Abstract
ObjectiveThe objective was to compare thoracic spinal stiffness between healthy participants and participants with chronic thoracic pain and to explore the associations between spinal stiffness, pain and muscle activity. The reliability of spinal stiffness was also evaluated.Material and methodsSpinal stiffness was assessed from T5 to T8 using a mechanical device in 25 healthy participants and 50 participants with chronic thoracic pain (symptoms had to be reported within the evaluated region of the back). The spinal levels for which spinal stiffness was measured were standardized (i.e. T5 to T8 for all participants) to minimize between-individual variations due to the evaluation of different spinal levels. The device load and displacement data were used to calculate the global and terminal spinal stiffness coefficients at each spinal level. Immediately after each assessment, participants were asked to rate their pain intensity during the trial, while thoracic muscle activity was recorded during the load application using surface electromyography electrodes (sEMG). Within- and between-day reliability were evaluated using intraclass correlation coefficients (ICC), while the effects of chronic thoracic pain and spinal levels on spinal stiffness and sEMG activity were assessed using mixed model ANOVAs. Correlations between pain intensity, muscle activity and spinal stiffness were also computed.ResultsICC values for within- and between-day reliability of spinal stiffness ranged from 0.67 to 0.91 and from 0.60 to 0.94 (except at T5), respectively. A significant decrease in the global (F1,73 = 4.04, p = 0.048) and terminal (F1,73 = 4.93, p = 0.03) spinal stiffness was observed in participants with thoracic pain. sEMG activity was not significantly different between groups and between spinal levels. Pain intensity was only significantly and "moderately" correlated to spinal stiffness coefficients at one spinal level (-0.29≤r≤-0.51), while sEMG activity and spinal stiffness were not significantly correlated.ConclusionThe results suggest that spinal stiffness can be reliably assessed using a mechanical device and that this parameter is decreased in participants with chronic thoracic pain. Studies are required to determine the value of instrumented spinal stiffness assessment in the evaluation and management of patients with chronic spine-related pain.
Highlights
Back and neck pain are very common musculoskeletal conditions in the general population, with a one-year prevalence of lumbar, thoracic and neck pain respectively estimated up to 43%, 35% and 32%.[1, 2] The prevalence rate of complementary and alternative medicine use, such as chiropractic and osteopathy, has been reported to be as high as 75% among patients with back and neck pain.[3]
A significant decrease in the global (F1,73 = 4.04, p = 0.048) and terminal (F1,73 = 4.93, p = 0.03) spinal stiffness was observed in participants with thoracic pain. surface electromyography electrodes (sEMG) activity was not significantly different between groups and between spinal levels
The results suggest that spinal stiffness can be reliably assessed using a mechanical device and that this parameter is decreased in participants with chronic thoracic pain
Summary
Back and neck pain are very common musculoskeletal conditions in the general population, with a one-year prevalence of lumbar, thoracic and neck pain respectively estimated up to 43%, 35% and 32%.[1, 2] The prevalence rate of complementary and alternative medicine use, such as chiropractic and osteopathy, has been reported to be as high as 75% among patients with back and neck pain.[3]. [5, 6] In clinical practice, MSSA and PPIVM are assessed by contacting a spinous process with the hypothenar or thenar eminence and applying a gradual and light posterior to anterior pressure.[5] These procedures are performed at multiple spinal levels and dysfunctional segments are usually determined based on various aspects such as the patient’s pain response, the quality of motion, the position during the movement in comparison to adjacent segments and the clinician’s experience of assessing the same spinal level in other patients.[5] most clinicians believe segmental motion analysis is "somewhat" or "very" accurate for estimating spinal mobility [5], conflicting and acceptable evidence have been respectively found for interobserver and intraobserver reproducibility of MSSA, while strong evidence of unacceptable reproducibility has been found for PPIVM [7, 8]. Several factors have been shown to affect the clinician’s sensations or the tissue behavior during this procedure such as patient’s anthropometrics, position and breathing as well as the procedure characteristics (load, velocity, angulation, spinal levels, contact area and breathing) [9, 10], perhaps explaining its limited reliability and inaccuracy
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