An Investigation into the Impact Spinal Manipulation May Have on the Performance by IJRASET

VII

https://doi.org/10.22214/ijraset.2022.45442

July 2022

An Investigation into the Impact Spinal Manipulation May Have on the Performance of Strength Athletes: A Research Survey Dr. Brogan Williams PhD, MS, Selinus University of Science and literature, North Shore, Auckland, 0622, New Zealand Abstract: The amount of research behind spinal manipulation is growing, however, very little attention has been paid to the possible impacts SM has on athletes – or furthermore strength athletes. The central research question is “What impact does spinal manipulation have on strength athletes?”. The objective of this research question is to guide the exploration and observation of how spinal manipulation impacts the performance of strength athletes. This was achieved via an international research survey. A null and alternative hypothesis was established. Each question was designed to measure how effective SM was on strength performance. There were 5 questions in total that covered the most prominent results in the literature; recovery, technique, R.O.M, pain, strength. Each question required an answer between 1-10, determining how effective the participant felt SM was regarding that specific topic, and each participant’s survey would be submitted out of 50, covering 5 questions worth 1/10 each. 69 participants (n=69; ±0.10 - 10%) enrolled in the research article, 81.2% male, 18.8% female and between the age of 21-55. The null hypothesis was successfully rejected with 95% of the sample population scoring a sample mean value (33.7, 95% CI 31.2 - 36.3) >25 (over 50%), meeting the critical value inclusion criteria of 5% (P = 0.05); concluding it statistically significant with 95% confidence Interval, a 2.6 margin of error and a SD of 10.8. That is a 67% result in favour to SM being effective for strength performance. In conclusion: the data shows that spinal manipulation is an effective treatment to improve overall performance in strength athletes, this includes pain modulation, ROM, technique, strength and recovery improvements. Keywords: Spinal manipulation; chiropractic adjustment; spine; pain; ROM; muscle; education. I. INTRODUCTION The decision to explore further research around the effects of spinal manipulation (SM) and on strength athletes is both appropriate and deemed necessary to push forward the body of evidence around this subject. A null and alternative hypothesis was established and the chosen modality of research was approved based on how well that process would align with the purpose of this paper. To effectively collect and display meaningful data an opportunistic sampling process was employed and a cross sectional survey method of study chosen with a single right tailed hypothesis. The survey provided data representing the efficacy of SM for over performance. The results were investigated and analysed to reach a statistical and meaningful conclusion. II. CONSENT Each participant was required to agree to a consent form prior to taking the survey. This was primarily to educate the participant on the study and to ensure they are 18 or above. The consent form was as follows: CONSENT, You have been invited to participate in a research study titled “AN INVESTIGATION INTO THE POSSIBLE IMPACTS OF SPINAL MANIPULATION ON STRENGTH ATHLETES”. This study is being done by Brogan Williams as part of his master’s thesis with Selinus University of Science and Literature. The purpose of this study is to explore the possible impacts of spinal manipulation (or chiropractic adjustments) on strength athletes or gym members who train strength. If you agree with the terms and participate in the study you will be asked to complete an online survey/question aire. We require your name, age, gender, and your experience with SM + strength training. Your data will be published in the final research study and master's thesis - your name WILL NOT be disclosed to protect your privacy. By clicking “I agree”, you are indicating that you’re at least 18 years old and have read and understood this consent form, and agree to participate in this research study and have your data used and published Thank you for your participation.

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International Journal for Research in Applied Science & Engineering Technology (IJRASET) ISSN: 2321-9653; IC Value: 45.98; SJ Impact Factor: 7.538 Volume 10 Issue VII July 2022- Available at www.ijraset.com III. THE HYPOTHESIS 1) Research Question: What impact does spinal manipulation have on strength athletes? 2) Null Hypothesis: Spinal manipulation has no significant impact on strength athletes. 3) Alternative Hypothesis: Spinal manipulation has a positive impact on strength athletes greater than the hypothetical mean of 25.

Fig. 1 One-Tailed test [1] A P value of 0.05 or less is required as the critical value required to reject the null hypothesis. The hypothetical mean is set at 25/50, which represents 50% on the survey questions as a percentage, as each question is worth 10 marks. 5 questions in total equals 50 marks. Each question in the survey will be marked from 1 – 10, between  (Not at all) 1 – 10 (Yes very much so)  5 questions total, each represents 10 (10 = SM works, 0 = does not work) 5 questions each worth 10 marks is a total out of 50. That total mark out of 50 represents how well SM has worked for that individual athlete. To reject the null hypothesis, the sample mean value must be statistically significantly higher than score 25/50 = 0.5. So, we can conclude that the population mean value of the observed variable is statistically significantly higher than 25/50 = above 0.5. Most of the sample group mean is required to score 25/50 or above (50% or higher) and be within the 5% probability value to ensure the results are statistically valid; meaning it is less than 5% likely this data happened by chance and the results are very statistically significant. For the null hypothesis to be rejected we require 95% of the sample population to score the mean value statistically significantly higher than 25 (over 50%) in the survey, meeting the critical value inclusion criteria of 5% (P = 0.05); concluding it statistically significant. IV. SAMPLING PROCESS To secure valid results, it was crucial to have a survey that was perfectly set up for the project and goal at hand. The survey was posted online and advertised as open to all who wanted to participate if they fit the criteria required – this resulted in an opportunistic or convenient style of sample collection. The inclusion criteria for those wanting to be involved was as following: 1) Male or Female 2) 18 – 60 3) Has competed in powerlifting, weightlifting or strongman or follows a strength based training regime 4) Has had spinal manipulation or been under chiropractic care during this time

Fig. 2 Unlimited Population Equation [2]

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International Journal for Research in Applied Science & Engineering Technology (IJRASET) ISSN: 2321-9653; IC Value: 45.98; SJ Impact Factor: 7.538 Volume 10 Issue VII July 2022- Available at www.ijraset.com This inclusion criteria establishes a total population of over N: 1,000,000. Due to the high number of total population involved a high number of sample population is required in the survey for accuracy reasons. The number 1,000,000 is used to represent an “unlimited population” as statically the sample numbers do not increase beyond that threshold of total population. To achieve a moderate to high confidence level (90%) and a low margin of error (10%), many participants were required to be surveyed to provide statistically valid or accurate results. z is the z score ε is the margin of error N is the population size p̂ is the population proportion

Fig. 3 Equations [3] Total Population: N=1,000,000+ Sample Population: n=69 (±0.10 - 10%) Confidence level: CL=90% Margin of Error: 10% Recommended Sample Size: n=69 (±0.10 - 10%)

Fig. 4 Sample Chart [4] As above you can see the sample size chosen was n=69 (±0.10 - 10%) providing a 90% confidence level and a low margin of error at 10%. Due to sampling variability, the mean of a sample will change from sample to sample. A high confidence level (CL=90% and above) provides you the confidence that there is a 90% chance that within the range of values you have, there is an accurate representation of the true mean for that population, within (±0.10 - 10%). The more participants in the survey, the more data collected and a lower margin of error can be achieved – which provides more confidence in the conclusions that are drawn from the samples received. V. METHOD A 5-question cross sectional survey was designed and posted on the hosting website www.ownsurvey.com. Each survey consisted of 5 questions, each worth 10 marks for a grand total of 50 marks. 69 participants took the survey resulting in 69 data sets being analysed using Microsoft Excel via inductive quantitative methods (T-test and P-value). Each question was designed to cover key results that the literature review highlighted. Most specifically, the impact SM has on pain, ROM, strength, recovery & proprioception.

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Fig. 5 Survey Questions [5] VI. DATA ANALYSIS Microsoft Excel and OwnSurvey.com was used employing inductive quantitative methods (T-test and P-value). Descriptive statistical analysis was also conducted providing metrics such as the mean, mode, median, minimum, maximum, range, sample variance, skewness, sum, count, standard deviation, confidence intervals, population and sample mean, mean difference and various graphs to make sense of this data.

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International Journal for Research in Applied Science & Engineering Technology (IJRASET) ISSN: 2321-9653; IC Value: 45.98; SJ Impact Factor: 7.538 Volume 10 Issue VII July 2022- Available at www.ijraset.com VII. RESULTS 69 participants (n=69; ±0.10 - 10%) enrolled in the research article, 81.2% male, 18.8% female and between the age of 21-55. The null hypothesis was successfully rejected with 95% of the sample population scoring a sample mean value (33.7, 95% CI 31.2 - 36.3) >25 (over 50%), meeting the critical value inclusion criteria of 5% (P = 0.05); concluding it statistically significant with 95% confidence Interval, a 2.6 margin of error and a SD of 10.8. That is a 67% result in favor to SM being effective for strength performance.

Fig. 6 Participant age. [6]

Fig. 7 Participant gender. [7]

Fig. 8 T test and descriptive statistics. [8]

Fig. 9 Participant gender. [9]

Fig. 9 Participant age. [10]

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International Journal for Research in Applied Science & Engineering Technology (IJRASET) ISSN: 2321-9653; IC Value: 45.98; SJ Impact Factor: 7.538 Volume 10 Issue VII July 2022- Available at www.ijraset.com Each question was designed to measure how effective SM was on strength performance. There were 5 questions in total that covered the most prominent results in the literature; recovery, technique, R.O.M, pain, strength. Each question was required an answer between 1-10, determining how effective the participant felt SM was regarding that specific value, and each participant’s survey would submit a total out of 50. The total out of 50 represents how effect SM is on strength performance overall, and for the convenience of this graph, those numbers were converted to percentages. Does SM improve recovery: 68% (mean of 6.8/10) Does SM improve lifting technique: 60% (mean of 6/10) Does SM improve R.O.M: 73% (mean of 7.3/10) Does SM decrease pain: 78% (mean of 7.8/10) Does SM improve strength: 59% (mean of 5.9/10)

Fig. 11 Research question percentages. [11] VIII.

DISCUSSION

We can successfully reject the Null Hypothesis pertaining to the research question “What impact does spinal manipulation have on strength athletes?” based on the results published. A P value of 0.05 or less was required as the critical value to reject the null hypothesis and accept the alternative hypothesis , and out of 69 participants (n=69; ±0.10 - 10%), a mean score was presented at 33.7/50 with a confidence interval of 95% CI [31.2 - 36.3]. These results represent the mean answer for all 5 questions, which were out of 10 and covered 5 key aspects of how SM impacts strength performance that was also clear in the literature review: 1) Recovery 2) Technique 3) R.O.M 4) Pain 5) Strength

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Fig. 12 Null & Alternative Hypothesis. [12] Although the alternative hypothesis was represented by the total of questions (which gave an overview of the effects SM has on strength performance) we can also discuss how each question independently performed – drawing conclusions around the possible meaning behind that. The highest scoring question was whether SM helped reduce pain, and this question received a resounding yes with a mean of 7.8/10 (95% CI 6.55 – 9.05). Interestingly enough, the highest score was 10/10 which was 30.4% of the 69 sets of data received – providing a clear picture that athletes really do feel this effect and likely use SM for this effect. The literature review showed many high-quality studies supporting the efficacy of pain modulation by SM and multiple ways or reasons this may be occurring as seen on “The Williams Axis of SM effects” (Williams, 2020). Additionally, following the question on “pain” as the highest-ranking response was R.O.M (range of motion) at 7.3/10 (95% CI 5.82 – 8.76), recovery at 6.8/10 (95% CI 5.21 – 8.47), technique at 6/10 (95% CI 4.28 – 7.74) and the lowest data set was for strength at 5.9/10 (95% CI 4.23 – 7.71).

Fig. 13 Research question results in %. IX. CONCLUSION Overall, athletes are feeling the effects and the positive impacts of SM, and these 5 areas that were chosen to be explored in this study are not only evident throughout the literature but clear to see in the research data of this study. It is important to note, that although extremely useful, SM is no magic bullet and we do require more research on this topic before we can draw hard conclusions [13]. It is also important to mention that although very impressive, many of these effects are temporary and likely not lasting – this isn’t a bad thing however, as there are many ways clinicians and doctors alike can use these short-term adaptations to implement and cement long term healthy adjustments and changes to the system [14]. It is about using SM within the understanding of movement, biomechanics, exercise and rehab to maximize the results you can provide for your patient [15]. Outdated or limited thinking and expectations that SM or chiropractic adjustments can “heal” ailments or disease is outdated and a damaging sentiment for the patient and the progression of modern physical medicine. REFERENCES [1] [2] [3]

K. Tan, “One-tailed hypothesis test,” PrepNuggets, 2021. https://prepnuggets.com/glossary/one-tailed-hypothesis-test/ “Sample Size Calculator,” www.calculator.net, May 03, 2022. https://www.calculator.net/sample-sizecalculator.html?type=1&cl=95&ci=5&pp=50&ps=1000000&x=0&y=0 (accessed May 02, 2022). Zieben007, “English: This is a visualization of the margin of error. I made this image based on a PNG image authored by Fadethree.,” Wikimedia Commons, Apr. 01, 2014. https://commons.wikimedia.org/wiki/File:Margin-of-error- 95.svg#/media/File:Margin-of-error-95.svg

[4]

OwnSurvey.com, “Spinal Manipulation and Strength Athletes | OwnSurvey.com,” www.ownsurvey.com, 2022. https://www.ownsurvey.com/take-a-

[5]

survey.php?questionnaire=YJGmZtlH9jJb37U (accessed May 04, 2022). B. Williams, “An Investigation into the Impact Spinal Manipulation May Have on the Performance of Strength Athletes,” PhD Thesis, Selinus University of Science and Literature, 2022.

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G. Gyer, J. Michael, J. Inklebarger, and J. S. Tedla, “Spinal manipulation therapy: Is it all about the brain? A current review of the neurophysiological effects of manipulation,” Journal of Integrative Medicine, vol. 17, no. 5, pp. 328–337, Sep. 2019, doi: 10.1016/j.joim.2019.05.004. M. O. Roland, “A critical review of the evidence for a pain-spasm-pain cycle in spinal disorders,” Clinical Biomechanics, vol. 1, no. 2, pp. 102–109, May 1986, doi: 10.1016/0268-0033(86)90085-9. S. Lewis, P. Holmes, S. Woby, J. Hindle, and N. Fowler, “The relationships between measures of stature recovery, muscle activity and psychological factors in patients with chronic low back pain,” Manual Therapy, vol. 17, no. 1, pp. 27–33, Feb. 2012, doi: 10.1016/j.math.2011.08.001.

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