title: Manual therapy directed at the knee or lumbopelvic region does not influence quadriceps spinal reflex excitability.
abstract: Manual therapies, directed to the knee and lumbopelvic region, have demonstrated the ability to improve neuromuscular quadriceps function in individuals with knee pathology. It remains unknown if manual therapies may alter impaired spinal reflex excitability, thus identifying a potential mechanism in which manual therapy may improve neuromuscular function following knee injury.
  
  
  OBJECTIVE
  To determine the effect of local and distant mobilisation/manipulation interventions on quadriceps spinal reflex excitability.
  
  
  METHODS
  Seventy-five individuals with a history of knee joint injury and current quadriceps inhibition volunteered for this study. Participants were randomised to one of five intervention groups: lumbopelvic manipulation (grade V), lumbopelvic manipulation positioning (no thrust), grade IV patellar mobilisation, grade I patellar mobilisation, and control (no treatment). Changes in spinal reflex excitability were quantified by assessing the Hoffmann reflex (H-reflex), presynaptic, and postsynaptic excitability. A hierarchical linear-mixed model for repeated measures was performed to compare changes in outcome variables between groups over time (pre, post 0, 30, 60, 90 min).
  
  
  RESULTS
  There were no significant differences in H-reflex, presynaptic, or postsynaptic excitability between groups across time.
  
  
  CONCLUSIONS
  Manual therapies directed to the knee or lumbopelvic region did not acutely change quadriceps spinal reflex excitability. Although manual therapies may improve impairments and functional outcomes the underlying mechanism does not appear to be related to changes in spinal reflex excitability.
authors.affiliation: School of Pharmacy & Health Professions, Physical Therapy Department, 2500 California Plaza, Creighton University, Omaha, NE 68178, USA. Electronic address: GrindstaffTL@gmail.com.
authors.forename: Terry L
authors.initials: TL
authors.lastname: Grindstaff
authors.affiliation: University of North Carolina, Chapel Hill, NC, USA.
authors.forename: Brian G
authors.initials: BG
authors.lastname: Pietrosimone
authors.affiliation: University of Virginia, Charlottesville, VA, USA.
authors.forename: Lindsay D
authors.initials: LD
authors.lastname: Sauer
authors.affiliation: JKM Technologies LLC, Charlottesville, VA, USA.
authors.forename: D Casey
authors.initials: DC
authors.lastname: Kerrigan
authors.affiliation: University of Virginia, Charlottesville, VA, USA.
authors.forename: James T
authors.initials: JT
authors.lastname: Patrie
authors.affiliation: University of Virginia, Charlottesville, VA, USA.
authors.forename: Jay
authors.initials: J
authors.lastname: Hertel
authors.affiliation: Central Michigan University, Mt. Pleasant, MI, USA.
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Ingersoll
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D004576:Electromyography / Q000379:methods; D005260:Female; D006181:H-Reflex / Q000502:physiology*; D006801:Humans; D007718:Knee Injuries / Q000175:diagnosis / Q000534:rehabilitation*; D008161:Lumbosacral Region; D008297:Male; D020393:Manipulation, Spinal / Q000379:methods*; D053580:Muscle Strength / Q000502:physiology; D026201:Musculoskeletal Manipulations / Q000379:methods; D056888:Patient Positioning; D052097:Quadriceps Muscle / Q000502:physiology*; D016059:Range of Motion, Articular / Q000502:physiology*; D012016:Reference Values; D016896:Treatment Outcome; D055815:Young Adult
keywords: H-reflex; Knee pain; Manipulation; Mobilization