The relation between the application angle of spinal manipulative therapy (SMT) and resultant vertebral accelerations in an in situ porcine model

It has been hypothesized that the posterior tissues of the spine are frictionless and therefore allow only the normal force component of spinal manipulative therapy (SMT) to pass to underlying vertebrae. Given this assumption, vertebrae could not be moved in practitioner-defined directions by altering the application angle of SMT. To investigate this possibility, porcine lumbar spines were excised and then SMT applied at 90 degrees to the posterior tissues of the target vertebra. A standard curve was constructed of increasing SMT force versus vertebral acceleration. SMT forces were then applied at 60 degrees and 120 degrees and the resulting accelerations substituted into the standard curve to obtain the transmitted force. Results showed that vertebral accelerations were greatest at a 90 degrees SMT application angle and decreased in all axes at application angles not equal 90 degrees. The average decrease in transmitted force using application angles of 60 degrees and 120 degrees was within 5% of the predicted absolute value. In this model, SMT applied at a non-normal angle does not increase vertebral acceleration in that same direction, but acts to reduce transmitted force. This work provides justification for future studies in less available human cadavers. It is not yet known if variations in SMT application angle have relevance to clinical outcomes or patient safety. (C) 2008 Elsevier Ltd. All rights reserved.