A randomized control trial to determine the effectiveness and physiological effects of spinal manipulation and spinal mobilization compared to each other and a sham condition in patients with chronic low back pain: Study protocol for The RELIEF Study.

BACKGROUND: Low back pain (LBP) is one of the most common reasons for seeking medical care. Manipulative therapies are a common treatment for LBP. Few studies have compared the effectiveness of different types of manipulative therapies. Moreover, the physiologic mechanisms underlying these treatments are not fully understood. Herein, we present the study protocol for The Researching the Effectiveness of Lumbar Interventions for Enhancing Function Study (The RELIEF Study). METHODS AND STUDY DESIGN: The RELIEF Study is a Phase II RCT with a nested mechanistic design. It is a single-blinded, sham-controlled study to test the mechanisms and effectiveness of two manual therapy techniques applied to individuals (n = 162; 18-45 years of age) with chronic LBP. The clinical outcome data from the mechanistic component will be pooled across experiments to permit an exploratory Phase II RCT investigating the effectiveness. Participants will be randomized into one of three separate experiments that constitute the mechanistic component to determine the muscular, spinal, and cortical effects of manual therapies. Within each of these experimental groups study participants will be randomly assigned to one of the three treatment arms: 1) spinal manipulation, 2) spinal mobilization, or 3) sham laser therapy. Treatments will be delivered twice per week for 3-weeks. DISCUSSION: This data from this will shed light on the mechanisms underlying popular treatments for LBP. Additionally, the coupling of this basic science work in the context of a clinical trial will also permit examination of the clinical efficacy of two different types of manipulative therapies.

Vastus lateralis fascicle length changes during stair ascent and descent.

STUDY DESIGN: Experimental descriptive laboratory study. OBJECTIVES: To describe the change in fascicle length of the human vastus lateralis (VL) muscle during the stance phase of stair ascent and descent. BACKGROUND: Muscle fascicle length changes during lower limb functional activities, such as walking and jumping, do not always coincide with joint angle changes. METHODS AND MEASURES: Thirty-three healthy, college-age women walked up and down 4 standard steps. VL fascicle length and pennation angle were measured using real-time ultrasonography. Knee angle was monitored using an electrical goniometer. Foot switches indicated foot contact and release. VL muscle activity was monitored using surface electrodes. The VL muscle-tendon complex and tendon length were calculated based on published models. RESULTS: During initial weight acceptance in stair ascent, the knee joint extended only 3 degrees , VL muscle activity increased to a maximum, VL fascicles shortened, and the tendon lengthened. As the knee extended to ascend the step, the fascicles and tendon shortened throughout the movement. During weight acceptance in stair descent, VL muscle activity increased, VL fascicle length did not change significantly, but the tendon lengthened as 10 degrees of knee flexion occurred. As the knee flexed to complete descent, VL muscle activity peaked, and VL fascicles and tendon lengthened. CONCLUSION: VL fascicles shorten and lengthen as expected during the respective knee extension and knee flexion phases of stair ascent and descent. However, during initial weight acceptance in both stair ascent and descent, the fascicle length change did not coincide with the knee joint kinematics.