Author: Amélie Debie
Supervisor: Marco Gerritse
Background: The thoracolumbar junction (TLJ), vertebrae T10-L2, is a transitional zone of biomechanics between the thoracic and lumbar spine. It is a buffer zone as it often provides compensation for biomechanical dysfunctions in the axial skeleton. This region is regularly mentioned as a significant malefactor in low back pain (LBP) and it has indirect repercussions on the functioning of inserting structures. Maintaining TLJ a neutral zone is important in remaining asymptomatic. Despite the frequent use of osteopathic manipulation techniques (OMT), a lack of objective evidence on manipulation remains. This prevents evidencing the importance of OMT in LBP-management and other musculoskeletal issues
Objective: To substantiate, by DIERS Formetric 4D ® measurements, that increased range of motion (ROM) in all three-dimensional planes follows osteopathic manipulation.
Material and methods: ROM of the TLJ was measured in male and female subjects aged 18 to 45 years. This non-randomised trial only targets the short-term manipulation effect. The control group (n = 14) received placebo treatment, consisting of the application of non-switched electrode patches on the TLJ. The experimental group (n = 37) received an osteopathic decoaptation manipulation. Dynamic measurements of spinal ROM were performed with DIERS before and after the interventions.
Results: A decreased ROM in L2 flexion/extension (p < 0.015) and increased pelvic inclination ROM (p < 0.035) after TLJ manipulation was evidenced. Pelvic inclination had a significantly higher effect in the manipulation group. Pelvic inclination was correlated with self-reported LBP and L2 flexion/extension with LBP, gender and blockages.
Conclusion: Thoracolumbar manipulation increases pelvic inclinational ROM, which can be ascribed to reflexogenic effect on musculus iliopsoas and restoration of regular biomechanics. Decreased ROM of L2 can be attributed to a bracing-mechanism and nociceptive reaction to manipulation. Nine additional variables show trends towards increased ROM after OMT but are not statistically significant due to limitations and subsequently require further research.