Effects of Lumbosacral Manipulation on Isokinetic Strength of the Knee Extensors and Flexors in Healthy Subjects: A Randomized, Controlled, Single-Blind Crossover Trial

Grant D. Sanders, Arthur J. Nitz, Mark G. Abel, T. Brock Symons, Robert Shapiro, W. Scott Black, James W. Yates

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


Objective: The purpose of this study was to investigate the effect of manual manipulations targeting the lumbar spine and/or sacroiliac joint on concentric knee extension and flexion forces. Torque production was measured during isometric and isokinetic contractions. Methods: This was a randomized, controlled, single-blind crossover design with 21 asymptomatic, college-aged subjects who had never received spinal manipulation. During 2 separate sessions, subjects' peak torques were recorded while performing maximal voluntary contractions on an isokinetic dynamometer. Isometric knee extension and flexion were recorded at 60° of knee flexion, in addition to isokinetic measurements obtained at 60°/s and 180°/s. Baseline measurements were acquired before either treatment form of lumbosacral manipulation or sham manipulation, followed by identical peak torque measurements within 5 and 20 minutes posttreatment. Data were analyzed with a repeated measures analysis of variance. Results: A statistically significant difference did not occur between the effects of lumbosacral manipulation or the sham manipulation in the percentage changes of knee extension and flexion peak torques at 5 and 20 minutes posttreatment. Similar, nonsignificant results were observed in the overall percentage changes of isometric contractions (spinal manipulation 4.0 ± 9.5 vs sham 1.2 ± 6.3, P = .067), isokinetic contractions at 60°/s (spinal manipulation -. 4.0 ± 14.2 vs sham -. 0.3 ± 8.2, P = .34), and isokinetic contractions at 180°/s (spinal manipulation -. 1.4 ± 13.9 vs sham -. 5.5 ± 20.0, P = .18). Conclusion: The results of the current study suggest that spinal manipulation does not yield an immediate strength-enhancing effect about the knee in healthy, college-aged subjects when measured with isokinetic dynamometry.

Original languageEnglish
Pages (from-to)240-248
Number of pages9
JournalJournal of Chiropractic Medicine
Issue number4
StatePublished - Dec 1 2015

Bibliographical note

Funding Information:
All forms and procedures were approved by the University of Kentucky Medical Institutional Review Board (#12-0280-F1V), and the study was registered with ClinicalTrials.gov (NCT02407418). This study was not supported by grants or other funding from any organization. The principal investigator (PI) performed all screening, data collection, and manipulation/sham procedures during each of the 3 sessions. The final aspect of the physical examination included static and motion palpation of the patient’s lumbar spine and sacroiliac (SI) joints to determine the levels of segmental restrictions to be manipulated during the second or third session. If eligibility had been met, the participants then completed an initial familiarization session with the isokinetic dynamometer. Strength testing then began at least 2 days later.

Publisher Copyright:
© 2015 National University of Health Sciences.


  • Knee
  • Muscle strength
  • Spinal manipulation

ASJC Scopus subject areas

  • Chiropractic


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