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Biomechanics of Spinal Manipulative Therapy

By |April 29, 2018|Biomechanics|

Biomechanics of Spinal Manipulative Therapy

The Chiro.Org Blog

SOURCE:   Spine J. 2001 (Mar); 1 (2): 121–130

John J. Triano, DC, PhD

Conservative Medicine,
Chiropractic Division,
Texas Back Institute,
6300 W. Parker Road,
Plano, TX 75093, USA.

BACKGROUND CONTEXT:   Modern scientific investigations into spinal manipulative therapy (SMT) began in 1975. Conditions often treated include acute and chronic low back pain, radicular pain, neck pain, and some forms of headache. The field of spinal manipulation has often been treated by the literature, incorrectly, as being homogeneous. Much of the confusion regarding this form of treatment can be traced to the ambiguity surrounding the procedures themselves. This report summarizes the clinical biomechanics of SMT and evidence for its associated manipulable lesion is reviewed. Finally, a classification system based on biomechanics is proposed that may facilitate more detailed research in the future.

PURPOSE:   A categorization system for SMT was sought that would be more objective than is clinically available. Such a system may serve as a means to strengthen future studies, determine operating principles, applicability, treatment effectiveness, and nature of the manipulable lesion.

STUDY DESIGN:   Literature synthesis.

METHODS:   A search of the indexed biomechanical and medical literature as well as a hand search of published works was conducted. The criteria for article selection consisted of studies that included measurements of mechanical characteristics of treatment techniques used under the general headings of SMT or manual therapy. A second set of studies was identified that explored the biomechanics of buckling behavior of vertebral segments as a model of the manipulable lesion. Quantitative characteristics of SMT were extracted and grouped to form a basis for classification.

RESULTS:   A total of 31 articles were identified that contained quantitative data on the biomechanical properties of SMT methods. An additional seven studies were found that quantified spinal buckling behavior. Common features of SMT procedures lead to a matrix that biomechanically characterizes the types of procedures in use. Buckling behavior was compared qualitatively with clinical observations to form a plausible and evidence-based hypothesis of the manipulable lesion.

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Study offers suggestions on what to do when sex is a pain in the back

By |September 12, 2014|Biomechanics|



Professor Stuart McGill demonstrates the motion of the spine during sex in a handout photo. Contrary to popular belief, spooning is not always the best sex position for those with a bad back, according to new research from the University of Waterloo. THE CANADIAN PRESS/HO-University of Waterloo

For many people, intimacy in the bedroom often takes a back seat to low back pain, say researchers, who have scientifically determined the best sexual positions to prevent spinal muscles from seizing up at an inopportune moment.

In what they believe is the first biomechanical study of its kind, researchers at the University of Waterloo have found that certain positions are better than others for keeping different kinds of back pain at bay.

And they’ve thrown out the long-held belief that spooning — where partners lie sideways curled back to front — is the only pose for back-saving sex.

“Before now, spooning was often recommended by physicians as the one position that fit all. But as we’ve discovered, that is not the case,” said Natalie Sidorkewicz, a PhD candidate and lead author of the paper published Thursday in the journal Spine.

“What that failed to do was recognize that there are all sorts of triggers for back pain,” she said from Waterloo, Ont. “So someone may find relief in one position that may cause pain for someone else.”

To conduct the study, the researchers recruited 10 heterosexual couples, with an average age of about 30, to have sexual intercourse in a controlled laboratory setting.

Each participant was fitted with remote sensors, which tracked how their spines moved when they engaged in five common sex positions. Infrared and electromagnetic motion capture systems — such as those used to animate figures in video games and films — showed how the men’s and women’s spines flexed when they assumed each position.

“So we were able to actually determine what angle the spine is at, at each moment in time that they’re having sex,” said Sidorkewicz, adding that electrodes on participants’ skin also captured activity in their core and hip muscles.

The findings were used to create an atlas, or set of guidelines, that recommends different sex positions and thrusting techniques based on what movements trigger a patient’s pain.