A Randomized Controlled Trial Comparing Different Sites of High-velocity Low Amplitude Thrust on Sensorimotor Integration Parameters

Increasing evidence suggests that a high-velocity, low-amplitude (HVLA) thrust directed at a dysfunctional vertebral segment in people with subclinical spinal pain alters various neurophysiological measures, including somatosensory evoked potentials (SEPs). We hypothesized that an HVLA thrust applied to a clinician chosen vertebral segment based on clinical indicators of vertebral dysfunction, in short, segment considered as “relevant” would significantly reduce the N30 amplitude compared to an HVLA thrust applied to a predetermined vertebral segment not based on clinical indicators of vertebral dysfunction or segment considered as “non-relevant”. In this double-blinded, active-controlled, parallel-design study, 96 adults with recurrent mild neck pain, ache, or stiffness were randomly allocated to receiving a single thrust directed at either a segment considered as “relevant” or a segment considered as “non-relevant” in their upper cervical spine. SEPs of median nerve stimulation were recorded before and immediately after a single HVLA application delivered using an adjusting instrument (Activator). A linear mixed model was used to assess changes in the N30 amplitude. A significant interaction between the site of thrust delivery and session was found (F_1,840 = 9.89, p < 0.002). Pairwise comparisons showed a significant immediate decrease in the N30 complex amplitude after the application of HVLA thrust to a segment considered "relevant" (- 16.76 ± 28.32%, p = 0.005). In contrast, no significant change was observed in the group that received HVLA thrust over a segment considered "non-relevant" (p = 0.757). Cervical HVLA thrust applied to the segment considered as "relevant" altered sensorimotor parameters, while cervical HVLA thrust over the segment considered as "non-relevant" did not. This finding supports the hypothesis that spinal site targeting of HVLA interventions is important when measuring neurophysiological responses. Further studies are needed to explore the potential clinical relevance of these findings.

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Keywords:   Neuroscience, Sensorimotor processing, Health care, Musculoskeletal system, Neurophysiology

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Introduction

A recent narrative review explored the effects of high-velocity, low-amplitude (HVLA) thrusts delivered to vertebral segments. [1] The article differentiated between HVLA thrusts applied to clinician chosen vertebral segment based on clinical indicators of vertebral dysfunction, in short segments considered as “relevant” vs HVLA thrusts delivered to predetermined vertebral segments not based on clinical indicators of vertebral dysfunction or segments considered as “non-relevant”. [1] Four of the eight included studies (i.e., 50%), which examined the effects of HVLA thrusts on segments considered as “non-relevant”, found a positive change in neuromuscular control measures. [1] In contrast, 14 of the 18 (i.e., 78%) of the studies which examined HVLA thrust to segment considered as “relevant” reported improvements in measures of neuromuscular control. [1] This raises the interesting question of whether the site of a HVLA thrust matters, and if so, how it might matter.

The term joint dysfunction is an umbrella term that can encompass anything from a infected joint to an arthritic join. However, for the purposes of this study the type of vertebral dysfunction we are talking about are the type of biomechanical lesions of the vertebral column that chiropractors and other manual therapists might apply their HVLA thrusts. Chiropractors do not usually randomly apply HVLA thrust at a segment of the spine. Usually, they will assess the spine for areas of the spine characterized by tight vertebral muscles, reduced intervertebral movement and tenderness to touch. [2] This type of joint dysfunction is often referred to as a vertebral subluxation in chiropractic profession. [3–6] Vertebral subluxation is a term recognised as biomechanical lesions of the vertebral column by the World Health Organization (ICD-10-CM code M99.1). [7] However, other professions have used many other names, thus for the purposes of this study we will simply refer to it as joint dysfunction.

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