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Introduction: Manual therapy (MT) hypothetically affects discrepant neuromuscular control and movement observed in populations with low back pain (LBP). Previous studies have demonstrated the limited influence of MT on movement, predominately during range of motion (ROM) testing. It remains unclear if MT affects neuromuscular control in mobility-based activities of daily living (ADLs). The sit-to-stand (STS) task represents a commonly-performed ADL that is used in a variety of clinical settings to assess functional and biomechanical performance., Objective: To determine whether MT affects functional performance and biomechanical performance during a STS task in a population with LBP., Methods: Kinematic data were recorded from the pelvis and thorax of participants with LBP, using an optoelectronic motion capture system as they performed a STS task before and after MT from November 2011 to August 2014. MT for each participant consisted of two high-velocity low-amplitude spinal manipulations, as well as two grade IV mobilizations of the lumbar spine and pelvis targeted toward the third lumbar vertebra and sacroiliac joint in a side-lying position; the order of these treatments was randomized. Pelvis and thorax kinematic data were used to derive the time-varying lumbar angle in the sagittal plane for each STS trial. The difference between the maximum and minimum lumbar angles during the STS trial determined the sagittal ROM that was used as the biomechanical outcome. Time to complete each STS trial was used as a functional measure of performance. Pre-MT and post-MT values for the lumbar sagittal ROM and time to completion were statistically analysed using paired samples t-tests., Results: Data were obtained from 40 participants with 35 useful datasets (NRS = 3.3 ± 1.2; 32.4 ± 9.8 years; 16 females, 19 males). After MT, lumbar sagittal ROM increased by 2.7 ± 5.5 degrees ( p  = 0.007). Time to complete the STS test decreased by 0.4 ± 0.4 s ( p  < 0.001)., Discussion: These findings provide preliminary evidence that MT might influence the biomechanical and functional performance of an STS task in populations with LBP. The MT intervention in this study involved a combination of spinal manipulations and mobilizations. Future work will expand upon these data as a basis for targeted investigations on the effects of either spinal manipulation and mobilization on neuromuscular control and movement in populations with LBP., Competing Interests: Competing interestsThe authors declare that they have no competing interests., (© The Author(s). 2020.)

Objective: Low back disorders (LBDs) are the most common complaint among workers; therefore, many questions arise about cost-effective treatment approaches. This investigation evaluated the differences in cost-related factors among a population of patients selecting chiropractic vs allopathic care for the treatment of nonspecific LBDs. The study hypothesis was that chiropractic care would be more cost-effective or equivalent to allopathic care for the noncomplicated LBDs., Methods: Cases were extracted from an insurance company database of patients reporting work-related low back injuries who were treated with either chiropractic or allopathic approaches. Cases were matched using the International Classification of Diseases, Ninth Revision, codes 722 (intervertebral disk disorders), 724 (other and unspecified disorders of the back), and 847 (sprains and strains of other and unspecified parts). The data set included 76 chiropractic cases and 2386 medical cases., Results: The total amount paid by the insurance company was 1.7 times higher for patients treated by doctors of chiropractic (DCs) compared with those treated by medical doctors (MDs), and the cost of clinical treatment was 3.3 times higher for the DCs than MDs., Conclusion: The cost for treatment by DCs was greater than that of MDs for similarly classified conditions affecting the low back. The amount paid by the insurance company was primarily related to the number of services given by each provider.

Objective: Carpal tunnel syndrome (CTS) is a major, costly public health issue that could be dramatically affected by the identification of additional conservative care treatment options. Our study aimed to evaluate the effectiveness of two distinct massage therapy protocols on strength, function, and symptoms associated with CTS., Design: This was a randomized pilot study design with double pre-tests and subjects blinded to treatment group assignment., Setting/location: The setting for this study was a wellness clinic at a teaching institution in the United States., Subjects: Twenty-seven (27) subjects with a clinical diagnosis of CTS were included in the study., Interventions: Subjects were randomly assigned to receive 6 weeks of twice-weekly massage consisting of either a general (GM) or CTS-targeted (TM) massage treatment program., Outcome Measures: Dependent variables included hand grip and key pinch dynamometers, Levine Symptom and Function evaluations, and the Grooved Pegboard test. Evaluations were conducted twice during baseline, 2 days after the 7th and 11th massages, and at a follow-up visit 4 weeks after the 12th massage treatment., Results: A main effect of time was noted on all outcome measures across the study time frame (p < 0.001); improvements persist at least 4 weeks post-treatment. Comparatively, TM resulted in greater gains in grip strength than GM (p = 0.04), with a 17.3% increase over baseline (p < 0.001), but only a 4.8% gain for the GM group (p = 0.21). Significant improvement in grip strength was observed following the 7th massage. No other comparisons between treatment groups attained statistical significance., Conclusions: Both GM and TM treatments resulted in an improvement of subjective measures associated with CTS, but improvement in grip strength was only detected with the TM protocol. Massage therapy may be a practical conservative intervention for compression neuropathies, such as CTS, although additional research is needed.

Two experiments reported the effect of movement time and knowledge of results on overall spatial errors in rapid simultaneous bimanual aiming movements. In Exps. 1 (n=32) and 2 (n=32), participants used light, aluminum levers oriented vertically in the sagittal plane to make reversal movements over the same distance (20 degrees - 20 degrees or 60 degrees - 60 degrees) or different distances (20 degrees - 60 degrees) in each arm in 250, 350, or 450 msec. to the reversal point. The participants in Exp. 1 were given knowledge of results on the spatial and temporal accuracy for both arms, while in Exp. 2 knowledge of results was provided for one arm only. Strong speed-accuracy tradeoffs were shown for all groups in both experiments, but errors were larger in the different distance movements compared to the same distance groups. Spatial errors were also elevated in Exp. 2 when knowledge of results was not available compared to those conditions where knowledge of results was available. Overall, bimanual speed-accuracy tradeoffs are similar to single arm movements when one moves the same distance in each arm and when knowledge of results is available.

Objective: To evaluate the effect of practice schedule, type of feedback, and experience level on simulated force production accuracy in chiropractic students., Methods: Thirty-three chiropractic students simulated a high-velocity low-amplitude prone thoracic spine manipulation. Three force goals based on percent of maximum thrusting ability were used in blocked and random variable practice. Participants received either visual feedback or knowledge of performance feedback regarding their force-time history. Serial retention tests without feedback followed blocked and random variable practice. Peak and average rates of thrust development, as well as the constant error, absolute constant error, and variable error of peak force production, were calculated., Conclusion: Familiarity and practice of high-velocity low-amplitude spinal manipulation resulted in greater accuracy of peak force production. Lower error scores were observed in acquisition with blocked variable practice. However, short-term accuracy was enhanced in retention when participants had used random variable practice. Random variable practice combined with visual feedback improved force production accuracy in retention. The variability of peak force production increased to 61% of maximum thrusting ability and then decreased. The greatest accuracy with least variability of peak force production was seen near 75% of maximum thrusting ability.