Research Article
BibTex RIS Cite

Investigation of postero-anterior mobilization in the lumbar spine: A finite element analysis study

Year 2022, Volume: 6 Issue: 3, 356 - 359, 01.03.2022
https://doi.org/10.28982/josam.1061640

Abstract

Background/Aim: Postero-anterior (PA) mobilization is a non-invasive treatment method traditionally used to treat low back pain (LBP) in many countries. However, the effects of PA mobilization on lumbar spine biomechanics are still unknown. The aim of this study is to determine the maximum von Mises stresses on the lumbar vertebra (L5), with force applied at different angles during PA mobilization therapy using finite element analysis (FEA).
Methods: L5 vertebra CT images of a 30-year-old male patient were modeled in three dimensions (3D) with MIMICS software to examine the PA mobilization biomechanics. The resulting L5 spine model was submitted to the finite element software ANSYS (version 19) to evaluate the effects of PA mobilization. To simulate PA mobilization on the L5 vertebra, a static force of 100 N was applied over the spinal process in three different directions. The distribution of von Mises stresses occurring in the L5 spine was determined in the analyses.
Results: During PA mobilization, the stress distributions on the vertebrae caused by the static force applied in three different directions in the L5 vertebra spinal process was determined. As a result of the analysis, higher stress values were found in the posterior elements of the vertebrae in all directions compared to the vertebral corpus. However, when compared according to the direction of application, the lowest stress values were detected in the pedicles and laminas in PA mobilization applied toward the spine center.
Conclusion: Vertebral pedicles, laminae, and spinous process are critical areas prone to fracture. It was argued that the change in the direction of PA mobilization applied in the L5 vertebral spinal process affects the von Mises stress distributions occurring in the pedicles and laminae.

References

  • 1. Manchikanti L. Epidemiology of low back pain. Pain physician. 2000;3:167-92.
  • 2. Koes B, Van Tulder M, Thomas S. Diagnosis and treatment of low back pain. BMJ. 2006;332:1430-4.
  • 3. Abu-Naser SS, ALDAHDOOH R. Lower back pain expert system diagnosis and treatment. 2016.
  • 4. Hammer WI. Functional soft tissue examination and treatment by manual methods: new perspectives: Jones & Bartlett Learning; 2005.
  • 5. Farrell JP, Jensen GM. Manual therapy: a critical assessment of role in the profession of physical therapy. Physical therapy. 1992;72:843-52.
  • 6. Holt KR, Haavik H, Elley CR. The effects of manual therapy on balance and falls: a systematic review. Journal of manipulative and physiological therapeutics. 2012;35:227-34.
  • 7. Maitland G, Hengeveld E, Banks K, English K. Maitland's vertebral manipulation: Elsevier Butterworth. Heinemann; 2005.
  • 8. Shah SG, Kage V. Effect of seven sessions of posterior-to-anterior spinal mobilisation versus prone press-ups in non-specific low back pain–randomized clinical trial. Journal of clinical and diagnostic research: JCDR. 2016;10:YC10.
  • 9. Kamel DM, Raoof NAA, Tantawy SA. Efficacy of lumbar mobilization on postpartum low back pain in Egyptian females: A randomized control trial. Journal of back and musculoskeletal rehabilitation. 2016;29:55-63.
  • 10. Kanlayanaphotporn R, Chiradejnant A, Vachalathiti R. Immediate effects of the central posteroanterior mobilization technique on pain and range of motion in patients with mechanical neck pain. Disability and rehabilitation. 2010;32:622-8.
  • 11. Kılıçaslan ÖF, Levent A, Celik HK, Tokgöz MA, Köse Ö, Rennie A. Effect of cartilage thickness mismatch in osteochondral grafting from knee to talus on articular contact pressures: A finite element analysis. Joint Diseases and Related Surgery. 2021;32:355-62.
  • 12. Ye Y, You W, Zhu W, Cui J, Chen K, Wang D. The applications of finite element analysis in proximal humeral fractures. Computational and mathematical methods in medicine. 2017;2017.
  • 13. Rungruangbaiyok C, Azari F, van Lenthe GH, Vander Sloten J, Tangtrakulwanich B, Chatpun S. Finite Element Investigation of Fracture Risk Under Postero-Anterior Mobilization on a Lumbar Bone in Elderly With and Without Osteoporosis. Journal of Medical and Biological Engineering. 2021;41:285-94.
  • 14. Boonyoung C, Kwanyuang A, Chatpun S. A finite element study of posteroanterior lumbar mobilization on elderly vertebra geometry. 2018 11th Biomedical Engineering International Conference (BMEiCON): IEEE; 2018. p. 1-4.
  • 15. Natarajan RN, Watanabe K, Hasegawa K. Biomechanical analysis of a long-segment fusion in a lumbar spine—a finite element model study. Journal of biomechanical engineering. 2018;140.
  • 16. Xu G, Fu X, Du C, Ma J, Li Z, Tian P, et al. Biomechanical comparison of mono-segment transpedicular fixation with short-segment fixation for treatment of thoracolumbar fractures: a finite element analysis. Proceedings of the Institution of Mechanical Engineers, Part H: Journal of Engineering in Medicine. 2014;228:1005-13.
  • 17. Park WM, Park Y-S, Kim K, Kim YH. Biomechanical comparison of instrumentation techniques in treatment of thoracolumbar burst fractures: a finite element analysis. Journal of Orthopaedic Science. 2009;14:443-9.
  • 18. Su Y, Wang X, Ren D, Liu Y, Liu S, Wang P. A finite element study on posterior short segment fixation combined with unilateral fixation using pedicle screws for stable thoracolumbar fracture. Medicine. 2018;97.
  • 19. Beliveau PJ, Wong JJ, Sutton DA, Simon NB, Bussières AE, Mior SA, et al. The chiropractic profession: a scoping review of utilization rates, reasons for seeking care, patient profiles, and care provided. Chiropractic & manual therapies. 2017;25:1-17.
  • 20. Hengeveld E, Banks K, Maitland GD. Maitland's peripheral manipulation: Elsevier/Butterworth Heinemann; 2005.
  • 21. McArthur C, Ziebart C, Laprade J. What do we know about spinal manual therapy for people with osteoporosis? A narrative review. Physical Therapy Reviews. 2021;26:42-52.
  • 22. Snodgrass SJ, Rivett DA, Robertson VJ. Manual forces applied during posterior-to-anterior spinal mobilization: a review of the evidence. Journal of manipulative and physiological therapeutics. 2006;29:316-29.
  • 23. Hincapié CA, Cassidy JD, Côté P, Rampersaud YR, Jadad AR, Tomlinson GA. Chiropractic spinal manipulation and the risk for acute lumbar disc herniation: a belief elicitation study. European Spine Journal. 2018;27:1517-25.
  • 24. Skappak C. Back pain in the emergency department: Pathological fracture following spinal manipulation. Canadian Journal of Emergency Medicine. 2018;20:307-12.
  • 25. Swait G, Finch R. What are the risks of manual treatment of the spine? A scoping review for clinicians. Chiropractic & manual therapies. 2017;25:1-15.
  • 26. Lee RY, McGregor AH, Bull AM, Wragg P. Dynamic response of the cervical spine to posteroanterior mobilisation. Clinical Biomechanics. 2005;20:228-31.
Year 2022, Volume: 6 Issue: 3, 356 - 359, 01.03.2022
https://doi.org/10.28982/josam.1061640

Abstract

References

  • 1. Manchikanti L. Epidemiology of low back pain. Pain physician. 2000;3:167-92.
  • 2. Koes B, Van Tulder M, Thomas S. Diagnosis and treatment of low back pain. BMJ. 2006;332:1430-4.
  • 3. Abu-Naser SS, ALDAHDOOH R. Lower back pain expert system diagnosis and treatment. 2016.
  • 4. Hammer WI. Functional soft tissue examination and treatment by manual methods: new perspectives: Jones & Bartlett Learning; 2005.
  • 5. Farrell JP, Jensen GM. Manual therapy: a critical assessment of role in the profession of physical therapy. Physical therapy. 1992;72:843-52.
  • 6. Holt KR, Haavik H, Elley CR. The effects of manual therapy on balance and falls: a systematic review. Journal of manipulative and physiological therapeutics. 2012;35:227-34.
  • 7. Maitland G, Hengeveld E, Banks K, English K. Maitland's vertebral manipulation: Elsevier Butterworth. Heinemann; 2005.
  • 8. Shah SG, Kage V. Effect of seven sessions of posterior-to-anterior spinal mobilisation versus prone press-ups in non-specific low back pain–randomized clinical trial. Journal of clinical and diagnostic research: JCDR. 2016;10:YC10.
  • 9. Kamel DM, Raoof NAA, Tantawy SA. Efficacy of lumbar mobilization on postpartum low back pain in Egyptian females: A randomized control trial. Journal of back and musculoskeletal rehabilitation. 2016;29:55-63.
  • 10. Kanlayanaphotporn R, Chiradejnant A, Vachalathiti R. Immediate effects of the central posteroanterior mobilization technique on pain and range of motion in patients with mechanical neck pain. Disability and rehabilitation. 2010;32:622-8.
  • 11. Kılıçaslan ÖF, Levent A, Celik HK, Tokgöz MA, Köse Ö, Rennie A. Effect of cartilage thickness mismatch in osteochondral grafting from knee to talus on articular contact pressures: A finite element analysis. Joint Diseases and Related Surgery. 2021;32:355-62.
  • 12. Ye Y, You W, Zhu W, Cui J, Chen K, Wang D. The applications of finite element analysis in proximal humeral fractures. Computational and mathematical methods in medicine. 2017;2017.
  • 13. Rungruangbaiyok C, Azari F, van Lenthe GH, Vander Sloten J, Tangtrakulwanich B, Chatpun S. Finite Element Investigation of Fracture Risk Under Postero-Anterior Mobilization on a Lumbar Bone in Elderly With and Without Osteoporosis. Journal of Medical and Biological Engineering. 2021;41:285-94.
  • 14. Boonyoung C, Kwanyuang A, Chatpun S. A finite element study of posteroanterior lumbar mobilization on elderly vertebra geometry. 2018 11th Biomedical Engineering International Conference (BMEiCON): IEEE; 2018. p. 1-4.
  • 15. Natarajan RN, Watanabe K, Hasegawa K. Biomechanical analysis of a long-segment fusion in a lumbar spine—a finite element model study. Journal of biomechanical engineering. 2018;140.
  • 16. Xu G, Fu X, Du C, Ma J, Li Z, Tian P, et al. Biomechanical comparison of mono-segment transpedicular fixation with short-segment fixation for treatment of thoracolumbar fractures: a finite element analysis. Proceedings of the Institution of Mechanical Engineers, Part H: Journal of Engineering in Medicine. 2014;228:1005-13.
  • 17. Park WM, Park Y-S, Kim K, Kim YH. Biomechanical comparison of instrumentation techniques in treatment of thoracolumbar burst fractures: a finite element analysis. Journal of Orthopaedic Science. 2009;14:443-9.
  • 18. Su Y, Wang X, Ren D, Liu Y, Liu S, Wang P. A finite element study on posterior short segment fixation combined with unilateral fixation using pedicle screws for stable thoracolumbar fracture. Medicine. 2018;97.
  • 19. Beliveau PJ, Wong JJ, Sutton DA, Simon NB, Bussières AE, Mior SA, et al. The chiropractic profession: a scoping review of utilization rates, reasons for seeking care, patient profiles, and care provided. Chiropractic & manual therapies. 2017;25:1-17.
  • 20. Hengeveld E, Banks K, Maitland GD. Maitland's peripheral manipulation: Elsevier/Butterworth Heinemann; 2005.
  • 21. McArthur C, Ziebart C, Laprade J. What do we know about spinal manual therapy for people with osteoporosis? A narrative review. Physical Therapy Reviews. 2021;26:42-52.
  • 22. Snodgrass SJ, Rivett DA, Robertson VJ. Manual forces applied during posterior-to-anterior spinal mobilization: a review of the evidence. Journal of manipulative and physiological therapeutics. 2006;29:316-29.
  • 23. Hincapié CA, Cassidy JD, Côté P, Rampersaud YR, Jadad AR, Tomlinson GA. Chiropractic spinal manipulation and the risk for acute lumbar disc herniation: a belief elicitation study. European Spine Journal. 2018;27:1517-25.
  • 24. Skappak C. Back pain in the emergency department: Pathological fracture following spinal manipulation. Canadian Journal of Emergency Medicine. 2018;20:307-12.
  • 25. Swait G, Finch R. What are the risks of manual treatment of the spine? A scoping review for clinicians. Chiropractic & manual therapies. 2017;25:1-15.
  • 26. Lee RY, McGregor AH, Bull AM, Wragg P. Dynamic response of the cervical spine to posteroanterior mobilisation. Clinical Biomechanics. 2005;20:228-31.
There are 26 citations in total.

Details

Primary Language English
Subjects Clinical Sciences
Journal Section Research article
Authors

Erol Öten 0000-0002-8794-8202

Levent Uğur 0000-0003-3447-3191

Publication Date March 1, 2022
Published in Issue Year 2022 Volume: 6 Issue: 3

Cite

APA Öten, E., & Uğur, L. (2022). Investigation of postero-anterior mobilization in the lumbar spine: A finite element analysis study. Journal of Surgery and Medicine, 6(3), 356-359. https://doi.org/10.28982/josam.1061640
AMA Öten E, Uğur L. Investigation of postero-anterior mobilization in the lumbar spine: A finite element analysis study. J Surg Med. March 2022;6(3):356-359. doi:10.28982/josam.1061640
Chicago Öten, Erol, and Levent Uğur. “Investigation of Postero-Anterior Mobilization in the Lumbar Spine: A Finite Element Analysis Study”. Journal of Surgery and Medicine 6, no. 3 (March 2022): 356-59. https://doi.org/10.28982/josam.1061640.
EndNote Öten E, Uğur L (March 1, 2022) Investigation of postero-anterior mobilization in the lumbar spine: A finite element analysis study. Journal of Surgery and Medicine 6 3 356–359.
IEEE E. Öten and L. Uğur, “Investigation of postero-anterior mobilization in the lumbar spine: A finite element analysis study”, J Surg Med, vol. 6, no. 3, pp. 356–359, 2022, doi: 10.28982/josam.1061640.
ISNAD Öten, Erol - Uğur, Levent. “Investigation of Postero-Anterior Mobilization in the Lumbar Spine: A Finite Element Analysis Study”. Journal of Surgery and Medicine 6/3 (March 2022), 356-359. https://doi.org/10.28982/josam.1061640.
JAMA Öten E, Uğur L. Investigation of postero-anterior mobilization in the lumbar spine: A finite element analysis study. J Surg Med. 2022;6:356–359.
MLA Öten, Erol and Levent Uğur. “Investigation of Postero-Anterior Mobilization in the Lumbar Spine: A Finite Element Analysis Study”. Journal of Surgery and Medicine, vol. 6, no. 3, 2022, pp. 356-9, doi:10.28982/josam.1061640.
Vancouver Öten E, Uğur L. Investigation of postero-anterior mobilization in the lumbar spine: A finite element analysis study. J Surg Med. 2022;6(3):356-9.