Abstract
This study aimed to investigate the effects of a single session of chiropractic spinal adjustment on the cortical drive to the lower limb in chronic stroke patients. In a single-blinded, randomized controlled parallel design study, 29 individuals with chronic stroke and motor weakness in a lower limb were randomly divided to receive either chiropractic spinal adjustment or a passive movement control intervention. Before and immediately after the intervention, transcranial magnetic stimulation (TMS)-induced motor evoked potentials (MEPs) were recorded from the tibialis anterior (TA) muscle of the lower limb with the greatest degree of motor weakness. Differences in the averaged peak-peak MEP amplitude following interventions were calculated using a linear regression model. Chiropractic spinal adjustment elicited significantly larger MEP amplitude (pre = 0.24 ± 0.17 mV, post = 0.39 ± 0.23 mV, absolute difference = +0.15 mV, relative difference = +92%, p < 0.001) compared to the control intervention (pre = 0.15 ± 0.09 mV, post = 0.16 ± 0.09 mV). The results indicate that chiropractic spinal adjustment increases the corticomotor excitability of ankle dorsiflexor muscles in people with chronic stroke. Further research is required to investigate whether chiropractic spinal adjustment increases dorsiflexor muscle strength and walking function in people with stroke.
Highlights
Stroke is the second-most common cause of death worldwide [1] and the leading cause of severe disability in adults [2]
The results of this study indicate that the changes in muscle force output following spinal adjustments are at least in part occurring at the cortical level, because it leads to significantly larger MEPmax for transcranial magnetic stimulation (TMS) induced input-output curves for both an upper and lower limb muscle, with significantly larger amplitudes of movement-related cortical potential (MRCP) components following the spinal adjustments, while no changes were observed in the spinal excitability measures [21]
The results suggested that the chiropractic adjustment elicited larger motor evoked potentials (MEPs) compared to the control intervention (Figure 2)
Summary
Stroke is the second-most common cause of death worldwide [1] and the leading cause of severe disability in adults [2] It has a high prevalence, affecting ∼200 people per 100,000 [3] and often requires extensive rehabilitation, with high economic and social costs [4]. Weakness in ankle dorsiflexor muscles, such as the tibialis anterior (TA) muscle, is one of the major causes of gait dysfunction in people with stroke [6, 7]. Multiple rehabilitation techniques, such as physical therapy, brain-computer interface-based approaches, and motor relearning techniques have been shown to enhance motor recovery after. The site of the spinal subluxation is identified by utilizing a combination of pathophysiologic indicators of spinal dysfunction [17]
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