PROVIDED.Spinal manipulation is a popular and widely used CAM treatment for back pain. It has been shown to beeffective in a preponderance of clinical trials, but the reasons why manipulation works are unknown. Thelong-term goal for this study is to understand the physiological mechanisms of various forms of spinalmanipulation in order to refine and improve this therapy for appropriately selected patients. Back painpatients demonstrate deficiencies in sensorimotor function. These may be related to the effects thatmanipulation appears to have on neurophysiology. Hence, the objective of this study is to assess the effectsof high-velocity low-amplitude spinal manipulation(HVLA-SM) and low-velocity variable amplitude spinalmanipulation (LVVA-SM) on three types of sensorimotor abilities in patients with low back pain. Incollaboration with the University of Iowa, the Palmer Center for Chiropractic Research will pursue thefollowing Specific Aims: 1) To determine the immediate pre-to-post changes from HVLA-SM and LVVA-SM,compared to a no-treatment control, on sensorimotor function as measured by: lumbo-pelvic repositioningability, standing postural sway, and response to sudden trunk loading; 2) To determine the effects of 2 weeks(4 applications @ 2 per week) of HVLA-SM and LVVA-SM, compared to a no-treatment control, onsensorimotor function as measured by: lumbo-pelvic repositioning ability, standing postural sway, andresponse to sudden trunk loading; 3) To determine the effects of 6 weeks (12 applications @ 2 per week) ofHVLA-SM and LVVA-SM on sensorimotor function as measured by: lumbo-pelvic repositioning ability,standing postural sway, and response to sudden trunk loading; 4) To explore whether changes insensorimotor function are associated with changes in self-reported back pain intensity, related disability, orhealth status at 2 weeks (after 4 SM Visits) and at 6 weeks (after 12 SM Visits); and 5) To determine ifsensorimotor function changes are greater in patients clinically classified as being most appropriate formanipulation. If spinal manipulation is demontrated to improve the sensorimotor functions of back painpatients and correlate with improvements in clinical symptoms and related disability, it will further define theappropriate clinical role of this CAM treatment, potentially enhance understanding about the etiology of backpain, and lead to improved treatment for a costly and common public health problem.
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