Abstract
BackgroundSpinal manipulation (SM) has been shown to have an effect on pain perception. More knowledge is needed on this phenomenon and it would be relevant to study its effect in asymptomatic subjects.ObjectivesTo compare regional effect of SM on pressure pain threshold (PPT) vs. sham, inactive control, mobilisation, another SM, and some type of physical therapy. In addition, we reported the results for the three different spinal regions.MethodA systematic search of literature was done using PubMed, Embase and Cochrane. Search terms were ((spinal manipulation) AND (experimental pain)); ((spinal manipulative therapy OR spinal manipulation) AND ((experimental pain OR quantitative sensory testing OR pressure pain threshold OR pain threshold)) (Final search: June 13th 2017). The inclusion criteria were SM performed anywhere in the spine; the use of PPT, PPT tested in an asymptomatic region and on the same day as the SM. Studies had to be experimental with at least one external or internal control group. Studies on only spinal motion or tenderness, other reviews, case reports, and less than 15 invited participants in each group were excluded. Evidence tables were constructed with information relevant to each research question and by spinal region. Results were reported in relation to statistical significance and were interpreted taking into account their quality.ResultsOnly 12 articles of 946 were accepted. The quality of studies was generally good. In 8 sham controlled studies, a psychologically and physiologically “credible” sham was found in only 2 studies. A significant difference was noted between SM vs. Sham, and between SM and an inactive control. No significant difference in PPT was found between SM and another SM, mobilisation or some type of physical therapy. The cervical region more often obtained significant findings as compared to studies in the thoracic or lumbar regions.ConclusionSM has an effect regionally on pressure pain threshold in asymptomatic subjects. The clinical significance of this must be quantified. More knowledge is needed in relation to the comparison of different spinal regions and different types of interventions.
Highlights
Spinal manipulation (SM) has been shown to have an effect on pain perception
A significant difference was noted between SM vs. Sham, and between SM and an inactive control
No significant difference in pressure pain threshold (PPT) was found between SM and another SM, mobilisation or some type of physical therapy
Summary
Spinal manipulation (SM) has been shown to have an effect on pain perception. More knowledge is needed on this phenomenon and it would be relevant to study its effect in asymptomatic subjects. Spinal manipulation (SM) is a therapeutic tool used by several health care professions [1] It is reasonably inexpensive [2] and recognized to have a clinically significant impact on musculoskeletal pain [3]. It is a mechanical event that seems to decrease briefly the intra-discal pressure and to stretch the surrounding muscles, causing their relaxation [7]. It can be differentiated from mobilisation, where the movement would be one or several low velocity low amplitude actions on the joints by the therapist, usually not accompanied by the “crack”
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