Yu Xiaojie, Wang Xiangrui, Zhang John, Wang Ying
Department of Physical Medicine and Rehabilitation, Renji Hospital, Jiaotong University, School of Medicine, Shanghai, China.
J Manipulative Physiol Ther. 2012 Jul;35(6):437-45. doi: 10.1016/j.jmpt.2012.07.001. Epub 2012 Aug 16.
The purpose of this study was to investigate the effects of instrument-assisted spinal manipulative therapy (SMT) targeted to the low-back region on changes in pressure pain thresholds (PPTs) and basal electromyographic activity (BEA) in asymptomatic participants.
A repeated-measures, single-blind, randomized trial was conducted on 30 participants, 19 men and 11 women (mean age, 24.5±3.9 years), without a current history of low-back pain. Each participant attended all 2 treatment group sessions and received instrument-assisted SMT or a sham manipulation procedure. Instrument-assisted SMT was administered using the Activator Method protocol. Bilateral PPT levels over L5-S1 zygapophyseal joints, L5 dermatome, and first dorsal interossei in the hand and bilateral BEA of low back and neck region were assessed pre- and posttreatment by an assessor blinded to the treatment allocation of the participant. A 3-way analysis of variance with time (pre-post) and side (ipslateral, contralateral to the intervention) as within-group variable and intervention (manipulation or sham) as between-group variable was used to evaluate changes in PPT. A paired sample t test was used to analyze the differences between pre- and posttreatment in BEA.
The group vs time interaction was statistically significant for PPT irrespective of the site tested or the side treated. Participants receiving the instrument-assisted SMT experienced greater improvement in PPT when compared with the control group. Paired sample t tests for BEA only show an immediate decrease in BEA of the paraspinal muscle on the pelvic deficiency side of the low-back region.
The application of instrument-assisted SMT resulted in an immediate and widespread hypoalgesic effect with local muscle relaxation in asymptomatic participants. It is hypothesized that therapeutic mechanisms, either segmental or central, may be involved in the therapeutic effects of instrument-assisted SMT.
本研究旨在调查针对下背部区域的器械辅助脊柱手法治疗（SMT）对无症状参与者压力疼痛阈值（PPT）和基础肌电图活动（BEA）变化的影响。
对30名参与者（19名男性和11名女性，平均年龄24.5±3.9岁）进行了一项重复测量、单盲、随机试验，这些参与者目前无下背痛病史。每位参与者参加了所有2个治疗组疗程，并接受了器械辅助SMT或假手法操作程序。器械辅助SMT采用激活器方法协议进行。由对参与者治疗分配不知情的评估者在治疗前后评估双侧L5 - S1关节突关节、L5皮节和手部第一背侧骨间肌的PPT水平以及下背部和颈部区域的双侧BEA。使用以时间（治疗前 - 后）和侧别（干预侧的同侧、对侧）作为组内变量以及干预（手法治疗或假治疗）作为组间变量的三因素方差分析来评估PPT的变化。使用配对样本t检验分析BEA治疗前后的差异。
无论测试部位或治疗侧别如何，PPT的组与时间交互作用在统计学上均具有显著性。与对照组相比，接受器械辅助SMT的参与者在PPT方面有更大改善。BEA的配对样本t检验仅显示下背部区域骨盆缺陷侧椎旁肌的BEA立即下降。
器械辅助SMT的应用在无症状参与者中产生了即时且广泛的镇痛作用以及局部肌肉松弛。据推测，节段性或中枢性治疗机制可能参与了器械辅助SMT的治疗效果。
