Forces applied during manual assessments of low back pain patients
Doctors of chiropractic (DCs) use manual palpation to subjectively assess the relative "stiffness" (resistance) of spinal articulations to help inform decisions regarding where to focus treatment. The objective of this study was to quantify the forces generated by DCs when assessing patients with low back pain (LBP). This is an observational study nested into a three-arm randomized clinical trial evaluating two forms of chiropractic treatment and one sham control. LBP patients of both genders between 21-65 years of age participated in the study. Measurements were collected with the participants lying prone on an examination table embedded with force plates. Three DCs applied manual force downward on the participants to obtain a sense of relative joint resistance over vertebral segments L1-L5, the superior sacrum, and bilateral sacroiliac (SI) joints. Peak forces generated during the manual assessments were extracted using custom-written, semi-automated, MathCad software. The results were descriptively analyzed using SPSS statistical software. Three clinicians manually assessed spinal resistance during 230 observations. Mean peak force ranged from 128-178N. Higher force levels were observed at lower vertebral levels and the pelvis by two of the clinicians. L3 and L4 spinal levels showed the greatest similarity of force applied by 3 DCs.
