Abstract
BackgroundSpinal manipulation (SM) has been shown to have an effect on the pressure pain threshold (PPT) in asymptomatic subjects, but SM has never been compared in studies on this topic to a validated sham procedure. We investigated the effect of SM on the PPT when measured i) in the area of intervention and ii) in an area remote from the intervention. In addition, we measured the size and duration of the effect.MethodIn a randomized cross-over trial, 50 asymptomatic chiropractic students had their PPT measured at baseline, immediately after and every 12 min after intervention, over a period of 45 min, comparing values after SM and a previously validated sham. The trial was conducted during two sessions, separated by 48 h. PPT was measured both regionally and remotely from the ‘treated’ thoracic segment. Blinding of study subjects was tested with a post-intervention questionnaire. We used mixed linear regression with the baseline value and time as co-variates. If a significant difference were found between groups, then an effect size would be calculated using Cohen’s d or Hedge’s h coefficient. Statistical significance was set at p < 0.05.ResultsStudy subjects had been successfully blinded. No statistically significant differences were found between SM and sham estimates, at any time or anatomical location.ConclusionWhen compared to a valid sham procedure and with successfully blinded subjects, there is no regional or remote effect of spinal manipulation of the thoracic spine on the pressure pain threshold in a young pain-free population.
Highlights
Spinal manipulation (SM) can be defined as a high velocity low amplitude forced manoeuvre applied to spinal joints outside the range of motion but within the normal range of anatomical joints, sometimes accompanied by a characteristic cracking sound [1]
Data were removed from the final analysis for one study subject because of malfunction of the algometer, resulting in 50 participants for the analyses of the regional pressure pain threshold (PPT) tests
For the remote PPT testing, another four subjects were excluded: one, because the lumbar region was painful at the second session and three because they had PPT values over 1000 kPa
Summary
Background Spinal manipulation (SM) can be defined as a high velocity low amplitude forced manoeuvre applied to spinal joints outside the range of motion but within the normal range of anatomical joints, sometimes accompanied by a characteristic cracking sound [1]. It can be compared to a mobilisation, which is defined as a type of manual therapy with a comparable execution and similar clinical results, but applied slower and/or repetitively over the joints within the range of motion and within the patient’s control [2, 3] SM has been shown, sometimes, to have a clinical impact in the treatment of musculoskeletal pain [4], the mechanisms underlying the reduction of pain are not yet well defined Such mechanisms can be studied by the means of experimentally induced pain. We measured the size and duration of the effect
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