Abstract. Background. Low back pain (LBP) is a recognized public health problem, impacting up to 8. US adults at some point in their lives. Patients with LBP are utilizing integrative health care such as spinal manipulation (SM). SM is the therapeutic application of a load to specific body tissues or structures and can be divided into two broad categories: SM with a high- velocity low- amplitude load, or an impulse "thrust", (HVLA- SM) and SM with a low- velocity variable- amplitude load (LVVA- SM). There is evidence that sensorimotor function in people with LBP is altered. This study evaluates the sensorimotor function in the lumbopelvic region, as measured by postural sway, response to sudden load and repositioning accuracy, following SM to the lumbar and pelvic region when compared to a sham treatment. Methods/Design. A total of 2. Quad Cities area located in Iowa and Illinois. They are allocated through a minimization algorithm in a 1: 1: 1 ratio to receive either 1. HVLA- SM treatments over 6 weeks, 1. LVVA- SM treatments over 6 weeks or 2 weeks of a sham treatment followed by 4 weeks of full spine "doctor's choice" SM. Sensorimotor function tests are performed before and immediately after treatment at baseline, week 2 and week 6. Self- report outcome assessments are also collected. The primary aims of this study are to 1) determine immediate pre to post changes in sensorimotor function as measured by postural sway following delivery of a single HVLA- SM or LVVA- SM treatment when compared to a sham treatment and 2) to determine changes from baseline to 2 weeks (4 treatments) of HVLA- SM or LVVA- SM compared to a sham treatment. Secondary aims include changes in response to sudden loads and lumbar repositioning accuracy at these endpoints, estimating sensorimotor function in the SM groups after 6 weeks of treatment, and exploring if changes in sensorimotor function are associated with changes in self- report outcome assessments. Discussion. This study may provide clues to the sensorimotor mechanisms that explain observed functional deficits associated with LBP, as well as the mechanism of action of SM. Background. Low back pain (LBP) is well recognized as a public health problem, impacting up to 8. US adults at some point in their lives [1]. Estimates of the point prevalence vary from 1. The pathophysiology of patients with LBP is not well understood. An estimated 9. 0% of LBP in clinical practice is labeled "idiopathic" [1], meaning that the mechanism is unclear. Given how little we know about the underlying causes of LBP, it is not surprising that a gold standard treatment does not currently exist. A recent survey to determine health care utilization patterns in patients with chronic LBP, found this population demonstrated an average of 2. In conclusion, the authors state that 1) there is a high utilization of health care for chronic LBP patients, including a high rate of advanced imaging, narcotic prescription and physical therapy; 2) most of the tests and treatments performed did not meet the criteria of evidence- based practice; and 3) there is an over- utilization of treatment types. In addition to conventional medical treatments such as analgesics and physical therapy, LBP patients are also utilizing integrative health care such as spinal manipulation (SM) delivered by a doctor of chiropractic [4]. There is an increasing body of evidence suggesting that SM provides important benefit to patients with LBP [5,6]. Not much is known, however, about the mechanism of action of these treatments. This study looks closely at the biomechanical and neural effects of SM treatment. Microsoft Windows 7 Full Activator Adjusting ToolGet help, support, and tutorials for Windows products—Windows 10, Windows 8.1, Windows 7, and Windows 10 Mobile. Apple changed the way we use and perceive Tablets by instilling just the right amount of spiff, engineering and art into a simple, intuitive device we now adulate as. Working with headphones on usually means you’d rather not be bothered, but sometimes it means you’re just listening to something while you work. If you want to be. In its broadest definition, SM involves the therapeutic application of a load (i. There are many variations of SM in terms of their velocity, amplitude, loading frequency, choice of lever, location and direction of load, and treatment frequency [7,8]. Based on SM force- time profiles, they can be divided into two broad categories: SM with a high- velocity low- amplitude load, or an impulse "thrust", to body tissues (HVLA- SM) and SM with a low- velocity variable- amplitude load (LVVA- SM) [8- 1. LVVA- SM is often referred to as "mobilization [1. HVLA- SM is referred to as "adjustments [1. HVLA- SM is typically associated with a cavitation sound produced when the synovial joint linings are quickly separated. In LVVA- SM the loads are applied slowly, cyclically, and the amplitude of each load may vary. The general theory is that the mechanism of action of SM may be related to the impact that manipulative forces have on tissues surrounding the low back. At the same time, this study is considering the nature of LBP itself. Could SM produce its beneficial effects by altering some deficit in the spinal structure or function? Sensorimotor Function Tests. It is well known that the spine is intrinsically dependent on stabilizing muscle forces. Crisco and Panjabi demonstrated in cadaveric studies that the ligamentous spine can sustain around 8. N of compressive load before buckling [1. Therefore, neuromuscular control and coordination are important for the normal postural stability and daily movements of the spine [1. Additionally well- coordinated muscle contractions can prevent overloading ligaments and joint capsules beyond their physiological limits [1. There is increasing evidence suggesting that the dysfunction of muscle control and coordination (i. Muscle control depends on input from length and tension receptors in muscles as well as other proprioceptors in and around spinal joints. Panjabi proposed a hypothesis that links damage in the spinal ligaments and discs to muscle control dysfunction seen in chronic back pain [3. Inaccurate feedback from proprioceptors in ligaments, muscles and joints may prevent proper initiation of protective muscle responses [3. The precise nature of the proposed sensorimotor dysfunction is still unknown. There is evidence that biomechanical function in patients with LBP is altered, as measured by tests such as postural sway, response to sudden impact loads, and repositioning accuracy [3. All of these functional tests involve sensorimotor function to some extent. Linking SM to Sensorimotor Dysfunction. There is important work showing that forces of the magnitude of SM loads can stimulate proprioceptors in the joints and muscles [3. The approach in this current study is to use SM as a tool to influence proprioceptive input to spinal tissues and observe the effects that input has on sensorimotor function. Thus, this study may provide clues to the sensorimotor mechanisms that underlie the observed functional deficits associated with LBP, as well as the mechanism of action of SM. Postural Sway. The capability of a person to maintain balance in an upright posture requires a complex integration of accurate sensory input and precisely coordinated motor output [3. Sensory inputs include the vestibular system, the visual system and the proprioceptors in muscles and joints. Muscle activity must be simultaneously controlled at three levels to achieve stability: spinal reflex, brain stem balance and cognitive programming [4. Disturbances to the neuromuscular system can affect the degree of efficiency and accuracy with which posture is maintained [4. LBP patients have impaired postural stability compared to healthy individuals [4. It is hypothesized that the reduced proprioceptive acuity derived from muscle or joint mechanoreceptors can be a cause of altered postural sway [4. Another theory is that LBP patients have impaired short- term memory that leads to delays in processing postural control information and increased sway [4. Response to Sudden Impact Loads. In the flow of everyday living, people sometimes experience sudden and unanticipated forces, such as stepping off a curb unexpectedly. An individual's central nervous system is designed to deal with these challenges, or sudden loads, to the system in such a way that minimal disruption occurs to the individual's current activities. These sophisticated procedures include the rapid activation of muscles to oppose the sudden load and the concurrent relaxation of the corresponding antagonistic muscles. It has been found that LBP patients respond differently compared to healthy individuals [4. It takes their muscles longer to respond and their response is smaller [5. Several studies demonstrated that the response of the trunk musculature is dependent on the direction of perturbation [3. Embedded product keys, win 7, 8, and 1. A couple questions pertaining to embedded product keys in the bios: 1) When did they start embedding product keys into the bios? If I were to buy a retail copy of Windows 7, 8, or 1. Will it look in the bios for the product key? What is a tool from Microsoft, not third- party, that shows the product key?
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