Impact of Extremity Manipulation on Postural Sway Characteristics:
A Preliminary, Randomized Crossover StudyThis section was compiled by Frank M. Painter, D.C.
Send all comments or additions to: Frankp@chiro.org
FROM: J Manipulative Physiol Ther 2020 (Jun); 43 (5): 457-468 ~ FULL TEXT
Christopher A. Malaya, DC, Joshua Haworth, MS, PhD, Katherine A. Pohlman, DC, MS, PhD, Cody Powell, DC, Dean L. Smith, DC, MS, PhD
Center for Neuromotor and Biomechanics Research,
University of Houston,
Houston, Texas and Research Center,
Parker University,
Dallas, Texas.
Thanks to JMPT for permission to reproduce this Open Access article!
Objective: Evaluate multisegmental postural sway after upper- vs lower-extremity manipulation.
Methods: Participants were healthy volunteers (aged 21-40 years). Upper- or lower-extremity manipulations were delivered in a randomized crossover design. Postural assessments were made pre-post manipulation, in floor and rocker board conditions. Analysis included traditional balance measures of pathlength and range and sample entropy (SampEn) to examine the temporal structure of sway of the head, trunk, and surface.
Results: No statistical changes in pathlength or sway range on the ground surface condition were observed. No increases in the amount of sway occurred in any condition. Chiropractic manipulation of either upper or lower extremities led to reductions in traditional measures of postural control on the rocker board. In the anteroposterior direction (sagittal plane), lower-extremity manipulation led to increased trunk SampEn while on the ground, and conversely a decreased SampEn while on the rocker board. In the mediolateral rocker board condition (frontal plane), manipulation elicited a change in SampEn that differed according to site of manipulation; upper-extremity manipulation increased SampEn, whereas lower-extremity manipulation reduced SampEn.
Conclusion: Both upper- and lower-extremity manipulation influenced several measures of postural sway on both the ground and the rocker board. Lower-extremity manipulation improved the organization of sway at the trunk (anteroposterior direction) and the board (mediolateral direction). Given the reduction and reorganization of sway metrics seen in this study, we propose extending this line of research to the elderly who are at greatest risk of increased sway and falls.
Keywords: Laterality of Motor Control; Manipulation, Chiropractic; Nonlinear Dynamics; Postural Balance.
From the FULL TEXT Article:
Introduction
Postural control is an integral part of all physical behavior [1, 2] and involves controlling the body's position in space for the purposes of both stability and orientation. [3] Maintaining postural stability even during quiet stance is multisegmental1 and dynamic [4, 5] because the body is never completely motionless. [6] For this reason, Smart and Smith2 recommended that the chiropractic profession examine posture from a dynamic perspective to better characterize its control strategies to inform targeted clinical interventions. However, since that publication, few studies have examined dynamic posture after manipulation. [7]
Traditional measures of postural control (eg, center of pressure range) provide information about the amount of sway. Nonlinear measures (eg, sample entropy) are based on dynamic systems principles and provide complementary information about the structure and underlying patterns of sway. Traditional measures have helped to typify ankle and hip joint strategies that facilitate the behavioral goal of not falling over and the affordance of suprapostural tasks (eg, stabilization of the head for refined vision). More recently, nonlinear metrics of balance have been identified as a leading avenue in the study of dynamic postural control. [8] Sample entropy (SampEn) has been used to assess movement variability in system complexity of the underlying control structure, [9] which is necessary for successful adaptive posture. Less-than-optimal variability depicts an overly rigid and unchanging system, whereas greater-than-optimal variability represents instability. [2, 9]
Previous studies have documented that chiropractic manipulation as a therapeutic intervention results in plastic changes in sensorimotor integration within the central nervous system (CNS) in human participants. [10] These studies provide preliminary evidence to support a role of the CNS in the mechanism of action of spinal manipulation, specifically those using a high-velocity, low-amplitude thrust. Although evidence relating to the sensorimotor changes afforded by manipulation of the joints of the extremities is more limited, manipulation of these joints may also bring about changes in the CNS. Regarding postural control, the cerebellum plays a key role in modifying and adjusting movements (eg, timing and coordination), [11] and its role would be especially important during balance in a dynamic situation (for example, on a rocker board). Coordination by the cerebellum depends on interactions between adjacent limb segments [12] and their sensory afferents, contributing to the spinocerebellar tracts. [13] Each cerebellar lobe is primarily driven by inputs from the ipsilateral side of the body. [14] With this in mind, extremity manipulations could stimulate the cerebellum on the ipsilateral side more than a spinal manipulation.
Dynamic postural control previously has been shown to improve after lower-extremity manipulation, such as with a rearfoot distraction manipulation in healthy participants. [15] Another recent study investigated the effect of joint mobilization and manipulation at the talocrural joint on corticospinal excitability in individuals with resolved symptoms following ankle sprain. [16] Individuals in the thrust manipulation group demonstrated increased corticospinal excitability of the tibialis anterior approximately 30 minutes after intervention, whereas corticospinal excitability decreased in the mobilization group. This finding suggests that manipulation of the ankle joint may provide a means to optimize muscle recruitment and subsequently movement quality. [16]
Although we also expect that improved sensorimotor performance after upper-limb manipulation is reasonable, [17] we are unaware of any studies assessing this effect regarding postural control.
With these points in mind, the aim of our study was to explore the effect of upper- and lower-extremity chiropractic manipulations on multisegmental postural control (surface, trunk, and head) and sway as evaluated on different surfaces—the ground vs a rocker board. The decision for sensor placement was that the participant's head, low back, and foot-surface interaction represents foci for postural control. Currently, there are differing opinions regarding the control of posture, as some suggest that stabilizing the head is the primary goal of postural control, whereas others suggest it is the center of mass (low back). We propose in the current study that the surface sensor may serve as the informational locus of postural control during dynamic stance in a spastic environment (ie, on the rocker board).
The rocker board, in addition to amplifying sway dynamics beyond mere standing, provides a self-driven task with which to evaluate sensorimotor integration. Stance on the rocker board includes both a dynamic postural challenge and also a direct source of control over the environment. Modulating the vertical motion of each lower extremity allows the stander to adjust the rotations of the board, which establishes the new environment to which they must subsequently respond. Thus, monitoring the motion of the board (with the sensor) affords a unique perspective into sensorimotor integration and potential modifications of this integration induced by chiropractic extremity manipulation. Attention might actually be focused on the dynamics of board motion, which is the real point in the world that the person is able to coordinate sensory and motor experiences. Because the rocker board has only 1 degree of freedom, we separately consider anteroposterior (AP) and lateral sways. Additionally, although we assessed conventional static measures of sway magnitude (pathlength and range) at the head, trunk, and surface, we also assessed the structure and rhythmicity of the sway using SampEn.
We hypothesized that there would be a significant difference (P < .05) in sway magnitude (pathlength, range) and structure (SampEn) between upper- and lower-extremity manipulations. In particular, we thought upper-extremity manipulation would exhibit larger sway magnitude (both pathlength and range) and greater irregularity, suggesting less adaptive postural control compared with lower-extremity manipulation. We also hypothesized that the dynamic context of the rocker board surface condition would most clearly and prominently elicit these differences compared with the ground surface condition.
Discussion
In this experiment, we sought to explore the effects of chiropractic manipulation (intervention) on the standing postural sway of a typically developed, healthy, young adult population. We used an inertial measurement unit (Shimmer) to measure motion of the head, trunk, and surface, as each has previously been implicated as a focus of control for various postural strategies. In addition to traditional surface (floor) and measures (pathlength and range), we used a dynamic surface (rocker board) and a measure of dynamics (SampEn) to add perspective to which particular aspects of sway might be affected. On separate occasions, upper-and lower-limb manipulations were applied, as we considered the possibility that the region of manipulation might mediate the efficacy of the intervention.
Our results showed no significant changes in pathlength or range of sway on the ground surface condition, at any sensor location, after manipulation (single-sample t tests, see bold values in Tables 1 and 2). Because the postural control systems of our participants had over 2 decades of practice, the fact that our manipulations had no effect on standing sway magnitude on the ground seems reasonable. This confirms the work of Goertz et al34 in which no changes of sway magnitude were found during quiet standing in patients with low back pain after (spinal) manipulation. However, lower-extremity manipulation affected the sway dynamics of the trunk while standing on the ground. Further, chiropractic manipulation of either the upper or lower extremities led to several reductions in traditional measures of postural control (sway range and pathlength) when participants stood on the rocker board, and a surface interaction effect of the dynamics (SampEn) of trunk motion. This supports our hypothesis that the dynamic context of the rocker board better elucidates differences in postural control than the ground surface condition.
Our findings, in addition to those of Goertz et al [34] and Maribo et al, [35] strongly suggest that traditional measures of postural control (sway range, etc) may be insensitive in determining postural change, from a dynamic (behavioral) perspective, following manipulation. This is why we chose a priori to reinforce our evaluation of participants’ postural sway with dynamic nonlinear analyses (SampEn). Rather than provide merely a quantification of the magnitude of sway behavior, SampEn provides a means to discriminate the complexity of postural motion [33, 36]. This affords a more appropriate evaluation of the structure of sway behavior under dynamic surface conditions, that is, on a rocker board.
As expected, we did find that chiropractic manipulation of either upper or lower extremities led to several reductions in traditional measures of postural control (sway range and pathlength) while participants stood on the rocker board (according to single-sample t tests). The single-sample t tests (comparing difference scores against 0) indicate whether a non-0 change is represented by the difference score, implicating the manipulation as the change agent. Lower-extremity manipulation was associated with reductions in translation of head pathlength in the ML direction, range of roll while standing on the rocker board, and translation of the rocker board via pathlength in the ML direction. The upper extremity was associated with reductions in trunk pathlength and sway range in the AP direction on the rocker board. In addition, AP pathlength of the rocker board and roll pathlength, and range of sway in the roll direction, were reduced after upper-extremity manipulation. These results could be considered prognostic, with the assertion that a particular manipulation would lead to a particular modification of the measured property of postural sway. However, this is bound simply to statistical significance, and further extension toward a claim of clinical significance should be cautioned. Even more, understanding the essential meaningfulness of the impact will require further investigation, including parallel measure of clinical outcomes.
To our knowledge, this is the first study to provide data on the effects of upper- and lower-extremity manipulation on postural control. Notably, neither upper- nor lower-extremity manipulation increased sway magnitude at any measured location. Lower-extremity manipulation reduced sway magnitude only in the frontal plane at the head and rocker board. Upper-extremity manipulation, on the other hand, influenced primarily sagittal sway magnitude of the trunk and rocker board as well as roll of the board in the frontal plane. This was not expected. We hypothesized that sway magnitude would decrease for both upper and lower extremities under the same conditions. We did not anticipate that upper-extremity manipulation would have effects in largely a different plane of motion compared with lower-extremity manipulation. The pattern of results suggests differences in behavioral control strategies depending on manipulation location.
Manual therapy and spinal manipulation can alter local and distal motoneuron excitability. [10, 37, 38, 39, 40] Theoretically, impairments in the lower quarter could influence the function of the upper quarter and similarly, dysfunction in the upper quarter could have an impact upon the function of the lower quarter. [41] We see this in a few of our results, such as the upper-extremity manipulation affecting rocker board motion in roll, or the lower-extremity manipulation affecting head stability in the ML direction. This regional interdependence may be the result of neurophysiological mechanisms at local or remote locations, or the combined interaction between biomechanical and neurophysiological mechanisms. [42] For these reasons, some believe that full kinetic chain evaluation of spinal and extremity joints be assessed and addressed, if needed. [43] Our results highlight this need for a comprehensive and pragmatic approach to evaluation and intervention.
The study also raises an important question about the specificity of intervention, both regarding the location of the delivered intervention on the body and the context of behavior of the individual. This suggests that clinicians’ manipulations might need location specificity to affect the task being performed. In our case, chiropractic manipulation of the upper extremity led primarily to a change in the sagittal plane. For an application example, lower-extremity manipulation might reasonably aid postural head stability more than upper-extremity manipulation on the rocker board in the coronal plane. This could be useful in a task such as reading where more head stability is necessary for improved performance. We recommend further investigation to explore the variety of specific and contextual effects that can be elicited by manipulations at different intervention locations.
Anteroposterior motions of the trunk showed equal magnitude but opposite directions of SampEn changes after a lower-extremity manipulation, depending on the surface condition (Table 2). While standing on the ground, a lower-extremity manipulation actually increased SampEn (less rhythmicity, less structure). Conversely, after lower-extremity manipulation on the rocker board (oriented in the AP direction), SampEn of the trunk motion decreased (more rhythmicity, more structure). We found similar responses in the roll direction of the rocker board noted between upper- and lower-extremity manipulation as demonstrated by a statistically significant interaction between surface and intervention. Here, lower-extremity manipulation reduced SampEn of the rocker board, while upper-extremity manipulation increased SampEn. There was also another increase in SampEn in the roll direction of the trunk sensor following lower-extremity manipulation. As the human body is constantly in motion, dynamic tasks (such as a standing on a rocker board) likely require dynamic solutions.6 Greater rhythmicity and structure of a dynamic task implies greater sensorimotor adaptation and, in turn, greater long-term stability.
In the case of the ground surface condition, we believe the corresponding increase in SampEn also represented an increase in sensorimotor adaptation. We believe the decreasing structure of sway behavior represents an increased exploration of the base of support during quiet standing on the ground. Since pathologic systems exhibit a tendency for less flexible, more deterministic dynamic patterns as well as greater risk of falls, [44, 45] this increase in complexity while standing on the ground likely represents an augmentation in sensorimotor functioning to adapt to potential stressors. [45]
Post-manipulation inputs and outputs in the medial to lateral direction on the rocker board, as quantified by SampEn, were also significantly less chaotic and more ordered. That is to say, on a rocker board, movement in the frontal plane became less complex, more rhythmic, and more predictable after chiropractic manipulation. Interestingly, balancing on a rocker board is a self-driven task: a balancer has total control over their inputs to the board as well as their own responsive outputs. [46] Balancing is a combined sensorimotor task, using not only the balancer's sensory inputs of position of self and board, but also their subsequent, responsive motor output to maintain balance. As such, the chiropractic manipulation delivered to either the upper or lower extremities can be seen to function as a combined sensorimotor intervention, rather than affecting a single system in isolation. In this case, the manipulation manifests as a more robust ability not only to sense the environment, but also to respond to it predictably and controllably.
Balance evaluations are very different across studies, both in protocols and in measurement methods. [47] Despite this heterogeneity, retrospective and prospective analyses have shown a strong correlation between falling and an increase in postural sway [48] compared with those whose sway is more typical of young adults. [49] For older persons who have greater postural sway, the increased risk of falling is not only correlated with standing on a static surface, but also on an unstable board. [47] Our results provide evidence that in young, healthy adults, challenging the postural control system with a rocker board was necessary to demonstrate sway reductions following manipulation in pathlength and range, as the floor condition showed no effect.
Based upon results that extremity manipulation reduced multiple sway measures in the rocker condition of healthy young adults, we hypothesize that elderly patients at risk of falls might have the most to gain from chiropractic manipulation, since their sway is greater. Sensorimotor function and multisensory integration associated with fall risk and the physical component of quality of life have been shown to improve in older adults receiving chiropractic care. [18] However, a limited amount of research has been published that supports a role for chiropractic manipulation in improving postural stability and balance. [7, 50] Even less data exist that relate extremity manipulation to balance, despite the knowledge that ankle and hip joints dominate standing postural control mechanisms. Recent evidence supported the notion that peripheral proprioceptive loss might be the largest contributing factor to increased postural sway in older adults. [51] Given that manual therapy has been advocated as a method to facilitate proprioceptive information, which, in turn, affects neuromuscular contro [10, 52] and, subsequently, balance,15 it is odd that there do not exist more studies investigating the potential relationship between manipulation and fall risk. This current study has demonstrated that further research is necessary.
Limitations
Given the small sample size and lack of clinically measured outcomes, we suggest caution in the interpretation of clinical significance. Future research may wish to investigate the concurrent mechanical (eg, joint mobility) or neurophysiological (eg, afferent activity) changes that occur with the changes in postural outcomes observed herein. Although our study population of healthy young adults demonstrated several changes in postural control following extremity manipulation, these results should not be generalized to other populations (eg, elderly patients). Rather, we suggest conducting a similar study with an elderly population to explore the potential effects on those with greater risk of falling. We did not use a placebo or non-intervention control group in this study, because our aim was to determine differences in postural control between upper- and lower-extremity manipulations as they may be delivered in routine clinical settings. Future studies may wish to use more highly controlled conditions to examine the efficacy as well as the potential benefits and harms of upper- vs lower-extremity manipulation effects on postural sway. We used an inertial measurement unit for postural data collection. Sensors such as these come with a certain level of noise. This is one of the main reasons why trained and effective signal processing (such as sample rate and filtering) is an imperative step in the employment of this technology. By extension, added caution is suggested when significant differences are identified in a study such as this. Clear description of signal processing methods and an acknowledgement of limitations should be expected, with replication suggested as a primary remedy.
Conclusion
The results indicate that both upper- and lower-extremity manipulation influenced several measures of postural sway, mostly in the dynamic rocker board condition. Changes included reductions in sway range and pathlength. Lower-extremity manipulation improved the organization of sway behavior at the trunk (AP direction) and the board (ML direction) when needed most, on an unstable surface. No extremity manipulations increased postural sway range or pathlength on either the stable or unstable surfaces. Given the favorable reduction and reorganization of (dynamic) sway metrics seen in this study, we propose extending this line of research to the elderly who are at greatest risk of increased sway and falls.
Practical Applications
This study found that both upper- and lower-extremity manipulation influenced
several measures of postural sway.Lower-extremity manipulation improved the organization of sway behavior
at the trunk (AP direction) and the board (ML direction) when needed most,
on an unstable surface.No extremity manipulations increased postural sway range or pathlength
on either the stable or unstable surfaces.This line of research should continue with the elderly population, as they are at
greatest risk of increased sway and falls.Contributorship Information
Concept development (provided idea for the research): C.A.M., J.H., K.A.P., C.P., D.L.S.
Design (planned the methods to generate the results): C.A.M., J.H., K.A.P., C.P., D.L.S.
Supervision (provided oversight, responsible for organization and implementation, writing of the manuscript): K.A.P., C.A.M., J.H., D.L.S.
Data collection/processing (responsible for experiments, patient management, organization, or reporting data): C.A.M., J.H., K.A.P., C.P., D.L.S.
Analysis/interpretation (responsible for statistical analysis, evaluation, and presentation of the results): C.A.M., J.H., K.A.P., D.L.S.
Literature search (performed the literature search): C.A.M., J.H., C.P., D.L.S.
Writing (responsible for writing a substantive part of the manuscript): C.A.M., J.H., K.A.P., D.L.S.
Critical review (revised manuscript for intellectual content, this does not relate to spelling and grammar checking): C.A.M., J.H., K.A.P., C.P., D.L.S.
References:
Smart Jr, LJ Mobley BS Otten EW Smith DL Amin MR
Not just standing there: the use of postural coordination to aid visual tasks.
Hum Mov Sci. 2004; 22: 769-780Smart Jr, LJ Smith DL
Postural dynamics: clinical and empirical implications.
J Manipulative Physiol Ther. 2001; 24: 340-349Shumway-Cook A Woollacott MH
Motor Control: Translating Research Into Clinical Practice.
5th ed. Wolters Kluwer, Philadelphia, PA2017Haworth JL Strang AJ Hieronymus M Walsh MS
Temporal more than spatial regulation of sway is important for posture in response
to an ultra-compliant surface.
Somatosens Motor Res. 2018; 35: 45-51Walsh M Slattery E McMath A Cox R Haworth J
Training history constrains postural sway dynamics: a study of balance in collegiate ice hockey players.
Gait Posture. 2018; 66: 278-282Horak FB MacPherson JM
Postural orientation and equilibrium. In: Rowell LG, Shepherd JT, eds.
Exercise: Regulation and Integration of Multiple Systems.
Oxford University Press, New York, NY1996: 255-292Holt KR Haavik H Elley CR
The Effects of Manual Therapy on Balance and Falls: A Systematic Review
J Manipulative Physiol Ther. 2012 (Mar); 35 (3): 227–234Buckley TA Oldham JR Caccese JB
Postural control deficits identify lingering post-concussion neurological deficits.
J Sport Health Sci. 2016; 5: 61-69Stergiou N Harbourne R Cavanaugh J
Optimal movement variability: a new theoretical perspective for neurologic physical therapy.
J Neurol Phys Ther. 2006; 30: 120-129Haavik, H and Murphy, B.
The Role of Spinal Manipulation in Addressing Disordered Sensorimotor Integration
and Altered Motor Control
J Electromyogr Kinesiol. 2012 (Oct); 22 (5): 768–776Ghez C Krakauer J
The organization of movement.
in: Kandel ER Schwartz JH Jessel TM Principles of Neural Science.
4th ed. McGraw-Hill, New York, NY2000: 653-673Spanne A Jorntell H
Processing of multi-dimensional sensorimotor information in the spinal
and cerebellar neuronal circuitry: a new hypothesis.
PLoS Comput Biol. 2013; 9e1002979Takakusaki K
Functional neuroanatomy for posture and gait control.
J Mov Disord. 2017; 10: 1-17Ghez C Thatch WT
The cerebellum.
in: Kandel ER Schwartz JH Jessel TM Principles of Neural Science.
4th ed. McGraw-Hill, New York, NY2000: 832-852Wassinger CA Rockett A Pitman L Murphy MM Peters C
Acute effects of rearfoot manipulation on dynamic standing balance in healthy individuals.
Man Ther. 2014; 19: 242-245Fisher BE Piraino A Lee YY et al.
The effect of velocity of joint mobilization on corticospinal excitability
in individuals with a history of ankle sprain.
J Orthop Sports Phys Ther. 2016; 46: 562-570De Bruyn N Essers B Thijs L et al.
Does sensorimotor upper limb therapy post stroke alter behavior and brain connectivity
differently compared to motor therapy? Protocol of a phase II randomized controlled trial.
Trials. 2018; 19: 242Holt K, Haavik H, Lee A, Murphy B, Elley C.
Effectiveness of Chiropractic Care to Improve Sensorimotor Function Associated
With Falls Risk in Older People: A Randomized Controlled Trial
J Manipulative Physiol Ther. 2016 (May); (39) 4: 267–278Smith DL Dainoff MJ Smith JP
The effect of chiropractic adjustments on movement time: a pilot study using Fitts Law.
J Manipulative Physiol Ther. 2006; 29: 257-266Lelic, D.; Niazi, I.K.; Holt, K.; Jochumsen, M.; Dremstrup, K.; Yielder, P.; Murphy, B.
Manipulation of Dysfunctional Spinal Joints Affects Sensorimotor Integration
in the Prefrontal Cortex: A Brain Source Localization Study
Neural Plast. 2016 (Mar 7); 2016: 3704964Harris PA Taylor R Thielke R Payne J Gonzalez N Conde JG
Research electronic data capture (REDCap)—a metadata-driven methodology
and workflow process for providing translational research informatics support.
J Biomed Inform. 2009; 42: 377-381Beck RW
Functional Neurology for Practitioners of Manual Therapy.
Churchill Livingstone, New York, NY2008Burns A Greene BR McGrath MJ et al.
SHIMMER™ – A wireless sensor platform for noninvasive biomedical research.
IEEE Sensors J. 2010; 10: 1527-1534Kluge F Gassner H Hannink J Pasluosta C Klucken J Eskofier BM
Towards mobile gait analysis: concurrent validity and test-retest reliability
of an inertial measurement system for the assessment of spatio-temporal gait parameters.
Sensors (Basel). 2017; 17Li X González Navas C Garrido-Castro JL
Fiabilidad y validez de la medida de la movilidad cervical en pacientes con
espondiloartritis axial utilizando un sensor inercial.
Rehabilitación. 2017; 51: 17-21Shahzad A Ko S Lee S Lee J Kim K
Quantitative assessment of balance impairment for fall-risk estimation
using wearable triaxial accelerometer.
IEEE Sensors J. 2017; 17: 6743-6751Whitney SL Roche JL Marchetti GF et al.
A comparison of accelerometry and center of pressure measures during
computerized dynamic posturography: a measure of balance.
Gait Posture. 2011; 33: 594-599Ramdani S Seigle B Lagarde J Bouchara F Bernard PL
On the use of sample entropy to analyze human postural sway data.
Med Eng Phys. 2009; 31: 1023-1031Roerdink M Hlavackova P Vuillerme N
Center-of-pressure regularity as a marker for attentional investment in
postural control: a comparison between sitting and standing postures.
Hum Mov Sci. 2011; 30: 203-212Lake DE Richman JS Griffin MP Moorman JR
Sample entropy analysis of neonatal heart rate variability.
Am J Physiol Regul Integr Comp Physiol. 2002; 283: R789-R797Schmit JM Regis DI Riley MA
Dynamic patterns of postural sway in ballet dancers and track athletes.
Exp Brain Res. 2005; 163: 370-378Richman JS Moorman JR
Physiological time-series analysis using approximate entropy and sample entropy.
Am J Physiol Heart Circulatory Physiol. 2000; 278: H2039-H2049Yentes JM Hunt N Schmid KK Kaipust JP McGrath D Stergiou N
The appropriate use of approximate entropy and sample entropy with short data sets.
Ann Biomed Eng. 2013; 41: 349-365Goertz CM Xia T Long CR et al.
Effects of spinal manipulation on sensorimotor function in low back pain patients—arandomised controlled trial.
Man Ther. 2016; 21: 1831-1890Maribo T Schiottz-Christensen B Jensen LD Andersen NT Stengaard-Pedersen K
Postural balance in low back pain patients: criterion-related validity of
centre of pressure assessed on a portable force platform.
Eur Spine J. 2012; 21: 425-431Hansen C Wei Q Shieh JS Fourcade P Isableu B Majed L
Sample entropy, univariate, and multivariate multi-scale entropy in comparison
with classical postural sway parameters in young healthy adults.
Frontiers Hum Neurosci. 2017; 11: 206Christiansen TL Niazi IK Holt K et al.
The effects of a single session of spinal manipulation on strength and cortical drive in athletes.
Eur J Appl Physiol. 2018; 118: 737-749Dishman JD Bulbulian R
Spinal reflex attenuation associated with spinal manipulation.
Spine (Phila Pa 1976). 2000; 25 (discussion 2525): 2519-2524Dishman JD Burke JR Dougherty P
Motor neuron excitability attenuation as a sequel to lumbosacral manipulation in
subacute low back pain patients and asymptomatic adults: a cross-sectional H-reflex study.
J Manipulative Physiol Ther. 2018; 41: 363-371Suter E McMorland G Herzog W
Short-term effects of spinal manipulation on H-reflex amplitude in healthy and symptomatic subjects.
J Manipulative Physiol Ther. 2005; 28: 667-672Sueki DG Cleland JA Wainner RS
A Regional Interdependence Model of Musculoskeletal Dysfunction:
Research, Mechanisms, and Clinical Implications
J Man Manip Ther. 2013 (May); 21 (2): 90-102Bialosky JE Bishop MD Price DD Robinson ME George SZ
The mechanisms of manual therapy in the treatment of musculoskeletal pain: a comprehensive model.
Man Ther. 2009; 14: 531-538Brantingham JW Cassa TK Bonnefin D et al.
Manipulative and multimodal therapy for upper extremity and temporomandibular disorders:
a systematic review.
J Manipulative Physiol Ther. 2013; 36: 143-201Schmit JM Riley MA Dalvi A et al.
Deterministic center of pressure patterns characterize postural instability in Parkinson's disease.
Exp Brain Res. 2006; 168: 357-367Zhou J Habtemariam D Iloputaife I Lipsitz LA Manor B
The complexity of standing postural sway associates with future falls in
community-dwelling older adults: the MOBILIZE Boston study.
Sci Rep. 2017; 7: 2924Golomer E Cremieux J Dupui P Isableu B Ohlmann T
Visual contribution to self-induced body sway frequencies and visual perception of male professional dancers.
Neurosci Lett. 1999; 267: 189-192Pizzigalli L Micheletti Cremasco M Mulasso A Rainoldi A
The contribution of postural balance analysis in older adult fallers: a narrative review.
J Bodyw Mov Ther. 2016; 20: 409-417Yalla SV Crews RT Fleischer AE Grewal G Ortiz J Najafi B
An immediate effect of custom-made ankle foot orthoses on postural stability in older adults.
Clin Biomech (Bristol, Avon). 2014; 29: 1081-1088Goble DJ Baweja HS
Postural sway normative data across the adult lifespan: results from
6280 individuals on the Balance Tracking System balance test.
Geriatr Gerontol Int. 2018; 18: 1225-1229Lopez D King HH Knebl JA Kosmopoulos V Collins D Patterson RM
Effects of comprehensive osteopathic manipulative treatment on balance in elderly patients: a pilot study.
J Am Osteop Assoc. 2011; 111: 382-388Anson E Bigelow RT Swenor B et al.
Loss of peripheral sensory function explains much of the increase in postural sway in healthy older adults.
Front Aging Neurosci. 2017; 9: 202Pickar JG.
Neurophysiological Effects of Spinal Manipulation
Spine J (N American Spine Society) 2002 (Sep); 2 (5): 357–371
Return to EXTREMITY ADJUSTING
Since 2-09-2021
| Home Page | Visit Our Sponsors | Become a Sponsor |
Please read our DISCLAIMER |