Claire

Richo's part of Proposal: 1) INTRO:

2) Lumbosacral manipulation in osteopathy (quick overview to highlight that this technique is recommended by osteo texts and what they claim it is useful for.

Spinal manipulation, or High Velocity Low Amplitude (HVLA) technique, is a technique applied by chiropractors, physiotherapists, osteopaths and physicians. There are many theories as to how this technique can be of benefit to the patient. Specifically, Osteopaths widely hold the belief that HVLA techniques, applied to various parts of the body, can aid to reduce TART diagnostic findings within the affected tissues. The TART diagnosis within the Osteopathic profession refers to a collection of symptoms within a dysfunctional tissue; tenderness, asymmetry, altered range of motion and tissue texture change. These diagnostic findings confirm the presence of a //somatic dysfunction,// an Osteopathic term which refers to previously mentioned dysfunctional tissues. (greenman) HVLA techniques to the spine are widely used in the intent to reduce pain. Studies have indicated that HVLA techniques may, by way of stretching joint capsular structures, ligamentous structures, discal structures and muscular structures, activate the diffuse descending pain inhibitory pathways, supporting the theory that this technique provides an analgesic effect. (8) Futhermore, HVLA techniques applied to the lower back have been proven to be effective in the reduction of lower back pain.(1,2) Our study focusses on applying the technique to the Lumbo-Sacral junction to facillitate changes in the lower limbs, specifically the gastrocnemius muscle. We know that the Lumbo-Sacral junction is where the nerve roots of the innervation to teh gastrocnemius muscle originate, (11) and as such wish to investigate the effect that HVLA techniques have uopon the MEP's measured within the muscle, facillitated at the segment. A common belief among the osteopathic profession is that spinal pain can be caused by a //facilitated segment,// an increase in excitability and enhanced responsiveness of the dorsal horn neurons to afferent input. HVLA has been suggested to be effective in the treatment of such a dysfunction. (3) It is widely accepted that HVLA techniques affect not just the joints, but the associated musculature, disc, ligamentous and tendinous structures as well. Most commonly, HVLA techniques have been associated with decreasing TART findings within the facet joints of the spine. There has been studies undertaken which indicate the usefulness of HVLA techniques in reducing pain within the paraspinal musculature, as well as creating long lasting effects after doing so. (5-7) Also, HVLA has been hypothesised to reduce pain of a discal origin within the spine by transiently reducing the pressure-peak observed in the posterior annulus (3). There has been significant evidence to support the theory, that HVLA also aids in patient satisfaction with treatment by producing a placebo effect. After HVLA treatment, if a cavitation was reached, patients rated the treatment more effective and satisfactory than if other treatment methods were used. (9). The widely held belief is that the cavitation that occurs between the joint surfaces increases the plasticity of the joint capsule, hense increasing joint motion. (3) This capsular stretching has also been attributed to the inhibition of paraspinal muscle spasm. (4) There have been studies that have proven that continuous EMG activities of the adjacent multifidus muscle to the Lumbosacral junction have been diminished after having a HVLA technique applied to the Lumbo Sacral Junction. (10) Osteopaths can apply this technique to the lumbo-sacral junction by way of the hypothesis that doing so may affect TART findings in the lower limbs (NEED TO FIND THAT REFERENCE…..)

= Hurwitz E,Aker P,AdamsA,MeekerW, Shekelle P. Manipulation and mobilization of the cervical spine. Spine 1996;21:1746–60. [2] Koes B, AssendelftW, van der Heijden GJ, Bouter L. Spinal manipulation for low back pain.An updated systematic review of randomized clinical trials. Spine 1996;21:2860–73. [3] // J.Y. Maigne, P. Vautravers / Joint Bone Spine 70 (2003) 336–34 // [4] Bogduk N, Jull G. The theoretical pathology of acute locked back: a basis for manipulative therapy. Manual Med 1985;1:78–82. [5]Shambaugh P. Changes in electrical activity in muscles resulting from chiropractic adjustment: a pilot study. J Manipulative Physiol Ther 1987;10:300–3. [6] Zhu Y, Haldeman S, Starr A, Seffinger M, Su SH. Paraspinal muscle evoked cerebral potentials in patients with unilateral low back pain. Spine 1993;18:1096–102. [7] Vicenzino B, Collins D, Wright A. The initial effects of a cervical spine manipulative physiotherapy treatment on the pain and dysfunction of lateral epicondylalgia. Pain 1996;68:69–74. [8] Vicenzino B, Collins D, Benson H, Wright A. An investigation of the interrelationship between manipulative therapy-induced hypoalgesia and sympathoexcitation. J Manipulative Physiol Ther 1998;21: 448–53. [9] [10] Thabe =

[11] Electrophysiologic mapping of the segmental anatomy of the muscles of the lower extremity. Phillips-L-H-2d. Park-T-S. Department of Neurology, University of Virginia Health Sciences Center, Charlottesville 22908. Muscle-Nerve. 1991 Dec. 14(12). P 1213-8