Estimation of instantaneous and cumulative loads on the low back and neck of osteopaths

Abstract of paper presented at the 2nd Australia and New Zealand Osteopathic Research Conference, Melbourne, Australia, 6th December, 2008

Matthew Stewart, Robert Moran

Estimation of instantaneous and cumulative loads on the low back and neck of osteopaths while performing the pre-thrust positioning for a high velocity, low amplitude thrust technique applied to the thoracic spine.

Background:
There is epidemiological evidence that musculoskeletal disorders of the back and neck are prevalent among healthcare professionals. However, to date there are no known biomechanical studies to determine the instantaneous and cumulative loading in the low back and neck of osteopaths while performing the pre-thrust positioning for a high velocity, low amplitude thrust technique applied to the thoracic spine.

Objective:
The present study aimed to estimate instantaneous and cumulative loads on the low
back and neck of osteopaths while performing the pre-thrust positioning for a commonly used
high velocity, low amplitude thrust (HVLAT) technique applied to the thoracic spine.

Method:
The sample included 8 undergraduate students and 16 graduate students in the
osteopathy programme at Unitec New Zealand and two registered osteopaths (male n= 16, female
n=10). Digital still images of operators performing the pre-thrust positioning for a thoracic spine
HVLA thrust technique on a variable height table were analysed with motion analysis software.
From the observed data, instantaneous compression and shear loads at the L5-S1 and C7-T1
segments were estimated using a static biomechanical model. Estimates of weekly and yearly
cumulative compressive and shear loads were calculated based on assumptions from osteopaths’
anecdotal clinical experience.

Results:
Instantaneous compression loads on the L5-S1 segment ranged from 1023 N to 7575 N
and from 33 N to 477N on the C7-T1 segment. L5-S1 instantaneous shear loads ranged between
160 N and 829 N and between 18 N and 112 N for the C7-T1 segment.

Conclusions:
This study found a distinct correlation between body mass and instantaneous
lumbosacral spinal loading (Pearson’s r = 0.96). The magnitude of instantaneous compressive
lumbosacral spinal loads in this study were found to be within the range to cause vertebral
endplate fracture. Lumbosacral shear forces were found to be above the acceptable levels
recommended in spinal safety guidelines but below levels capable of causing pars interarticularis
fracture. Therefore, manipulative techniques that involve forward flexion may increase
instantaneous compressive and shear lumbosacral spinal loading above generally agreed
acceptable limits for spinal safety.

Research in Massage Therapy and Complementary and Alternative Medicine

There is growing interest in massage therapy and other forms of complementary and alternative medicine (CAM), as reflected in their increasing coverage in the popular media and in medical and psychological literature (Ong, Peterson, Bodeker, & Stewart-Brown, 2002). Research has demonstrated that use of massage therapy and other forms of CAM is increasing dramatically in many countries (National Centre for Complementary and Alternative Medicine, 2000; Wootton & Sparber, 2001). National surveys in the United States found that the proportion of individuals using some form of CAM rose from 34% in 1990 to 42% in 1997 (Eisenberg et al., 1998). Other national surveys in the United States have found that massage therapy use increased from 8% to 21% during the six years between 1997 and 2003. The most commonly cited reasons for using massage therapy were stress management and relaxation (American Massage Therapy Association, 2003). There is an increasing amount of research investigating the effect of massage therapy on health, with promising evidence of its effects on mood, energy levels, alertness, and physiology (Field, 1998; Moyer, Rounds, & Hannum, 2004).

There have been number of collaborative efforts between the University of Auckland and the New Zealand College of Massage over the last few years on research projects investigating the therapeutic effects of massage therapy. The abstracts from these projects are outlined below.

Massage Therapy as a
Technique For Coping With Stress

S. P. Lawler & L.D. Cameron
Department of Psychology, University of Auckland

In collaboration with The New Zealand College of Massage

This study assessed the effectiveness of massage therapy as an intervention for coping with stress in healthy university students approaching final examinations (N = 34). Participants were randomly assigned to an attention control condition (watching 3 different television programmes) or to a massage therapy group, who received one 45-minute massage per week for 3 consecutive weeks. Measures of blood pressure, heart rate, and state anxiety were taken before and after each of the sessions. Stress and coping were measured three times at baseline (T1), immediately after the three sessions (T2), and at one week follow up (T3). Both groups reported lower anxiety after each of the sessions, however the massage group had a greater reduction in comparison to the television group (p < .05). The massage group had a lower heart rate after each of the massages, while the television group showed no change (p < .05). There were no significant differences between the groups for systolic and diastolic blood pressure. At T2 the massage group reported a significant decrease in perceived stress and an increase in coping efficacy (p < .05). However by time 3 these effects were no longer evident. Future research might consider continuing the massage therapy throughout high periods of stress, such as examinations, in order to establish the effect of massage throughout these periods.

Massage Therapy for Migraines

S. P. Lawler & L.D. Cameron
Department of Psychology, University of Auckland

In collaboration with The New Zealand College of Massage

Migraine is a common disorder, with approximately 15 percent of women and 6 percent of men being afflicted at some stage in their lives. This study assessed the effectiveness of massage therapy in reducing headache frequency and intensity for people suffering from migraines. Participants (N = 47) were randomly assigned to either a control group or a massage group. Both groups kept daily diaries of their headache frequency and intensity. The massage group received one 45-minute massage per week for 6 consecutive weeks. For massage group participants, measures of state anxiety, fatigue, heart rate and finger temperature were taken before and after each massage session. There were significant decreases in heart rate (p’s < .005) and state anxiety (p’s < .001) and significant increases in finger temperature (p < .05) across all six sessions, suggesting that the massages successfully induced a relaxation response. Unexpectedly, fatigue ratings did not increase from pre to post test across all six-massage sessions. As predicted, the massage group reported a significant decrease in migraine frequency across the 6-week treatment period (p < .04) whereas the control condition did not.

Article on the NZMA site

Inpatients’ use, understanding, and attitudes towards traditional, complementary and alternative therapies at a provincial New Zealand hospital
Amanda Evans, Bruce Duncan, Patrick McHugh, John Shaw, Craig Wilson

http://www.nzma.org.nz/journal/121-1278/3159/

Useful Websites

American Massage Therapy Foundation
http://www.amtafoundation.org
Touch Research Institute
http://www.miami.edu/touch-research/home.html

References

American Massage Therapy Association. (2003). Massage therapy Consumer Survey Fact Sheet. www.amtamassage.org/infocenter/home.html

Eisenberg, D. M., Davis, R. B., Ettner, S. L., Appel, S., Wilkey, S., Rompay, M. V., et al. (1998). Trends in Alternative Medicine Use in the United States, 1990-1997: Results of a Follow-up National Survey. Journal of the American Medical Association, 280(18), 1569-1575.

Field, T. (1998). Massage therapy effects. American Psychologist, 53(12), 1270-1281.
Lawler, S. P., & Cameron, L. D. (2004). Massage therapy and complementary and alternative medicine: Attitudes and use among general practitioners and patients in Auckland, New Zealand. New Zealand Family Physician, 31(4), 229-238.

Moyer, C. A., Rounds, J., & Hannum, J. W. (2004). A meta-analysis of massage therapy research. Psychological Bulletin, 130(1), 3-18.

National Centre for Complementary and Alternative Medicine. (2000). Expanding Horizons of healthcare: Five-year strategic plan 2001-2005.: US Department of Health and Human Services.

Ong, C., Peterson, S., Bodeker, G., & Stewart-Brown, S. (2002). Health Status of people using complementary and alternative medical practitioner services in 4 English countries. American Journal of Public Health, 92(10), 1653-1656.

Wootton, J. C., & Sparber, A. (2001). Surveys of complementary and alternative medicine: part I. General trends and demographic groups. Journal of Alternative & Complementary Medicine., 7(2), 195-208.