The Effect of Thoracic Spine Manipulation on Peripheral Neurodynamic Mobility

Study Overview
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Brief Summary
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No studies have investigated the effects of a supine thoracic spine manipulation (TSM) on neurodynamic mobility, as compared to a sham intervention. This study aims to determine the immediate effects of TSM on the Upper Limb Provocation Test (ULPT) and Seated Slump Test (SST) compared to a sham intervention in asymptomatic subjects with neurodynamic limitations.

Detailed Description
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A convenience sample will be utilized to obtain subjects. Subjects will be given a brief questionnaire to identify possible contraindications for spinal treatment techniques and exclude individuals if necessary. Subjects will be randomized into one of two groups (spinal manual therapy or spinal range of motion which will serve as the name for the placebo group) and participate in neurodynamic testing procedures of the upper extremity (Upper Limb Provocation Testing) as well as lower extremity (Seated Slump Test). Subjects who are determined to be positive for one or more limbs will receive either a thoracic spine manipulation technique (spinal manual therapy) or a thoracic spine sham manipulation technique (spinal range of motion/placebo). After application of the technique, previously positive limbs will be retested. In attempt to determine validity and believability of the sham procedure and perception of its effect, subjects will be asked if they believe their upper/lower quarter mobility will change based on the group name and after the technique is applied. Subjects will also be asked if they believed they were in the treatment or placebo group.

Official Title
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The Immediate Effects of Thoracic Spine Manipulation Versus a Sham Comparator on the Upper Limb Provocation Test and Seated Slump Test

Conditions
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Musculoskeletal Manipulations

Intervention / Treatment
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* Procedure: Spinal Manual Therapy
* Procedure: Spinal Range of Motion


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Upper Limb Provocation Test results with limitation of greater than 60 deg of elbow extension at the time of measurement Seated Slump Test results with limitation of greater than 22 deg of knee extension at the time of measurement Exclusion Criteria: History of cervical or lumbar pain requiring medical intervention within the last two years, history of upper or lower extremity paresthesia/numbness, self reported bone density disorders, previous spinal cord injury, diagnosed intervertebral disc herniation, previous diagnosis of spinal stenosis or disc pathology, current pregnancy, history of circulatory or neurological disorders, history of spine and extremity fractures or dislocations in the last two years

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 70 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Spinal Manual Therapy<br>Supine thoracic spine manipulation located between the levels of T4-T7 | Procedure: Spinal Manual Therapy<br> <br> * Other names: Active treatment group;Procedure: Spinal Range of Motion<br> <br> * Other names: Placebo/Sham group;|
| Sham Comparator: Spinal Range of Motion<br>Supine thoracic spine sham manipulation located between the levels of T4-T7; identical procedure as the active treatment intervention but without the delivery of high velocity low amplitude thrust | Procedure: Spinal Manual Therapy<br> <br> * Other names: Active treatment group;Procedure: Spinal Range of Motion<br> <br> * Other names: Placebo/Sham group;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Upper Limb Provocation Test Range of Motion Change (measured in degrees of elbow extension) | Subjects will lie on their back with their shoulder slightly off the edge of a treatment table. The investigator will then bend the subjects neck away from the shoulder being tested and position the arm into the starting test position. The investigator will then straighten the subjects elbow until it is fully extended, or until the subject reports discomfort or an abnormal feeling in their arm. This procedure will be completed before and immediately after either the treatment intervention (manipulation) or the sham intervention is completed. | Pre and Immediately Post Intervention | 
| Seated Slump Test Range of Motion Change (measured in degrees of knee extension) | Subjects will sit at the edge of treatment table. Subjects will be asked to flex then neck towards their chest. The investigator will then apply a gentle force to their upper back and will ask the subject to remain in this position. The investigator will move the subjects foot upwards and straighten their leg until it is fully extended or until the subject reports discomfort or an abnormal feeling in their leg.This procedure will be completed before and immediately after either the treatment intervention (manipulation) or the sham intervention is completed. | Pre and Immediately Post Intervention | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Believability of Sham - measured via questionnaire | Subjects will be asked whether they believe they were in the active treatment group or the sham/placebo group after final measurements are taken. | Immediately Post Intervention (after final measurements are read and recorded) | 
| Perceived effect - measured via questionnaire | Subjects will be asked whether they believe their upper and/or lower quarter mobility will change based on the group name they are assigned. | Pre Intervention (immediately after initial measurements are recorded and prior to intervention) | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Thoracic Spine Manipulation, Neurodynamics, Sham