Investigation of Acute Effects of Thoracic Manipulation on Trunk Flexion and Balance in Athletes

Year 2023, Volume: 18 Issue: 2, 888 - 900, 31.12.2023

Nihat Sarıalioğlu Rıdvan Türkeri

https://doi.org/10.33459/cbubesbd.1326015

Abstract

The aim of this study is to examine the acute effects of thoracic manipulation on trunk flexion and balance characteristics in athletes. 60 male team athletes with a mean age of 22.60±0.32 years participated in the study voluntarily. Trunk flexion values and balance levels of all participants were determined before manipulation. After the measurements, the participants were randomly divided into two groups as the thoracic manipulation group (TMG) and the placebo manipulation group (PMG). Then, as a single session, thoracic manipulation was applied to the TMG group and placebo thoracic manipulation was applied to the PMG group. The trunk flexions and balance levels of each participant were remeasured after the application, and the differences before and after the application were examined. Since the data analyzed via SPSS 25.0 package program showed normal distribution, paired-t test was used to evaluate the pre-application and post-application results. The results were analyzed at the p<0.05 significance level. In the results of the study, it was determined that there was a significant improvement in the standard deviation of forward and backward sway (FBSD), medial-lateral sway (MLSD) and used perimeter (P) parameters in post-application static balance. A significant improvement in the mean balance error monitoring (ATE) parameter in the post-application dynamic balance was also determined. An increase in trunk flexion values was observed in the TMG group after the application. As a result, it is concluded that high-velocity, low-amplitude (HVLA) thoracic manipulation application provides instant positive contributions to trunk mobility and balance feature in athletes.

Keywords

Thoracic manipulation, Trunk flexion, Balance, Acute effect

Sporcularda Torakal Manipülasyonun Gövde Fleksiyonu ve Dengeye Akut Etkilerinin İncelenmesi

Abstract

Bu araştırmanın amacı, torakal manipülasyon uygulamasının sporcularda gövde fleksiyonu ve denge özelliklerine olan akut etkilerinin incelenmesidir. Araştırmaya yaş ortalamaları 22,60±0,2 yıl olan 60 erkek takım sporcusu gönüllü olarak katılmıştır. Tüm katılımcıların manipulasyon öncesi gövde fleksiyon değerleri ve denge düzeyleri belirlenmiştir. Ölçümler sonrası katılımcılar randomize şekilde, torakal manipülasyon uygulanan grup (TMG) ve plasebo manipülasyon uygulanan grup (PMG) olarak iki gruba ayrılmıştır Daha sonra tek seans olarak, TMG grubuna torakal manipülasyon, PMG grubuna ise plasebo torakal manipülasyon uygulaması yapılmıştır. Her katılımcının uygulama sonrası gövde fleksiyonları ve denge düzeyleri yeniden ölçülmüş, uygulama öncesi ve sonrası farklılıklar incelenmiştir. SPSS 25.0 paket program aracılığıyla, verilerin normalliği sınanmış, veriler normal dağılım gösterdiğinden uygulama öncesi ve sonrası sonuçların değerlendirilmesinde paired-t testi kullanılmıştır. Sonuçlar p<0.05 anlamlılık düzeyinde analiz edilmiştir. Araştırmanın sonuçlarında, uygulama sonrası statik dengede, ileri ve geri salınımın standart sapması (FBSD), medial-lateral salınımın standart sapması (MLSD) ve kullanılan çevre (P) parametrelerinde, dinamik dengede de ortalama denge hatası izleme (ATE) parametresinde anlamlı iyileşme olduğu tespit edilmiştir. Gövde fleksiyon değerlerinde ise, TMG grubunda uygulama sonrasında artış olduğu görülmüştür. Sonuç olarak, sporcularda yüksek hızlı, düşük amplitüdlü (HVLA) torakal manipülasyon uygulamasının gövde mobilitesine ve denge özelliğine anlık olumlu katkılar sunduğu kanaatine varılmaktadır.

Keywords

Torakal manipülasyon, Gövde fleksiyonu, Denge, Akut etki

References

• Adams, G., & Sim, J. (1998). A Survey of UK manual therapists' practice of and attitudes towards manipulation and its complications. Physiotherapy Research International, 3(3), 206-227. https://doi.org/10.1002/pri.141
• Atchison, J. W., Tolchin, R. B., Ross, B. S., & Eubanks, J. E. (2021). Manipulation, traction, and massage. In: Cifu D. X., Ed., Braddom's physical medicine and rehabilitation (pp. 316-337). Elsevier.
• Cardinale, M., Boccia, G., Greenway, T., Evans, O., & Rainoldi, A. (2015). The acute effects of spinal manipulation on neuromuscular function in asymptomatic individuals: A Preliminary study. Physical Therapy in Sport, 16(2), 121-126. https://doi.org/10.1016/j.ptsp.2014.06.004
• Cho, J., Lee, E., & Lee, S. (2017). Upper thoracic spine mobilization and mobility exercise versus upper cervical spine mobilization and stabilization exercise in individuals with forward head posture: A Randomized clinical trial. BMC Musculoskeletal Disorders, 18(1), 1-10. https://doi.org/10.1186/s12891-017-1889-2
• Cohen J. (1992) Quantitative methods in psychology a power primer. Psychological Bulletin, 112(1), 55-159. https://doi.org/10.1037//0033-2909.112.1.155
• Corso, M., Mior, S. A., Batley, S., Tuff, T., da Silva-Oolup, S., Howitt, S., & Srbely, J. (2019). The Effects of spinal manipulation on performance-related outcomes in healthy asymptomatic adult population: A Systematic review of best evidence. Chiropractic & Manual Therapies, 27(1), 1-18. https://doi.org/10.1186/s12998-019-0246-y
• Cuesta-Vargas, A. I., García-Romero, J. C., Arroyo-Morales, M., Diego-Acosta, Á. M., & Daly, D. J. (2011). Exercise, manual therapy, and education with or without high-intensity deep-water running for nonspecific chronic low back pain: A Pragmatic randomized controlled trial. American Journal of Physical Medicine & Rehabilitation, 90(7), 526-538. https://doi.org/10.1097/PHM.0b013e31821a71d0
• Deutschmann, K. C., Jones, A. D., & Korporaal, C. M. (2015). A Non-randomised experimental feasibility study into the immediate effect of three different spinal manipulative protocols on kicking speed performance in soccer players. Chiropractic & Manual Therapies, 23(1), 1-10. https://doi.org/10.1097/PHM.0b013e31821a71d0
• Donatelli, R., Dimond, D., & Holland, M. (2012). Sport-specific biomechanics of spinal injuries in the athlete (throwing athletes, rotational sports, and contact-collision sports). Clinics in Sports Medicine, 31(3), 381-396. https://doi.org/10.1016/j.csm.2012.03.003
• Duray, M., Gülşen, Ç., Altuğ, F., Baskan, E., & Cavlak, U. (2018). Nörolojik hastalara bakım verenlerin bakım yükünün gövde kas kuvveti, enduransı ve esnekliği üzerine etkisi. Türk Fizyoterapi ve Rehabilitasyon Dergisi, 29(3), 79-84. https://doi.org/10.21653/tfrd.343067
• Durmus, D., Durmaz, Y., & Canturk, F. (2010). Effects of therapeutic ultrasound and electrical stimulation program on pain, trunk muscle strength, disability, walking performance, quality of life, and depression in patients with low back pain: a randomized-controlled trial. Rheumatology International, 30(7), 901-910. https://doi.org/10.1007/s00296-009-1072-7
• Dvorak, H., Kujat, C., & Brumitt, J. (2011). Effect of therapeutic exercise versus manual therapy on athletes with chronic low back pain. Journal of Sport Rehabilitation, 20(4), 494-504. https://doi.org/10.1123/jsr.20.4.494
• El-Khoury, G. Y., & Whitten, C. G. (1993). Trauma to the upper thoracic spine: anatomy, biomechanics, and unique imaging features. American Journal of Roentgenology, 160(1), 95-102. https://doi.org/10.2214/ajr.160.1.8416656
• Espí-López, G. V., López-Martínez, S., Inglés, M., Serra-Añó, P., & Aguilar-Rodríguez, M. (2018). Effect of manual therapy versus proprioceptive neuromuscular facilitation in dynamic balance, mobility and flexibility in field hockey players. A randomized controlled trial. Physical Therapy in Sport, 32, 173-179. https://doi.org/10.1016/j.ptsp.2018.04.017
• Gyer, G., Michael, J., Inklebarger, J., & Tedla, J. S. (2019). Spinal manipulation therapy: Is it all about the brain? A Current review of the neurophysiological effects of manipulation. Journal of Integrative Medicine, 17(5), 328-337. https://doi.org/10.1016/j.joim.2019.05.004
• Haavik, H., & Murphy, B. (2012). The role of spinal manipulation in addressing disordered sensorimotor integration and altered motor control. Journal of Electromyography and Kinesiology, 22(5), 768-776. https://doi.org/10.1016/j.jelekin.2012.02.012
• Harrison, D. E., Cailliet, R., Harrison, D. D., Troyanovich, S. J., & Harrison, S. O. (1999). A review of biomechanics of the central nervous system—Part III: Spinal cord stresses from postural loads and their neurologic effects. Journal of Manipulative and Physiological Therapeutics, 22(6), 399-410. https://doi.org/10.1016/s0161-4754(99)70086-2
• Honoré, M., Leboeuf-Yde, C., & Gagey, O. (2018). The regional effect of spinal manipulation on the pressure pain threshold in asymptomatic subjects: A Systematic literature review. Chiropractic & Manual Therapies, 26(1), 1-18. https://doi.org/10.1186/s12998-018-0181-3
• Hrysomallis, C. (2011). Balance ability and athletic performance. Sports Medicine, 41(3), 221-232. https://doi.org/10.2165/11538560-000000000-00000
• Huisman, P. A., Speksnijder, C. M., & de Wijer, A. (2013). The effect of thoracic spine manipulation on pain and disability in patients with non-specific neck pain: A Systematic review. Disability and Rehabilitation, 35(20), 1677-1685. https://doi.org/10.3109/09638288.2012.750689
• Izzo, R., Guarnieri, G., Guglielmi, G., & Muto, M. (2013). Biomechanics of the spine. Part II: Spinal instability. European Journal of Radiology, 82(1), 127-138. https://doi.org/10.1016/j.ejrad.2012.07.023
• Knudson, D. V. (2018). Warm-up and flexibility. In: Chandler T. J., Brown L. E., Eds., Conditioning for strength and human performance (pp. 212-231). Routledge.
• Liebsch, C., & Wilke, H. J. (2018). Basic biomechanics of the thoracic spine and rib cage. In: F. Galbusera & H. J. Wilke (Eds.), Biomechanics of the spine (pp. 35-50). Academic Press.
• Marshall, B. M., Franklyn-Miller, A. D., King, E. A., Moran, K. A., Strike, S. C., & Falvey, É. C. (2014). Biomechanical factors associated with time to complete a change of direction cutting maneuver. The Journal of Strength & Conditioning Research, 28(10), 2845-2851. https://doi.org/10.1519/JSC.0000000000000463
• Michaelson, P., Michaelson, M., Jaric, S., Latash, M. L., Sjolander, P., Djupsjobacka, M. (2003) Vertical posture and head stability in patients with chronic neck pain. Journal of Rehabilitation Medicine, 35(5), 229-235. https://doi.org/10.1080/16501970306093
• Michener, L. A., Kardouni, J. R., Sousa, C. O., & Ely, J. M. (2015). Validation of a sham comparator for thoracic spinal manipulation in patients with shoulder pain. Manual Therapy, 20(1), 171-175. https://doi.org/10.1016/j.math.2014.08.008
• Minarini, G., Ford, M., & Esteves, J. (2018). Immediate effect of T2, T5, T11 thoracic spine manipulation of asymptomatic patient on autonomic nervous system response: single-blind, parallel-arm controlled-group experiment. International Journal of Osteopathic Medicine, 30, 12-17. https://doi.org/10.1016/j.ijosm.2018.10.002
• Mıschenko, N., Kolokoltsev, M., Romanova, E., Ilyına, G., Kotlyar, N., Tsapov, E., & Ustselemova, N. (2020). Posture correction methods and physical qualities development in 10-12-year-old karate athletes. Journal of Physical Education and Sport, 20(6), 3146-3152. https://doi.org/10.7752/jpes.2020.s6426
• Myrick, K. M., Pallone, A. S., Feinn, R. S., Ford, K. M., & Garbalosa, J. C. (2019). Trunk muscle endurance, flexibility, stride foot balance, and contralateral trunk lean in collegiate baseball pitchers. The Journal of Strength & Conditioning Research, 33(10), 2641-2647. https://doi.org/10.1519/JSC.0000000000003292
• Oda, I., Abumi, K., Lü, D., Shono, Y., & Kaneda, K. (1996). Biomechanical role of the posterior elements, costovertebral joints, and rib cage in the stability of the thoracic spine. Spine, 21(12), 1423-1429. https://doi.org/10.1097/00007632-199606150-00005
• Niazi, I. K., Kamavuako, E. N., Holt, K., Janjua, T. A. M., Kumari, N., Amjad, I., & Haavik, H. (2020). The effect of spinal manipulation on the electrophysiological and metabolic properties of the tibialis anterior muscle. In Healthcare, 8(4), 548-563. https://doi.org/10.3390/healthcare8040548
• Okubo, Y., Kaneoka, K., Imai, A., Shiina, I., Tatsumura, M., Izumi, S., & Miyakawa, S. (2010). Electromyographic analysis of transversus abdominis and lumbar multifidus using wire electrodes during lumbar stabilization exercises. Journal of Orthopaedic & Sports Physical Therapy, 40(11), 743-750. https://doi.org/10.2519/jospt.2010.3192
• Özmen, T., & Güneş, G. Y. (2017). Prepubertal amatör cimnastikçilerde dinamik denge, dikey sıçrama ve gövde stabilitesi arasındaki ilişki. Spor Bilimleri Dergisi, 28(1), 24-29. https://doi.org/0.17644/sbd.337991
• Panjabi, M. M. (1992) The stabilizing system of the spine. Part II. Neutral zone and instability hypothesis. Journal of Spinal Disorders, 5(4), 390-397. https://doi.org/10.1097/00002517-199212000-00002
• Pickar, J. G. (2002). Neurophysiological effects of spinal manipulation. The Spine Journal, 2(5), 357-371. https://doi.org/10.1016/s1529-9430(02)00400-x
• Reeves, N. P., Narendra, K. S., & Cholewicki, J. (2007). Spine stability: The Six blind men and the elephant. Clinical Biomechanics, 22(3), 266-274. https://doi.org/10.1016/j.clinbiomech.2006.11.011
• Rogan, S., Taeymans, J., Clarys, P., Clijsen, R., & Tal-Akabi, A. (2019). Feasibility and effectiveness of thoracic spine mobilization on sympathetic/parasympathetic balance in a healthy population-a randomized controlled double-blinded pilot study. Archives of Physiotherapy, 9(1), 1-9. https://doi.org/10.1186/s40945-019-0067-2
• Romero del Rey, R., Saavedra Hernandez, M., Rodriguez Blanco, C., Palomeque del Cerro, L., & Alarcon Rodriguez, R. (2022). Short-term effects of spinal thrust joint manipulation on postural sway in patients with chronic mechanical neck pain: A randomized controlled trial. Disability and Rehabilitation, 44(8), 1227-1233. https://doi.org/10.1080/09638288.2020.1798517
• Sözen H., & Akyıldız C. (2019). Spor bilimlerinde denge ve dengenin değerlendirilmesi. Düz, S., ve ark. (Ed), Spor bilimleri alanında yeni ufuklar. Gece Kitaplığı.
• Spencer, S., Wolf, A., & Rushton, A. (2016). Spinal-exercise prescription in sport: Classifying physical training and rehabilitation by intention and outcome. Journal of Athletic Training, 51(8), 613-628. https://doi.org/10.4085/10626050-51.10.03
• Srokowska, A., Bodek, M., Kurczewski, M., Srokowski, G., Siedlaczek, M., & Lewandowski, A. (2019). Deep tissue massage and mobility and pain in the thoracic spine. Baltic Journal of Health and Physical Activity, 11(2), 99-108. https://doi.org/10.29359/BJHPA.11.2.10
• Sueki, D., Almaria, S., Bender, M., & McConnell, B. (2020). The immediate and 1-week effects of mid-thoracic thrust manipulation on lower extremity passive range of motion. Physiotherapy Theory and Practice, 36(6), 720-730. https://doi.org/10.1080/09593985.2018.1492056
• Sung, Y. B., Lee, J. H., & Park, Y. H. (2014). Effects of thoracic mobilization and manipulation on function and mental state in chronic lower back pain. Journal of Physical Therapy Science, 26(11), 1711-1714. https://doi.org/10.1589/jpts.26.1711
• Takeuchi, T., Abumi, K., Shono, Y., Oda, I., & Kaneda, K. (1999). Biomechanical role of the intervertebral disc and costovertebral joint in stability of the thoracic spine: A Canine model study. Spine, 24(14), 1414. https://doi.org/10.1097/00007632-199907150-00005
• Taylor, H. H., & Murphy, B. (2008). Altered sensorimotor integration with cervical spine manipulation. Journal of Manipulative and Physiological Therapeutics, 31(2), 115-126. https://doi.org/10.1016/j.jmpt.2007.12.011
• Van Middelkoop, M., Rubinstein, S. M., Kuijpers, T., Verhagen, A. P., Ostelo, R., Koes, B. W., & Tulder, M. W. (2011) A Systematic review on the effectiveness of physical and rehabilitation interventions for chronic non-specific low back pain. European Spine Journal, 20(1), 19-39. https://doi.org/10.1007/s00586-010-1518-3
• Vezina, M. J., & Hubley-Kozey, C. L. (2000). Muscle activation in therapeutic exercises to improve trunk stability. Archives of Physical Medicine and Rehabilitation, 81(10), 1370-1379. https://doi.org/10.1053/apmr.2000.16349
• Vieira-Pellenz, F., Oliva-Pascual-Vaca, Á., Rodriguez-Blanco, C., Heredia-Rizo, A. M., Ricard, F., & Almazán-Campos, G. (2014). Short-term effect of spinal manipulation on pain perception, spinal mobility, and full height recovery in male subjects with degenerative disk disease: A Randomized controlled trial. Archives of Physical Medicine and Rehabilitation, 95(9), 1613-1619. https://doi.org/10.1016/j.apmr.2014.05.002
• Walser, R. F., Meserve, B. B., & Boucher, T. R. (2009). The effectiveness of thoracic spine manipulation for the management of musculoskeletal conditions: A Systematic review and meta-analysis of randomized clinical trials. Journal of Manual & Manipulative Therapy, 17(4), 237-246. https://doi.org/10.1179/106698109791352085
• Welch A, & Boone R. (2008). Sympathetic and parasympathetic responses to specific diversified adjustments to chiropractic vertebral subluxations of the cervical and thoracic spine. Journal of Chiropractic Medicine, 7(3), 86–93. https://doi.org/10.1016/j.jcm.2008.04.001
• Willems, J. M., Jull, G. A., & Ng, J. F. (1996). An In vivo study of the primary and coupled rotations of the thoracic spine. Clinical Biomechanics, 11(6), 311-316. https://doi.org/10.1016/0268-0033(96)00017-4
• Wong, T. K., Ma, A. W., Liu, K. P., Chung, L. M., Bae, Y. H., Fong, S. S., & Wang, H. K. (2019). Balance control, agility, eye–hand coordination, and sport performance of amateur badminton players: A cross-sectional study. Medicine, 98(2), 1-6. https://doi.org/10.1097/MD.0000000000014134
• Yang, S. R., Kim, K., & Park, S. J. (2015). The effect of thoracic spine mobilization and stabilization exercise on the muscular strength and flexibility of the trunk of chronic low back pain patients. Journal of Physical Therapy Science, 27(12), 3851-3854. https://doi.org/10.1589/jpts.27.3851
• Zemková, E., Muyor, J. M., & Jeleň, M. (2018). Association of trunk rotational velocity with spine mobility and curvatures in para table tennis players. International Journal of Sports Medicine, 39(14), 1055-1062. https://doi.org/10.1055/a-0752-4224