Allison G, Edmonston S, Kiviniemi K, Lanigan H, Simonsen A V, Walcher S
Centre for Musculoskeletal Studies, Department of Surgery, University of Western Australia.
Physiother Res Int. 2001;6(3):145-56. doi: 10.1002/pri.223.
Spinal mobilization is commonly used to relieve pain and assist recovery of mobility in individuals with low back pain. Fundamental to this concept is the belief that spinal mobilization will influence the mechanical properties of the symptomatic motion segment. The objective of the present study was to examine the segmental effects of a standardized mobilization procedure on the posteroanterior (PA) stiffness of the lumbar spine.
Audio and visual feedback was used to train a physiotherapist to perform PA mobilization at a consistent load and frequency. After training, twenty-four subjects without low back pain were recruited for the intervention phase of the study. The spinal posteroanterior mobilization (SPAM) apparatus was used to measure the PA stiffness of the lumbar spine at three measurement sites (L1, L3 and L5). The trained physiotherapist then applied the standardized PA mobilization technique via the L3 spinous process for two minutes. Following mobilization, PA stiffness was measured three times at the three locations.
The physiotherapist was able to apply a standardized mobilization with a mean force of 146 N (standard deviation (SD) 8 N) at a frequency of 1.5 Hz. The first trial on each assessment demonstrated a pre-condition effect. Two minutes' PA mobilization resulted in no significant change in the PA stiffness of the lumbar spine at the level to which the mobilization was applied, or at the L1 and L5 segments. The 95% confidence intervals (CI) of the difference in PA stiffness before and after testing included zero at each measurement site.
Clinicians should pre-condition the spine when assessing PA stiffness both before and after interventions. A standardized mobilization of 150 N at 1.5 Hz for two minutes had no segmental effect on spinal PA stiffness. Subsequent studies need to consider other mechanisms that may contribute to the changes that occur after PA spinal mobilization.
脊柱松动术常用于缓解腰痛患者的疼痛并帮助恢复活动能力。这一概念的基础是认为脊柱松动术会影响有症状运动节段的力学特性。本研究的目的是检验标准化松动程序对腰椎后前（PA）刚度的节段性影响。
使用音频和视觉反馈训练一名物理治疗师以一致的负荷和频率进行PA松动。训练后，招募24名无腰痛的受试者进入研究的干预阶段。使用脊柱后前松动（SPAM）设备在三个测量部位（L1、L3和L5）测量腰椎的PA刚度。然后，训练有素的物理治疗师通过L3棘突应用标准化的PA松动技术两分钟。松动后，在三个位置测量三次PA刚度。
物理治疗师能够以1.5Hz的频率施加平均力为146N（标准差（SD）8N）的标准化松动。每次评估的第一次试验显示出预处理效应。两分钟的PA松动在应用松动的节段以及L1和L5节段的腰椎PA刚度上没有导致显著变化。测试前后PA刚度差异的95%置信区间（CI）在每个测量部位都包含零。
临床医生在干预前后评估PA刚度时应预先处理脊柱。以1.5Hz的频率施加150N的标准化松动两分钟对脊柱PA刚度没有节段性影响。后续研究需要考虑其他可能导致PA脊柱松动后发生变化的机制。
