The purpose of this continuation project (NIH/NCCAM # RO1 AT00123) is to use MRI to evaluate gapping of the zygapophysial (Z) joints following side-posture positioning and side-posture spinal adjusting in subjects with acute low back pain (LBP). A fundamental hypothesis of one of the beneficial effects of chiropractic spinal adjusting is that adhesions, developing in the Z joints following hypomobility of these structures, are thought to be alleviated by separation (gapping) of the Z joints through spinal adjusting. In the previous study, side-posture adjusting was found to gap the Z joints in healthy subjects.
The aim of this study is to determine if differences can be measured in the L4/L5 and L5/S1 Z joint spaces during side-posture positioning and after lumbar side-posture spinal adjusting of 112 subjects with acute LBP, and to determine if the amount of gapping is related to pain relief and improved function. Following 2 weeks of treatment, the subjects will be temporarily randomized into one of 4 MRI groups: 1) neutral positioning, followed by side-posture positioning (most painful side up); 2) neutral positioning, followed by side-posture adjusting (most painful side up), followed by neutral positioning; 3) neutral positioning, followed by side-posture adjusting (most painful side up) and remaining in side-posture; and 4) (pure control group) neutral positioning, followed by very brief side-posture positioning, followed by neutral positioning. MRI scans will be taken with the subjects in the original neutral position and in the final position. Both MRI scans will be conducted consecutively over approximately 30 minutes (12:19 minutes per scan). All spinal adjustments given during this appointment will be performed directly on the MRI gantry table after the first scan. A second MRI appointment will occur 2 weeks later after 2 weeks of treatment. At the second MRI appointment, subjects will be assigned to the MRI group opposite to the one to which they were randomized during the first MRI appointment. Three observers, blinded to each other and to subject grouping, will make anterior-to-posterior measurements (A-P gap) of the Z joints directly from the MRI scans. The gapping difference between the second and first scans of each MRI appointment will be analyzed to determine if differences exist between the 4 groups and if the amount of gapping is related to relief of pain (difference in Visual Analog Scale from initial exam to MRI appointment) and disability (difference in Bournemouth Questionnaire scores). The results of this study will be used to increase understanding of the mechanism of action of lumbar side posture adjusting and side-posture positioning in acute LBP patients.

Agency
National Institute of Health (NIH)
Institute
National Center for Complementary & Alternative Medicine (NCCAM)
Type
Research Project (R01)
Project #
5R01AT000123-04
Application #
7126734
Study Section
Special Emphasis Panel (ZRG1-MOSS-F (02))
Program Officer
Khalsa, Partap Singh
Project Start
2005-09-30
Project End
2009-08-31
Budget Start
2006-09-01
Budget End
2007-08-31
Support Year
4
Fiscal Year
2006
Total Cost
$327,405
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