title: Conservative lower back treatment reduces inhibition in knee-extensor muscles: a randomized controlled trial.
abstract: BACKGROUND
  Knee-joint pathologies, such as anterior knee pain (AKP), are associated with strength deficits and reduced activation of the knee extensors, which is referred to as muscle inhibition (MI). MI is thought to prevent full functional recovery, and treatment modalities that help to reduce or eliminate MI appear necessary for successful rehabilitation. Clinical observations suggest that AKP is typically associated with sacroiliac (SI) joint dysfunction. It is unknown whether SI-joint dysfunction contributes to knee-extensor deficits and whether correction of SI-joint dysfunction alleviates MI.
  
  
  OBJECTIVE
  The objective of this study was to assess whether conservative low back treatment reduces lower limb MI.
  
  
  METHODS
  In a randomized, controlled, double-blind study the effects of conservative lower back treatment on knee-extensor strength and MI were evaluated in patients with AKP.
  
  
  METHODS
  Twenty-eight patients with AKP were randomly assigned to either a treatment or a control group. After a lower back functional assessment, the treatment group received a conservative treatment in the form of a chiropractic spinal manipulation aimed at correcting SI-joint dysfunction. The control group underwent a lower back functional assessment but received no joint manipulation. Before and after the manipulation or the lower back functional assessment, knee-extensor moments, MI, and muscle activation during full effort, isometric knee extensions were measured.
  
  
  RESULTS
  Patients showed substantial MI in both legs. Functional assessment revealed SI-joint dysfunction in all subjects (23 symptomatic and 5 asymptomatic). After the SI-joint manipulation, a significant decrease in MI of 7.5% was observed in the involved legs of the treatment group. MI did not change in the contralateral legs of the treatment group or the involved and contralateral legs of the control group. There were no statistically significant changes in knee-extensor moments and muscle activation in either group.
  
  
  CONCLUSIONS
  The results of this study suggest that SI-joint manipulation reduces knee-extensor MI. Spinal manipulation may possibly be an effective treatment of MI in the lower limb musculature.
authors.affiliation: The University of Calgary, Canada.
authors.forename: E
authors.initials: E
authors.lastname: Suter
authors.forename: G
authors.initials: G
authors.lastname: McMorland
authors.forename: W
authors.initials: W
authors.lastname: Herzog
authors.forename: R
authors.initials: R
authors.lastname: Bray
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D018771:Arthralgia / Q000175:diagnosis / Q000503:physiopathology / Q000534:rehabilitation*; D004311:Double-Blind Method; D004576:Electromyography; D005260:Female; D006801:Humans; D007719:Knee Joint / Q000503:physiopathology*; D017116:Low Back Pain / Q000175:diagnosis / Q000503:physiopathology* / Q000534:rehabilitation*; D008297:Male; D020393:Manipulation, Spinal / Q000379:methods*; D008875:Middle Aged; D009119:Muscle Contraction / Q000502:physiology*; D018482:Muscle, Skeletal / Q000503:physiopathology; D010147:Pain Measurement; D016059:Range of Motion, Articular; D012016:Reference Values; D012446:Sacroiliac Joint / Q000503:physiopathology; D016896:Treatment Outcome