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Prediction of the Axial Rotation of the Atlanto-Occipital Joint by Means of the Modified Manual Ankle Rigidity Test and Radiography: Study Protocol for a Randomized Double-Blind, Controlled Trial

Joaquin Valdivia Tor, D.C.

Annals of Vertebral Subluxation Research ~ November 30, 2017 ~ Pages 286-296



Background: Chiropractors use a wide variety of diagnostic tests to detect and adjust vertebral subluxations. Measures of leg length inequality have evidenced some validity and one of its types, the supine leg check, is used by some chiropractic upper cervical procedures to measure in millimeters functional leg discrepancy that is supposed to occur due to an atlas misalignment lesion. Yet, this measurement is not supported by face validity. The modified ankle rigidity test may be more valid in measuring the muscular dysfunction related to the atlas subluxation, if any. The objective of this study is to evaluate the accurateness of the predicted rotational degree of the first vertebra as measured by X-ray through the response elicited by a chiropractic device at a particular rotational setting detected by the modified ankle rigidity test. Another secondary outcome will be measured to observe possible changes in functional leg discrepancy with the leg length inequality test. A mechanical chiropractic device will be used as the adjustment method.

A double-blind, randomized controlled trial consisting of 50 patients with chronic back pain will be conducted. Patients with no contraindications for spinal adjustment will be recruited. During the course of the session, different adjustments will be delivered with a mechanical chiropractic device until a change is observed as measured by the primary outcome test. Also, two secondary outcome measures will be taken. Patients will be randomized into two groups to receive the intervention at two different cervical spinal levels.

We expect the primary outcome test to measure a neurophysiological response elicited after the application of the mechanical chiropractic device at a certain rotational degree. This degree should match by at least one degree of rotation the rotational radiographic measurement of the first vertebra. The leg length inequality test may or may not show changes before and after the procedure. If the clinician is able to predict the matching by means of the primary outcome test, this would indicate a predictable and more valid diagnostic test for the spinal condition treated.

Trial registration:
ISRCTN20667529. Registered 25 May 2017.

Chiropractic, manual therapy; diagnostic test; leg length inequality; functional leg length; ankle rigidity; atlantooccipital joint; chiropractic intervention; adjustment, vertebral subluxation, spinal manipulation; radiography