Knee Pain Clinical Trial
Official title:
Effects of Lumbosacral Joint Mobilization/Manipulation on Lower Extremity Muscle Neuromuscular Response
The purpose of this study is to gain a better understanding of the effects of lumbopelvic
manual therapy on lower extremity biomechanics and arthrogenic muscle response. As a result
of this study, we also hope that physical therapists, athletic trainers, and other physical
medicine rehabilitation providers will gain a better understanding of lower extremity
injuries and have the scientific evidence to provide patients with techniques which would
allow for efficient return to activities of daily living without restrictions and possibly
prevent future injuries and minimize risk of osteoarthritis.
The objectives of this study are to:
- Determine the amount and duration of arthrogenic muscle response of quadriceps muscles
following lumbopelvic joint manipulation.
- Determine the effects of lumbopelvic joint manipulation on temporospatial parameters of
gait such cadence, step length, velocity and mean peak lower extremity joint moments.
- Determine if a correlation exists between patellofemoral joint pain and lumbopelvic
joint dysfunction.
- Determine the amount of change in clinical outcome measure scores following lumbopelvic
joint manipulation.
It is well known that musculoskeletal dysfunction at one joint is not limited to the joint
itself and can be related to dysfunction at joints proximal or distal in the kinetic chain.
Recent research has focused on the relationship of altered lower extremity kinematics and
common musculoskeletal pathologies.
Pain is often associated with musculoskeletal pathologies and is one of the strongest
stimuli affecting functional activities in a negative manner. Following injury or chronic
dysfunction, inhibitory neurons decrease the ability of musculature to fully recruit
excitatory motor neurons. This can lead to aberrant movement patterns and different
activation of muscles. Muscle inhibition has been attributed as a possible source of altered
motor activation patterns. Pain can be a result or cause of musculoskeletal dysfunction and
does not necessarily precede inhibition, but can have a contributing effect. The presence of
muscle inhibition is considered a limiting factor in the rehabilitation of musculoskeletal
pathologies. If muscle inhibition is properly addressed, individuals and athletes alike,
should be able to more appropriately meet the demands of the activities with a decreased
risk of future injury.
One technique used to determine presence of muscle inhibition is to measure the ability of
the muscle to produce a maximal voluntary isometric contraction and compare values with the
ability of the contralateral muscle. Since the contralateral limb may also experience muscle
inhibition,it is difficult to obtain an accurate measurement of the amount of muscle
inhibition occurring in the ipsilateral limb. A suggested solution is utilize the
burst-superimposition technique which provides the muscle with a supramaximal stimulus to
recruit any remaining muscle fibers which have not been stimulated.
Treatment of muscle inhibition is multifaceted. Utilization of manual therapy techniques
such as joint manipulation or mobilization directed at the lumbopelvic region have been
shown to be successful in disinhibiting lower extremity muscles. Previous studies have
demonstrated sacroiliac joint manipulation disinhibited the quadriceps muscle in individuals
with anterior knee pain. One of the limitations was these studies only observed an immediate
decrease of quadriceps inhibition and the duration of the treatment effect was unknown.
Effects of disinhibition of other lower extremity muscles and duration of disinhibition have
not been determined at this time. It is also unknown what effects manual therapy treatments
directed at the lumbopelvic region have on functional activities such as walking, squatting,
or ascending/descending stairs. By examining these effects, we will be attempting to provide
scientific evidence to validate common clinical practices in rehabilitative medicine.
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Allocation: Non-Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment
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