This is a """"""""proof of concept"""""""" study evaluating the mechanism of action of lumbar spinal manipulation. A fundamental hypothesis of chiropractic is that adhesions develop in the zygapophysial joints (Z joints) following hypomobility of these structures. Such adhesions are thought to be alleviated by separation (gapping) of the Z joints. Side posture adjusting is thought by many to gap the Z joints, yet no measurable differences of the Z joints before and after spinal manipulation have ever been published. The purpose of this study is to determine if differences can be measured in the L3-S1 Z joint spaces before and during side posture positioning of the lumbar region and also before and after lumbar side posture spinal adjusting. More specifically, this study will evaluate gapping of the L3/L4, L4/L5, and L5/S1 Z joints by taking measurements directly from MRI scans of the Z joints before and during positioning for a side posture adjustment and before and after side posture adjusting. To begin this study, healthy volunteers (32 female and 32 male) will be solicited. The volunteers will then be randomized into one of four groups: 1) neutral position followed by side posture positioning (trunk rotated to the subject's right), 2) neutral position followed by side posture spinal adjusting followed by neutral positioning, 3) neutral position followed by side posture spinal adjusting followed by side posture positioning, and 4) neutral position followed by neutral position (control group). MRI scans will be taken with the subjects in the original neutral position and in the final position (either second neutral position or side posture positioning). The experiments for each subject will be conducted over approximately a forty-five minute period. Three independent observers will be trained to make measurements of the Z joints directly from the MRI scans. The measurements will evaluate the anterior-to-posterior dimensions (gap) between the superior and inferior articular facets. The observers will not have access to the results of one another, and the MRI scans will be coded so that the observers will have no subject information and no indication as to whether any scan is pre- or post-treatment. The data will be analyzed to determine if differences exist between the before and during side posture positioning scans, the pre- and post manipulation scans, and the control group. The results of this 'proof of concept"""""""" study will be used to increase understanding of the mechanism of action of the lumbar side posture adjustment. If the results of this trial demonstrate gapping of the Z joints following manipulation, the next logical step would be the design and implementation of larger clinical trials using these same methods to evaluate the effects of side posture adjusting on the Z joints of subjects with acute and then chronic low back pain.

Agency
National Institute of Health (NIH)
Institute
National Center for Complementary & Alternative Medicine (NCCAM)
Type
Research Project (R01)
Project #
5R01AT000123-02
Application #
6375410
Study Section
Geriatrics and Rehabilitation Medicine (GRM)
Program Officer
Goertz, Christine Marie
Project Start
2000-06-05
Project End
2003-03-31
Budget Start
2001-04-01
Budget End
2003-03-31
Support Year
2
Fiscal Year
2001
Total Cost
$47,165
Indirect Cost
Name
National University of Health Sciences
Department
Administration
Type
Other Domestic Higher Education
DUNS #
068607589
City
Lombard
State
IL
Country
United States
Zip Code
60148
Cramer, Gregory D; Budavich, Matthew; Bora, Preetam et al. (2017) A Feasibility Study to Assess Vibration and Sound From Zygapophyseal Joints During Motion Before and After Spinal Manipulation. J Manipulative Physiol Ther 40:187-200
Little, Joshua W; Grieve, Thomas J; Cramer, Gregory D et al. (2015) Grading Osteoarthritic Changes of the Zygapophyseal Joints from Radiographs: A Reliability Study. J Manipulative Physiol Ther 38:344-51
Cramer, Gregory D; Cambron, Jerrilyn; Cantu, Joe A et al. (2013) Magnetic resonance imaging zygapophyseal joint space changes (gapping) in low back pain patients following spinal manipulation and side-posture positioning: a randomized controlled mechanisms trial with blinding. J Manipulative Physiol Ther 36:203-17
Cramer, Gregory D; Ross, Kim; Raju, P K et al. (2012) Quantification of cavitation and gapping of lumbar zygapophyseal joints during spinal manipulative therapy. J Manipulative Physiol Ther 35:614-21
Cramer, Gregory D; Ross, Kim; Pocius, Judith et al. (2011) Evaluating the relationship among cavitation, zygapophyseal joint gapping, and spinal manipulation: an exploratory case series. J Manipulative Physiol Ther 34:2-14
Cramer, Gregory D; Ross, J Kim; Raju, P K et al. (2011) Distribution of cavitations as identified with accelerometry during lumbar spinal manipulation. J Manipulative Physiol Ther 34:572-83
Cramer, Gregory D; Cantu, Joe A; Pocius, Judith D et al. (2010) Reliability of zygapophysial joint space measurements made from magnetic resonance imaging scans of acute low back pain subjects: comparison of 2 statistical methods. J Manipulative Physiol Ther 33:220-5
Cramer, Gregory D; Gregerson, Douglas M; Knudsen, J Todd et al. (2002) The effects of side-posture positioning and spinal adjusting on the lumbar Z joints: a randomized controlled trial with sixty-four subjects. Spine (Phila Pa 1976) 27:2459-66