H-Reflex Attenuation After Lumbosacral Manipulation in Patients With Low Back Pain
Spinal manipulation is a manual technique commonly used for the treatment of low back pain. The physiologic mechanisms of the spinal manipulation are largely unknown. One basic physiologic response for spinal manipulation is an alteration in motoneuronal activity, as assessed by the Hoffmann reflex (H-reflex) technique. The purpose of this study was to determine the effect of spinal manipulation on the amplitude and onset latency of H-reflex and on H/M amplitude ratio in patients with low back pain. Fifty-Eight patients with low back pain aged between 20-60 years, who had no exclusion criteria were included. Tibial nerve H-reflex and M wave were recorded before and after Lumbosacral spinal manipulation. Lumbosacral manipulation significantly decreased the amplitude of the H-reflex and H/M amplitude ratio (P<0.05). It had no significant effect on H-reflex latency or M wave amplitude and latency (P>0.05). Lumbosacral manipulation produces attenuation of alpha motoneuronal excitability. These findings support this theory that manual spinal therapy can lead to a reduction in muscle tone.
Druss BG, Marcus SC, Olfson M, Pincus HA. The most expensive medical conditions in America. Health Aff (Millwood) 2002; 21:105–11.
Andersson GB: Epidemiological features of chronic low-back pain. Lancet 1999, 354(9178):581-585.
Carey TS, Garrett JM, Jackman AM: Beyond the good prognosis. Examination of an inception cohort of patients with chronic low back pain. Spine (Phila Pa 1976) 2000, 25(1):115-120.
Klenerman L, Slade PD, Stanley IM, Pennie B, Reilly JP, Atchison LE, Troup JD, Rose MJ: The prediction of chronicity in patients with an acute attack of low back pain in a general practice setting. Spine (Phila Pa 1976) 1995, 20(4):478-484.
Von Korff M: Studying the natural history of back pain. Spine (Phila Pa 1976) 1994, 19(18 Suppl):2041S-2046S
Mousavi SJ, Akbari ME, Mehdian H, Mobini B, Montazeri A, Akbarnia B, Parnianpour M. Low back pain in Iran: a growing need to adapt and implement evidence-based practice in developing countries. Spine (Phila Pa 1976). 2011 May 1;36(10):E638-46
Louw QA, Morris LD, Grimmer-Somers K. The prevalence of low back pain in Africa: a systematic review. BMC Musculoskelet Disord 2007; 8:105.
Freburger JK, Holmes GM, Agans RP, Jackman AM, Darter JD, Wallace AS, et al. The rising prevalence of chronic low back pain. Arch Intern Med 2009; 169:251–8.
Bronfort G. Spinal manipulation: current state of research and its indications. Neurol Clin 1999; 17:91-111.
Thomson O, Haig L, Mansfield L. The effects of high-velocity low amplitude thrust manipulation and mobilisation techniques on pressure pain threshold in the lumbar spine [abstract]. Int J Osteopath Med 2009; 12:56-62.
Maigne R. Diagnosis and treatment of pain of vertebral origin. J Manipulative Physiol Ther 1999; 15:71-5.
Picker J. Neurophysiological effects of spinal manipulation. Spine J 2002;5:357-71.
Greenman P. Principles of manual medicine. 4th ed. Philadelphia: Lippincott; 2003. p 344-61.
Fryer G, Carub J, McIver S. The effect of manipulation and mobilization on pressure pain thresholds in the thoracic spine. J Osteopath Med 2004;7:8-14.
Vernon H. Pressure pain threshold evaluation of the effect of spinal manipulation in the treatment of chronic neck pain: a pilot study. J Manipulative Physiol Ther 1990;13:13.
DeVocht J, Pickar J, Wilder D. Spinal manipulation alters electromyographic activity of paraspinal muscles: a descriptive study. J Manipulative Physiol Ther 2005; 28:465-71.
Magine J, Vautravers PH. Mechanism of action of spinal manipulative therapy. Joint Bone Spine 2003; 70:336-41.
Desmedt JE. Mechanisms of vibration-induced inhibition or potentiation: tonic vibration reflex and vibration paradox in man. Adv Neurol 1983; 39:671-83.
Ziemann U, Ishii K, Borgheresi A, Yaseen Z, Battaglia F, Hallett M, Cincotta M, Wassermann EM. Dissociation of the pathways mediating ipsilateral and contralateral motor-evoked potentials in human hand and arm muscles. J Physiol 1999; 518 (Pt 3):895-906.
Kang YM, Choi WS, Pickar JG. Electrophysiologic evidence for an intersegmental reflex pathway between lumbar paraspinal tissues. Spine 2002; 27:E56-63.
Fulton RC, Strutton PH, McGregor AH, Davey NJ. Fatigueinducedchange in corticospinal drive to back muscles in elite rowers. Exp Physiol 2002; 87:593-600.
Dishman JD, Burke J. Spinal reflex excitability changes after cervical and lumbar spinal manipulation: a comparative study. Spine J 2003; 3:204-12.
Desmedt JE, Godaux E. Mechanism of the vibration paradox:excitatory and inhibitory effects of tendon vibration on single soleus muscle motor units in man. J Physiol 1978; 285: 197-207.
Green RM. Ethical Issues. Handbook of transcranial magnetic stimulation. London: Arnold; 2002. p. 50-6.
Dishman J, Bulbulian R. Spinal reflex attenuation associated with spinal manipulation. Spine 2000; 25:2519-25.
Hoch M. Effect of functional fatigue on the soleus Hoffman reflex in subjects with functional ankle instability [dissertation]. Athens: Ohio University; 2008
Herzog W. Mechanical, physiologic, and neuromuscular considerations of chiropractic treatments. In: Lawrence DJ, Cassidy JD, McGregor M, et al., eds. Advances in Chiropractic, vol. 3. New York: Mosby-Yearbook, 1996:69–285.
Orakifar N, Kamali F, Pirouzi S, Jamshidi F. Sacroiliac joint manipulation attenuates alpha-motoneuron activity in healthy women: a quasi experimental study. Arch Phys Med Rehabil. 2012 Jan;93(1):56-61.
Suter 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 Nov-Dec;28(9):667-72.