title: Pressures generated during spinal manipulation and their association with hand anatomy.
abstract: BACKGROUND
  The role of the variation in the application manipulation itself is largely unknown. A greater understanding of its input parameters is necessary to better understand spinal manipulation outcomes.
  
  
  OBJECTIVE
  The objective of this study is to determine if pressures generated during manipulation are altered by hand configuration.
  
  
  METHODS
  Paired comparison of 2 different variable groups.
  
  
  METHODS
  Sixteen chiropractors provided 2 manipulations to a rigid surface using 2 hand configurations used commonly in clinical practice: arched and flat. Interposed between the hand and the rigid surface was a pressure sensor array and radiographic cassette. For each manipulation, pressures were recorded and a radiographic image was captured. Two radiologists then located the osseous features of the hand with respect to the sensor array.
  
  
  RESULTS
  In 15 of 16 cases, arched configurations produced peak pressures that corresponded to the radiographic location of the pisiform bone. In flat configurations, peak pressure migrated about the location of the hamate bone. Radiologists' agreement for bone position was high (kappa = 0.96). Measures of peak pressure, total pressure, and pressure distribution were statistically different between hand configurations.
  
  
  CONCLUSIONS
  The results of this study suggest that hand configuration influences the magnitude, location, and distribution of pressure generated by the hand during manipulation. This knowledge may have importance in understanding the relation among application parameters of manipulation, therapeutic benefit, and patient safety.
authors.affiliation: University of Bridgeport College of Chiropractic, Canada.
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Perle
authors.forename: Gregory N
authors.initials: GN
authors.lastname: Kawchuk
mesh_terms: D000328:Adult; D005260:Female; D006225:Hand / Q000000981:diagnostic imaging / Q000502:physiology*; D006282:Health Personnel; D006801:Humans; D008297:Male; D026882:Manipulation, Chiropractic / Q000379:methods*; D011312:Pressure; D011859:Radiography