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Clinical Scenario :  Many people with lower quarter musculoskeletal dysfunction present with muscle weakness. Strength training hypertrophies muscle and increases strength, but often requires periods over 6 weeks, which can exceed the episode of care. Weakness can persist despite muscle hypertrophy, particularly in the early stages of joint pathology or in the presence of limb or spinal joint hypomobility, which may inhibit muscle activation. Emerging evidence suggests spinal manipulation can increase short-term strength. Screening for specific muscle weakness that could benefit from manipulation to particular spinal segments could facilitate efficient clinical intervention. Although the neuromuscular mechanisms through which manipulation can increase strength remains a topic of investigation, immediate gains can benefit patients by jump-starting an exercise program to train new muscle function gained and enhancing the motivation to continue strengthening. Evidence from randomized controlled trials would provide support for using manipulation to increase muscle strength, while studying healthy people would eliminate confounding factors, such as pain and pathology.   Clinical Question :  Does randomized controlled trial-level evidence support the concept that a single lumbar spine manipulation session can increase lower-limb strength in healthy individuals?   Summary of Key Findings :  Level 1b evidence of moderate quality from 3 randomized controlled trials showed immediate small to large effect size muscle strength increases immediately after lumbar spine manipulation.   Clinical Bottom Line :  Lumbar spine manipulation can result in immediate lower-limb isometric strength increases. While healthy people with normal muscle strength may improve minimally, joint manipulation for people with knee and hip weakness who are otherwise healthy can result in large effect size strength gains.   Strength of Recommendation :  Moderate quality level 1b evidence from randomized controlled trials with small samples support the use of spinal manipulation to immediately increase lower-limb strength. Additional studies investigating impact on strength and function immediately in people with musculoskeletal pathology are warranted.

Immediate Effects of a Single Spinal Manipulation on Lower-Limb Strength in Healthy Individuals: A Critically Appraised Topic