Discipline of Physiotherapy, School of Health Sciences, The University of Newcastle, Newcastle, Australia.
J Electromyogr Kinesiol. 2012 Oct;22(5):708-23. doi: 10.1016/j.jelekin.2012.04.015. Epub 2012 Jun 8.
To review and discuss the methods used for measuring spinal stiffness and factors associated with stiffness, how stiffness is used in diagnosis, prognosis, and treatment decision-making and the effects of manipulative techniques on stiffness.
A systematic search of MEDLINE, EMBASE, CINAHL, AMED and ICL databases was conducted. Included studies addressed one of four constructs related to stiffness: measurement, diagnosis, prognosis and/or treatment decision-making, and the effects of manipulation on stiffness. Spinal stiffness was defined as the relationship between force and displacement.
One hundred and four studies are discussed in this review, with the majority of studies focused on the measurement of stiffness, most often in asymptomatic persons. Eight studies investigated spinal stiffness in diagnosis, providing limited evidence that practitioner-judged stiffness is associated with radiographic findings of sagittal rotational mobility. Fifteen studies investigated spinal stiffness in prognosis or treatment decision-making, providing limited evidence that spinal stiffness is unlikely to independently predict patient outcomes, though stiffness may influence a practitioner's application of non-thrust manipulative techniques. Nine studies investigating the effects of manipulative techniques on spinal stiffness provide very limited evidence that there is no change in spinal stiffness following thrust or non-thrust manipulation in asymptomatic individuals and non-thrust techniques in symptomatic persons, with only one study supporting an immediate, but not sustained, stiffness decrease following thrust manipulation in symptomatic individuals.
The existing limited evidence does not support an association between spinal stiffness and manipulative treatment outcomes. There is a need for additional research investigating the effects of manipulation on spinal stiffness in persons with spinal pain.
综述和讨论测量脊柱刚度的方法以及与刚度相关的因素，刚度在诊断、预后和治疗决策中的应用，以及手法治疗对刚度的影响。
系统检索 MEDLINE、EMBASE、CINAHL、AMED 和 ICL 数据库。纳入的研究涉及与刚度相关的四个结构中的一个：测量、诊断、预后和/或治疗决策，以及手法对刚度的影响。脊柱刚度定义为力与位移的关系。
本综述共讨论了 104 项研究，其中大多数研究集中于刚度的测量，最常见于无症状人群。有 8 项研究调查了脊柱刚度在诊断中的应用，提供了有限的证据表明，从业者判断的刚度与矢状面旋转活动的放射学发现有关。15 项研究调查了脊柱刚度在预后或治疗决策中的应用，提供了有限的证据表明，脊柱刚度不太可能独立预测患者的结局，但刚度可能影响从业者对非推力手法治疗技术的应用。9 项研究调查手法治疗对脊柱刚度的影响，提供了非常有限的证据表明，在无症状个体中，推力或非推力手法治疗后脊柱刚度没有变化，在有症状个体中，非推力技术治疗后脊柱刚度也没有变化，只有一项研究支持在有症状个体中，推力手法治疗后即刻但不持续的刚度降低。
现有有限的证据不支持脊柱刚度与手法治疗结果之间的关联。需要进一步研究手法治疗对脊柱疼痛患者脊柱刚度的影响。
