, movement tests, and side of symptoms in patients with low back pain syndrome. Phys Ther. 1990;70:480-6. doi.org/10.1093/ptj/70.8.480. PubMed PMID: 2142784.
  9. Weitz EM. The lateral bending sign. Spine (Phila Pa 1976). 1981;6:388-97. doi.org/10.1097/00007632-198107000-00010. PubMed PMID: 7280828.
  10. Mannion A, Troke M. A comparison of two motion analysis devices used in the measurement of lumbar spinal mobility. Clin Biomech (Bristol, Avon). 1999;14:612-9. doi.org/10.1016/S0268-0033(99)00017-0. PubMed PMID: 10521644.
  11. Intolo P, Milosavljevic S, Baxter DG, Carman AB, Pal P, Munn J. The effect of age on lumbar range of motion: a systematic review. Man Ther. 2009;14:596-604. doi.org/10.1016/j.math.2009.08.006. PubMed PMID: 19729332.
  12. Hidalgo B, Gilliaux M, Poncin W, Detrembleur C. Reliability and validity of a kinematic spine model during active trunk movement in healthy subjects and patients with chronic non-specific low back pain. J Rehabil Med. 2012;44:756-63. doi.org/10.2340/16501977-1015. PubMed PMID: 22847223.
  13. Delitto A, George SZ, Van Dillen LR, Whitman JM, Sowa G, Shekelle P, et al. Low back pain. J Orthop Sports Phys Ther. 2012;42:A1-57. doi.org/10.2519/jospt.2012.42.4.A1. PubMed PMID: 22466247. PubMed PMCID: 4893951.
  14. Chou R, Qaseem A, Snow V, Casey D, Cross JT, Jr., Shekelle P, et al. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med. 2007;147:478-91. doi.org/10.7326/0003-4819-147-7-200710020-00006. PubMed PMID: 17909209.
  15. Childs JD, Piva SR, Erhard RE. Immediate improvements in side-to-side weight bearing and iliac crest symmetry after manipulation in patients with low back pain. J Manipulative Physiol Ther. 2004;27:306-13. doi.org/10.1016/j.jmpt.2004.04.004. PubMed PMID: 15195038.
  16. Lehman GJ, McGill SM. Spinal manipulation causes variable spine kinematic and trunk muscle electromyographic responses. Clin Biomech (Bristol, Avon). 2001;16:293-9. doi.org/10.1016/S0268-0033(00)00085-1. PubMed PMID: 11358616.
  17. Giles LG, Muller R. Chronic spinal pain: a randomized clinical trial comparing medication, acupuncture, and spinal manipulation. Spine (Phila Pa 1976). 2003;28:1490-502; discussion 502-3. doi.org/10.1097/01.BRS.0000077932.80560.02. PubMed PMID: 12865832.
  18. Evans DP, Burke MS, Lloyd KN, Roberts EE, Roberts GM. Lumbar spinal manipulation on trial. Part I--clinical assessment. Rheumatol Rehabil. 1978;17:46-53. doi: 10.1097/01.BRS.0000077932.80560.02. PubMed PMID: 12865832.
  19. Stamos-Papastamos N, Petty NJ, Williams JM. Changes in bending stiffness and lumbar spine range of movement following lumbar mobilization and manipulation. J Manipulative Physiol Ther. 2011;34:46-53. doi.org/10.1016/j.jmpt.2010.11.006. PubMed PMID: 21237407.
  20. Millan M, Leboeuf-Yde C, Budgell B, Descarreaux M, Amorim MA. The effect of spinal manipulative therapy on spinal range of motion: a systematic literature review. Chiropr Man Therap. 2012;20:23. doi.org/10.1186/2045-709X-20-23. PubMed PMID: 22866816. PubMed PMCID: 3487906.
  21. Arab AM, Abdollahi I, Joghataei MT, Golafshani Z, Kazemnejad A. Inter- and intra-examiner reliability of single and composites of selected motion palpation and pain provocation tests for sacroiliac joint. Man Ther. 2009;14:213-21. doi.org/10.1016/j.math.2008.02.004. PubMed PMID: 18373938.
  22. Åström M, Gummesson C. Assessment of asymmetry in pelvic motion-An inter-and intra-examiner reliability study. The European Journal of Physiotherapy. 2014;16:76-81. doi.org/10.3109/21679169.2014.884162.
  23. Josefsson T, Nordh E, Eriksson PO. A flexible high-precision video system for digital recording of motor acts through lightweight reflex markers. Comput Methods Programs Biomed. 1996;49:119-29. doi.org/10.1016/0169-2607(96)01715-4. PubMed PMID: 8735019.
  24. Egan DA, Cole J, Twomey L. An alternative method for the measurement of pelvic skeletal asymmetry (PSA) using an asymmetry ratio (AR). Journal of Manual & Manipulative Therapy. 1999;7:11-9. doi.org/10.1179/106698199790811889.
  25. DeStefano LA. Greenman’s principles of manual medicine: Lippincott Williams & Wilkins; 2011. p. 300-389.
  26. Toussaint HM, de Winter AF, de Haas Y, de Looze MP, Van Dieen JH, Kingma I. Flexion relaxation during lifting: implications for torque production by muscle activity and tissue strain at the lumbo-sacral joint. J Biomech. 1995;28:199-210. doi.org/10.1016/0021-9290(94)00051-5. PubMed PMID: 7896862.
  27. Harsted S, Mieritz RM, Bronfort G, Hartvigsen J. Reliability and measurement error of frontal and horizontal 3D spinal motion parameters in 219 patients with chronic low back pain. Chiropr Man Therap. 2016;24:13. doi.org/10.1186/s12998-016-0092-0. PubMed PMID: 27047658. PubMed PMCID: 4819270.
  28. Poitras S, Loisel P, Prince F, Lemaire J. Disability measurement in persons with back pain: a validity study of spinal range of motion and velocity. Arch Phys Med Rehabil. 2000;81:1394-400. doi.org/10.1053/apmr.2000.9165. PubMed PMID: 11030506.
  29. Nattrass CL, Nitschke JE, Disler PB, Chou MJ, Ooi KT. Lumbar spine range of motion as a measure of physical and functional impairment: an investigation of validity. Clin Rehabil. 1999;13:211-8. doi.org/10.1177/026921559901300305. PubMed PMID: 10392648.
  30. Harvey D, Byfield D. Preliminary studies with a mechanical model for the evaluation of spinal motion palpation. Clin Biomech (Bristol, Avon). 1991;6:79-82. doi.org/10.1016/0268-0033(91)90003-9. PubMed PMID: 23915479.