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Neural Responses to Physical Characteristics of a High-velocity, Low-amplitude Spinal Manipulation

Effect of Thrust Direction

Reed, William R., DC, PhD; Long, Cynthia R., PhD; Kawchuk, Gregory N., DC, PhD; Sozio, Randall S., BS; Pickar, Joel G., DC, PhD

doi: 10.1097/BRS.0000000000001344

Study Design. Electrophysiological recordings were obtained from proprioceptors in deep lumbar paraspinal muscles of anesthetized cats during high-velocity low-amplitude spinal manipulation (HVLA-SM).

Objective. To determine how thrust direction of an HVLA-SM affects neural input from back musculature.

Summary of Background Data. A clinician's ability to apply the thrust of an HVLA-SM in a specified direction is considered an important component of its optimal delivery. However, previous biomechanical studies indicate that the shear force component of the thrust vector is not actually transmitted to paraspinal tissues deep to the thoracolumbar fascia because the skin–fascia interface is frictionless.

Methods. Neural activity from muscle spindles in the multifidus and longissimus muscles was recorded from L6 dorsal rootlets in 18 anesthetized cats. After preload to the spinal tissues, HVLA-SMs (100-ms thrust duration) were applied through the intact skin overlying the L6 lamina. Thrusts were applied at angles oriented perpendicularly to the back and obliquely at 15° and 30° medialward or cranialward using a 6 × 6 Latin square design with three replicates. The normal force component was kept constant at 21.3 N. HVLA-SMs were preceded and followed by simulated spinal movement applied to the L6 vertebra. Changes in mean instantaneous discharge frequency (ΔMIF) of muscle spindles were determined both during the thrust and spinal movement.

Results. ΔMIFs during the HVLA-SM thrust were significantly greater in response to all thrust directions compared with the preload alone, but there was no difference in ΔMIF for any of the thrust directions during the HVLA-SM. HVLA-SM decreased some of the responses to simulated spinal movement but thrust direction had no effect on these changes.

Conclusion. The shear force component of an HVLA-SM's thrust vector is not transmitted to the underlying vertebra sufficient to activate muscle spindles of the attached muscles. Implications for clinical practice and clinical research are discussed.

Level of Evidence: N/A

Palmer College of Chiropractic, Davenport, IA

University of Alberta, Edmonton, Alberta, Canada.

Address correspondence and reprint requests to Joel G. Pickar, DC, PhD, Palmer Center for Chiropractic Research, Palmer College of Chiropractic, 741 Brady St., Davenport, IA 52803; E-mail:;

Received 28 August, 2015

Revised 2 October, 2015

Accepted 23 October, 2015

The manuscript submitted does not contain information about medical device(s)/drug(s).

NIH grants U19 AAT004137 and K01 AT005935 funds were received in support of this work.

No relevant financial activities outside the submitted work.

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