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Chiropractic Research Review

Directing Force to the Lumbar Spine

Postanterior (PA) mobilization is a technique used by various providers of manual therapy to assess and treat patients presenting with low back pain (LBP). The technique involves application by the clinician of an oscillating, anteriorly directed force to the spinous process of the vertebrae of a patient lying prone.

A study was conducted with the principal aim of investigating whether applying the PA force in the lumbar spine throughout a 20-degree range of angles would cause a change in stiffness of the lumbar PA response in pain free individuals. The secondary aim was to establish whether the variation in PA force direction caused a change in rotation movement of the pelvis or lower thoracic spine.

Twenty-four subjects with no history of low back pain or contradictions to mobilization volunteered for testing. Repeated-measures, within-subject design were used in this study. Lumbar PA stiffness was measured at the L3 and L5 levels with the PA force applied in three directions within the sagittal plane. The sagittal force directions covered a 20-degree range. A special laboratory device called the Spinal Physiotherapy Simulator was used to apply the forces and other equipment measured the resultant stiffness.

A small but significant variation of PA stiffness with direction of applied force was found. At L3, mean stiffness was greatest when the postanterior force was applied in a base direction; it was 11% less when the force was applied 10 degrees more caudad than the base direction and 14% less when the force was applied 10 degrees more cephalad than the base direction. There was no significant effect of direction when the force was applied at L5. Both sacral and thoracic rotations displayed significant variation with direction of force when load was applied at L5, with decreasing rotation as the force was applied in a more caudal direction.

Conclusion: PA stiffness and associated remote movements are affected to a small but statistically significant degree by the sagittal plane direction in which the PA force is applied to the spinous process of a vertebra in the lumbar spine. The authors recommend that the direction of applied force should be controlled or standardized during procedures that require PA loading, especially in research settings.

Caling B, Lee M. Effect of direction of applied mobilization force on the postanterior response in the lumbar spine. Journal of Manipulative and Physiological Therapeutics 2001:24(2), pp. 71-78.

Chiropractic Research Review

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