Evidence for increased neuromuscular drive following spinal manipulation in individuals with subacromial pain syndrome |
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| Institution: | 1. Division of Biokinesiology and Physical Therapy, University of Southern California, 1540 E. Alcazar Street, CHP155, Los Angeles, CA 90089; USA;2. Johns Hopkins University, Baltimore, MD, USA;3. Faculty of Medicine, Department of Rehabilitation, Laval University; Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, QC, Canada;4. FORSCOM Holistic Health and Fitness (H2F) Field Test, U.S. Army Forces Command, Fort Bragg, NC, USA;1. Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany;2. Department of Neurosurgery, Cantonal Hospital St. Gallen, St. Gallen, Switzerland;1. Private Practice, Align Body Clinic, Bath, UK;2. MRC Integrative Epidemiology Unit, School of Social and Community Medicine, University of Bristol, Bristol, UK;3. Centre for Academic Mental Health, School of Social and Community Medicine University of Bristol, Bristol, Bristol, UK;4. The NIHR Biomedical Research Unit in Nutrition, Diet and Lifestyle at the University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK;1. Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands;2. Laboratory for Kinematics and Neuromechanics, Department of Orthopaedics and Rehabilitation, Leiden University Medical Center, Leiden, the Netherlands;3. Department of Radiology, Leiden University Medical Center, Postzone J-11-R, PO box 9600, 2300RC Leiden, the Netherlands;1. Graduate Student, Kinesiology, Health Sciences, University of Ontario Institute of Technology, Ontario, Canada;2. Director of Research, New Zealand College of Chiropractic, Centre for Chiropractic Research, New Zealand College of Chiropractic, New Zealand;3. Assistant Professor, University of Ontario Institute of Technology, Ontario, Canada;4. Masters Student, University of Ontario Institute of Technology, Ontario, Canada;5. Professor, Head of Kinesiology, University of Ontario Institute of Technology, Ontario, Canada |
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| Abstract: | BackgroundThoracic spinal manipulation can improve pain and function in individuals with shoulder pain; however, the mechanisms underlying these benefits remain unclear. Here, we evaluated the effects of thoracic spinal manipulation on muscle activity, as alteration in muscle activity is a key impairment for those with shoulder pain. We also evaluated the relationship between changes in muscle activity and clinical outcomes, to characterize the meaningful context of a change in neuromuscular drive.MethodsParticipants with shoulder pain related to subacromial pain syndrome (n = 28) received thoracic manipulation of low amplitude high velocity thrusts to the lower, middle and upper thoracic spine. Electromyographic muscle activity (trapezius-upper, middle, lower; serratus anterior; deltoid; infraspinatus) and shoulder pain (11-point scale) was collected pre and post-manipulation during arm elevation, and normalized to a reference contraction. Clinical benefits were assessed using the Pennsylvania Shoulder Score (Penn) at baseline and 2–3 days post-intervention.FindingsA significant increase in muscle activity was observed during arm ascent (p = 0.002). Using backward stepwise regression analysis, a specific increase in the serratus anterior muscle activity during arm elevation explained improved Penn scores following post-manipulation (p < 0.05).InterpretationThoracic spinal manipulation immediately increases neuromuscular drive. In addition, increased serratus anterior muscle activity, a key muscle for scapular motion, is associated with short-term improvements in shoulder clinical outcomes. |
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