INTRODUCTION: Most studies on sensory changes after manual therapies have focused on pain sensitivity. This ignores the wider range of sensory alternations that may be important in assessing patient functioning and neglects the issue of bias, which is inherent in most methods of pain assessment employing threshold methodology. Signal detection theory (SDT) addresses the issue of bias and provides a measurement of intramuscular discrimination--the ability to discriminate between two stimuli--which can be assessed over the full range of sensation. This paper will discuss the strengths and limitations of SDT and report on the effects of trigger point therapy and manipulation on intramuscular discrimination to illustrate the potential contribution of this methodology to chiropractic.
METHODS: Intramuscular needle electrodes were used to provide a pair of electrical stimuli to the forearm extensor muscles. Subjects were asked to assess the differences between stimuli before and after treatment. The treatments consisted of manual trigger point therapy applied to the forearm extensors, cervical spine manipulation and a control treatment.
RESULTS: After the trigger point therapy, there was a significant improvement in the ability of the subjects to discriminate between intramuscular signals to treated muscle. Some individual subjects showed alterations in ability to discriminate after cervical spine manipulation but the effect was not significant in the group as a whole.
CONCLUSIONS: The methodology of signal detection theory provides a promising, bias-free method of assessing changes in intramuscular sensation after various treatments. In these experiments, trigger point therapy was found to enhance intramuscular discrimination, suggesting that a peripheral reflex may be involved.
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