Effects Of Spinal Manipulation Research Articles

One spinal manipulation session reduces local pain sensitivity but does not affect postural stability in individuals with chronic low back pain: a randomised, placebo-controlled trial

BackgroundClinical practice guidelines recommend spinal manipulation for patients with low back pain. However, the effects of spinal manipulation have contradictory findings compared to placebo intervention. Therefore, this study investigated the immediate effects of lumbar spinal manipulation on pressure pain threshold (PPT) and postural stability in people with chronic low back pain (cLBP). Second, we investigated the immediate effect of lumbar spinal manipulation on pain intensity and the interference of the participant beliefs about which treatment was received in the PPT, postural stability, and pain intensity.MethodsA two-arm, randomised, placebo-controlled, double-blind trial was performed. Eighty participants with nonspecific cLPB and a minimum score of 3 on the Numeric Pain Rating Scale received one session of lumbar spinal manipulation (n = 40) or simulated lumbar spinal manipulation (n = 40). Primary outcomes were local and remote PPTs and postural stability. Secondary outcomes were pain intensity and participant’s perceived treatment allocation. Between-group mean differences and their 95% confidence intervals (CIs) estimated the treatment effect. One-way analysis of covariance (ANCOVA) was performed to assess whether beliefs about which treatment was received influenced the outcomes.ResultsParticipants had a mean (SD) age of 34.9 (10.5) years, and 50 (62.5%) were women. Right L5 [between-group mean difference = 0.55 (95%CI 0.19 to 0.90)], left L5 [between-group mean difference = 0.45 (95%CI 0.13 to 0.76)], right L1 [between-group mean difference = 0.41 (95%CI 0.05 to 0.78)], left L1 [between-group mean difference = 0.57 (95%CI 0.15 to 0.99)], left DT [between-group mean difference = 0.35 (95%CI 0.04 to 0.65)], and right LE [between-group mean difference = 0.34 (95%CI 0.08 to 0.60)] showed superior treatment effect in the spinal manipulation group than sham. Neither intervention altered postural stability. Self-reported pain intensity showed clinically significant decreases in both groups after the intervention. A higher proportion of participants in the spinal manipulation group achieved more than two points of pain relief (spinal manipulation = 90%; sham = 60%). The participants’ perceived treatment allocation did not affect the outcomes.ConclusionOne spinal manipulation session reduces lumbar pain sensitivity but does not affect postural stability compared to a sham session in individuals with cLPB. Self-reported pain intensity lowered in both groups and a higher proportion of participants in the spinal manipulation group reached clinically significant pain relief. The participant’s belief in receiving the manipulation did not appear to have influenced the outcomes since the adjusted model revealed similar findings.

Immediate effects of spinal manipulation on painful sensitivity and postural stability in patients with chronic nonspecific low back pain: study protocol for a controlled randomised clinical trial

BackgroundLow back pain is one of the main public health concerns. Chronic low back pain (cLBP) reduces functional capacity and affects postural stability. Although health professionals widely use spinal manipulation, its immediate effect on painful sensitivity and postural stability is lacking. This study aims to verify the immediate effects of lumbar spinal manipulation on the pressure pain threshold and postural stability in individuals with cLBP.MethodsA two-arm, placebo-controlled clinical trial with parallel groups and examiner-blinded will be conducted with 80 participants with cLBP from an outpatient physical therapy department, randomly allocated at a 1:1 distribution. The experimental group will receive a lumbar spinal manipulation technique, and the placebo group will receive a simulated lumbar spinal manipulation. Both groups will receive one session of treatment and will be evaluated before and immediately after the intervention. The primary outcomes will be the pressure pain threshold and postural stability. Pain intensity and patient’s expectation will be assessed as a secondary outcome. The pressure pain threshold will be assessed using a pressure algometer in 6 different anatomical regions. The evaluation of postural stability will be performed in a baropodometry exam by displacing the centre of pressure. The pain intensity will be measured using the Numeric Pain Rating Scale. A Likert scale will be used for the patient’s expectation about the treatment. A two-way analysis of variance will compare the effect of the interventions between groups.DiscussionThis study will provide insights regarding the immediate effects of spinal manipulation in patients with cLBP against a simulated spinal manipulation using objective outcomes and considering patients’ expectations regarding the treatment.Trial registrationBrazilian Registry of Clinical Trials RBR-3ksq2c. Registered on 13 July 2020

Neuromechanical Responses to Spinal Manipulation and Mobilization: A Crossover Randomized Clinical Trial

ObjectiveThe purpose of this study was to compare the immediate effect of spinal manipulation (SMa) and spinal mobilization (SMo) on muscular responses, spinal stiffness, and segmental spinal pressure evoked pain in a population of participants with chronic middle back pain (MBP). MethodsIn a crossover randomized trial, 2 experienced chiropractors assessed whether volunteers were eligible for the protocol according to a list of specific inclusion and exclusion criteria. Individuals with MBP participated in 2 experimental sessions within 72 hours. During the first session, participants randomly received a SMa or SMo delivered by an apparatus using a servolinear motor. During the second session, the other modality was delivered. Spinal stiffness and pressure-provoked pain intensity outcomes were assessed before and after each therapy, and muscular responses were recorded during the treatment using surface electromyographic sensors. Signed-rank Wilcoxon tests for muscular responses and generalized model for repeated measure for spinal stiffness and pressure-provoked pain were used for statistical analyses. ResultsAmong the 32 potential participants, 26 (mean age 29.9 [±9.14], 15 women) completed both sessions. Between-group differences were observed for the muscular response amplitude (P < .001), and indeed the normalized RMS muscular response was found to be higher during SMa than SMo. Similar results were observed for pressure-provoked pain intensity at the level of therapeutic modality application (P = .002) as a higher decrease in pain was found after SMa (47.9 [±22.8] to 36.6 [±23.7]) compared with SMo (47.2 [±23.2] to 45.5 [±24.3]). No between-group differences were found for spinal stiffness change, nor for terminal (P = .08) and global spinal stiffness (P = .06). ConclusionIn a controlled environment, spinal manipulation and mobilization generated different muscle responses and had different immediate effects on pressure-provoked pain intensity for participants with MBP.

Effect of spinal manipulation on cardiopulmonary parameters in patients with functional scoliosis: A randomised controlled pilot trial

ENWEndNote BIBJabRef, Mendeley RISPapers, Reference Manager, RefWorks, Zotero AMA Gera C, Malik M. Effect of spinal manipulation on cardiopulmonary parameters in patients with functional scoliosis: A randomised controlled pilot trial. Advances in Rehabilitation. 2022;36(1):11-17. doi:10.5114/areh.2022.114226. APA Gera, C., & Malik, M. (2022). Effect of spinal manipulation on cardiopulmonary parameters in patients with functional scoliosis: A randomised controlled pilot trial. Advances in Rehabilitation, 36(1), 11-17. https://doi.org/10.5114/areh.2022.114226 Chicago Gera, Charu, and Manoj Malik. 2022. "Effect of spinal manipulation on cardiopulmonary parameters in patients with functional scoliosis: A randomised controlled pilot trial". Advances in Rehabilitation 36 (1): 11-17. doi:10.5114/areh.2022.114226. Harvard Gera, C., and Malik, M. (2022). Effect of spinal manipulation on cardiopulmonary parameters in patients with functional scoliosis: A randomised controlled pilot trial. Advances in Rehabilitation, 36(1), pp.11-17. https://doi.org/10.5114/areh.2022.114226 MLA Gera, Charu et al. "Effect of spinal manipulation on cardiopulmonary parameters in patients with functional scoliosis: A randomised controlled pilot trial." Advances in Rehabilitation, vol. 36, no. 1, 2022, pp. 11-17. doi:10.5114/areh.2022.114226. Vancouver Gera C, Malik M. Effect of spinal manipulation on cardiopulmonary parameters in patients with functional scoliosis: A randomised controlled pilot trial. Advances in Rehabilitation. 2022;36(1):11-17. doi:10.5114/areh.2022.114226.

The importance of selecting the correct site to apply spinal manipulation when treating spinal pain: Myth or reality? A systematic review

The concept that spinal manipulation therapy (SMT) outcomes are optimized when the treatment is aimed at a clinically relevant joint is commonly assumed and central to teaching and clinical use (candidate sites). This systematic review investigated whether clinical effects are superior when this is the case compared to SMT applied elsewhere (non-candidate sites). Eligible study designs were randomized controlled trials that investigated the effect of spinal manipulation applied to candidate versus non-candidate sites for spinal pain. We obtained data from four different databases. Risk of bias was assessed using an adjusted Cochrane risk of bias tool, adding four items for study quality. We extracted between-group differences for any reported outcome or, when not reported, calculated effect sizes from the within-group changes. We compared outcomes for SMT applied at a ‘relevant’ site to SMT applied elsewhere. We prioritized methodologically robust studies when interpreting results. Ten studies, all of acceptable quality, were included that reported 33 between-group differences—five compared treatments within the same spinal region and five at different spinal regions. None of the nine studies with low or moderate risk of bias reported statistically significant between-group differences for any outcome. The tenth study reported a small effect on pain (1.2/10, 95%CI − 1.9 to − 0.5) but had a high risk of bias. None of the nine articles of low or moderate risk of bias and acceptable quality reported that “clinically-relevant” SMT has a superior outcome on any outcome compared to “not clinically-relevant” SMT. This finding contrasts with ideas held in educational programs and clinical practice that emphasize the importance of joint-specific application of SMT.

Influence of vertebral manipulations on the autonomic nervous system

Introduction. Although its neurophysiological effects have not been fully elucidated, current evidence suggests the clinical effectiveness of spinal manipulation. Different studies suggest that manual therapy induces changes in the autonomic nervous system (ANS). Recent studies showed that mobilization produced a sympatheticexcitatory effect. However, studies using thrust manipulation appeared to be less consistent in their results.Objectives. The main objective of this review was to evaluate whether spinal manipulation induces effects on the ANS. Another objective was to correlate the changes in the measured variables with the activation or inhibition of the sympathetic or parasympathetic nervous system and with the level of spinal manipulation.Materials and methods. We performed a literature search in the following databases: PubMed, PEDro, CINAHL and OVID, using the keywords «Manipulation, spinal» and «Autonomic Nervous System». The PEDro scale was used to assess the methodological quality.Results. Nine studies met the inclusion criteria. Six trials measured cardiovascular function indicators (blood pressure, heart rate, Heart Rate Variability). Three other trials measured the pupil reaction. In most studies, cervical or upper thoracic region was manipulated.Conclusions. Our review does not provide definitive evidence of the effects of spinal manipulation on the ANS. However, most studies observed the existence of autonomic effects by modifying parameters such as blood pressure or Heart Rate Variability after manipulation. Increased parasympathetic activation probably occurs after cervical and lumbar treatment and increased sympathetic activation after dorsal treatment.

Spinal manipulation and modulation of pain sensitivity in persistent low back pain: a secondary cluster analysis of a randomized trial

BackgroundPain hypersensitivity can be assessed using Quantitative Sensory Testing (QST) and is associated with persistent low back pain. Spinal manipulation appears to modify pain hypersensitivity, and this could function as one mechanism leading to clinical improvements. In the current study, we applied a comprehensive QST battery to assess pain sensitivity in a cohort of low back pain patients before and after spinal manipulation to improve our understanding of the association between QST and clinical improvements. This study addresses two questions: Are clinical improvements following spinal manipulation in low back pain patients contingent on pain hypersensitivity, and does pain sensitivity change following spinal manipulation?MethodsWe performed a secondary analysis of data from a randomized clinical trial. One hundred and thirty-two participants with persistent LBP were treated with spinal manipulation four times over two weeks. Patient-reported outcomes and QST were assessed at baseline, after the fourth spinal manipulation session, and 14-days later. The clinical outcomes were changes in low back pain intensity and disability. Using latent profile analysis, we categorized the participants into clusters depending on their baseline QST scores. We used linear mixed models to examine the association between clusters and changes in patient-reported outcomes and QST.ResultsTwo clusters emerged: a Sensitized and a Not sensitized. The former had significantly lower regional pressure and thermal pain thresholds, remote pressure pain tolerance, and lower inhibitory conditioned pain modulation than the Not sensitized group. However, we only found between-cluster differences for regional pressure pain threshold following spinal manipulation. Thus, the clusters were not associated with patient-reported pain and disability changes or the remaining QST outcomes.ConclusionsWe report that the baseline QST profile was not associated with clinical improvements following spinal manipulation. We did observe a substantial change for regional pressure pain threshold, which suggests that any effect of spinal manipulation on pain sensitivity is most likely to be observed as changes in regional, mechanical pain threshold. However, the mechanism that invokes clinical improvement and pain sensitivity changes appear distinct. Due to methodological caveats, we advise caution when interpreting the results.Trial registrationClinical.Trial.gov identifier: NCT04086667, registered 11 September 2019 – Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04086667

Comparison of the effects of spinal manipulation and muscle energy techniques on motor control in Non- Specific Chronic Low Back Pain by Beta-band intermuscular pool coherence

Background: Until now, a variety of techniques have been introduced to address the adverse effects of NS-CLBP, including SMT and MET. However, most of these techniques have focused on pain assessment and disability. In other words, the effectiveness of these techniques on the corticospinal tract function was not studied. Therefore, the purpose of this study was to compare the effects of SMT and MET on corticospinal tract function during flexion-extension task phases in NS-CLBP using PC of Bb-IMC. Methods: A cross-sectional study was designed that in which 20 healthy and twenty-four (20–45 years) NS-CLBP patients men voluntarily participated. The patients had continuous or recurrent symptoms for 3 months or more without any referral pain to the lower extremities. The patients were randomly assigned to two equal intervention groups (SMT and MET) and the techniques were applied as described by Greenman. sEMGs from lumbopelvic muscles was recorded for all participants before and after the intervention while they performed three trials of F-ET and the PC for all muscles was calculated using Bb-IMC analysis. Multivariate analysis of variance test was used to compare the differences between the healthy subjects and patient groups before the interventions. Furthermore, in NS-CLBP patients, comparisons were made before and after the interventions in each group (i.e. SMT and MET groups). Results: There were significant differences in A and B muscle cross in the SMT group before and after the intervention in four phases of F-ET (P < 0.05). However, no significant differences were found in the MET group. Conclusion: These results showed that the SMT intervention was more effective than the MET intervention by reducing the PC of Bb-IMC in all phases of FE-T. Therefore, the PC of Bb-IMC could be considered as an approach for clinicians when designing the rehabilitation protocol to ensure optimal treatment.

The Immediate Effect of Spinal Manipulation on Ball Velocity and Neuromuscular Function During an Instep Kick in Former Varsity Soccer Players: A Feasibility Study.

Corso, M, Liang, L, Tran, S, Howitt, S, Srbely, J, and Mior, SA. The immediate effect of spinal manipulation on ball velocity and neuromuscular function during an instep kick in former Varsity soccer players: a feasibility study. J Strength Cond Res 36(9): 2558-2565, 2022-Spinal manipulation (SM) has been shown to increase ball velocity (BV) in soccer players. Evidence suggests that SM modulates responses at spinal or cortical levels to enhance force production in asymptomatic populations. No studies have explored the underlying neuromuscular mechanisms contributing to changes in BV post-SM in soccer players. We assessed the feasibility of measuring change in BV and neuromuscular function after SM in former Varsity level soccer players with a pre-post study design. Three to 5 maximal instep kicks were performed before and after SM at the L3-5 level. Ball velocity was measured using high-speed camera. Activation of lower limb and trunk musculature was recorded with electromyography. Outcomes included ease of recruitment, scheduling and data capture, as well as expectation and perception of SM effect and adverse events (AE). Fifteen potential subjects were recruited over 1.5 months. Eleven were scheduled (24-31 years; 8 females, 3 males). Two subjects reported mild AE after maximal voluntary isometric contraction testing. A significant increase in BV (mean change: 1.75 m·s -1 [95% confidence interval: 0.5-3.0]) and a trend to increased peak-activation of knee extensors (90.7%) were observed post-SM. Findings suggest that our recruitment strategy and methodology are feasible in a larger trial with some modifications. Our preliminary findings support previous research by suggesting that increased BV may be mediated through increased activation of knee extensors during the kick. Our findings may offer additional insight into the underlying neuromuscular mechanisms contributing to immediate change in BV post-SM.

Immediate effects of spinal manipulation in pain and global joint mobility in patients with chronic nonspecific low back pain

Objective: The aim of this study was to analyze the immediate effects of applying a manipulative intervention on chronic non-specific back pain and increasing global joint mobility. Method: A cross-sectional, randomized, single-blind study was carried out, consisting of 19 women aged between 18 and 55 years old, separated into two groups: Experimental Group (EG = 10) and Control Group (CG=9). The evaluation consisted of a physical examination, Rolland Morris questionnaire, fingertip-to-floor test, Visual Analogue Scale (VAS), and pressure algometry (L5) before and after the manipulative intervention. The EG was submitted to five vertebral manipulations, two in the bilateral pelvis region, one in the middle thoracic region (T5-T7) and two in the bilateral cervical region at the C3 level. The CG was submitted to two placebos manipulative techniques, being positioned in right and left lateral decubitus position for 10 seconds each, in the same position of global pelvic manipulation, but without the manipulative impulse (thrust). Results: The results were statistically significant in the EG in the reduction of sensation of pain (p&lt;0,001) and the increase of overall joint mobility (p&lt;0,05) when comparing pre and post intragroup moments. There were no statistically significant differences in relation to pain threshold evaluated in pressure algometry. Conclusion: It is concluded that a manipulative intervention is able to reduce the pain and to increase the global mobility immediately after its accomplishment.

Spinal Manipulation or Mobilization for Lumbar Disc Herniation with Radiculopathy: A Protocol for a Systematic Review and Meta-Analysis

Introduction: The purpose of this study is to conduct a systematic review and meta-analysis into the effects of spinal manipulation or mobilization for Lumbar Disc Herniation with Radiculopathy (LDHR). Methods: An electronic database search of titles and abstracts of articles published in English will be conducted in the following databases: PEDro (Physiotherapy Evidence Database), CINAHL (Cumulative Index to Nursing and Allied Health Literature), PubMed, Science Direct, Google Scholar, and The Cochrane Library. The specific search strategies will be dependent on the particular database being searched and hand searches of the reference lists of the included articles will also be performed. Studies will be included if they reported an acceptable comparison group, and also reported at least one of the main clinically relevant outcome measures for LDHR. Two independent reviewers will screen the identified records, and all disagreements will be resolved. The internal and external validities of the included studies will be assessed using the PEDro scale and the External Validity Assessment Tool (EVAT) respectively. The clinical relevance and risk of bias of the studies will be determined using the 5-Criteria developed by the Cochrane Back Review Group and the Cochrane Risk of Bias Assessment Tool respectively. Studies will be pooled into meta-analysis where appropriate using RevMan software and the outcomes will be reported using the PRISMA guidelines. Discussion: This review will summarize the current evidence about the effects of spinal manipulation or mobilization compared with other interventions in the management of individuals with Lumbar Disc Herniation with Radiculopathy (LDHR). A meta-analysis will also be conducted where appropriate in this review to compare the effects of spinal manipulation or mobilization with other interventions with a view to finding out which technique is better in the management of individuals with LDHR. Review Registration: This review has been registered with the International Prospective Register of Systematic Reviews (PROSPERO; registration number: CRD42019131292). Keywords: Spinal manipulation; spinal mobilization; lumbar disc herniation; systematic review; meta-analysis

The effect of spinal manipulation on brain neurometabolites in chronic nonspecific low back pain patients: a randomized clinical trial.

In patients with chronic nonspecific low back pain (NCLBP), brain function changes due to the neuroplastic changes in different regions. The current study aimed to evaluate the brain metabolite changes after spinal manipulation, using proton magnetic resonance spectroscopy (1H-MRS). In the current study, 25 patients with NCLBP aged 20-50years were enrolled. Patients were randomly assigned to lumbopelvic manipulation or sham. Patients were evaluated before and 5weeks after treatment by the Numerical Rating Scale (NRS), the Oswestry Disability Index (ODI), and 1H-MRS. After treatment, severity of pain and functional disability were significantly reduced in the treatment group vs. sham group (p < 0.05). After treatment, N-acetyl aspartate (NAA) in thalamus, insula, dorsolateral prefrontal cortex (DLPFC) regions, as well as choline (Cho) in the thalamus, insula, and somatosensory cortex (SSC) regions, had increased significantly in the treatment group compared with the sham group (p < 0.05). A significant increase was further observed in NAA in thalamus, anterior cingulate cortex (ACC), and SCC regions along with Cho metabolite in thalamus and SCC regions after treatment in the treatment group compared with the baseline measures (p < 0.05). Also, a significant increase was observed in Glx (glutamate and glutamine) levels of thalamus (p = 0.03). There was no significant difference in terms of brain metabolites at baseline and after treatment in the sham group. In the patient with low back pain, spinal manipulation affects the central nervous system and changes the brain metabolites. Consequently, pain and functional disability are reduced.

Effect of Spinal Manipulation on Vulvar Pain

Effect of Spinal Manipulation on Vulvar Pain

Immediate Effects of Spinal Manipulation on Shoulder Motion Range and Pain in Individuals With Shoulder Pain: A Randomized Trial

ObjectiveThe purpose of this study was to investigate the influence of thoracic spinal manipulation (SM) on shoulder pain and ranges of motion in individuals with shoulder pain. MethodsThe sample was composed of 60 individuals, randomly allocated into the manipulation group (n = 30), who received the SM, and the placebo group (n = 30) who received a placebo manipulation. Pain evaluation was performed using the visual analog scale, and evaluation of shoulder flexion and abduction ranges of motion was assessed using a goniometer pre- and post-intervention. The intervention was performed by either upper thoracic SM or a placebo manipulation. ResultsThe manipulation group demonstrated increased flexion and abduction of the painful shoulder (P < .01) and increased abduction of the nonpainful shoulder (P = .03), but only the abduction of the painful shoulder reached the minimal detectable change. The placebo group showed a post-intervention increase in the flexion (P = .03) and abduction (P < .01) movement of the painful shoulder. Both groups presented a statistically significant reduction in post-intervention pain (P < .01), but not clinically significant. ConclusionAlthough the SM demonstrated a statistically significant difference for shoulder pain, this was not over the clinically meaningful change. Only the abduction of the painful shoulder reached the minimal detectable change.

Endocrine response after cervical manipulation and mobilization in people with chronic mechanical neck pain: a randomized controlled trial.

Most of the research on the effects of spinal manipulation on endocrine function has been done on healthy subjects and has yielded contradictory results. The potential role of cervical manual therapy intervention in order to induce changes in the endocrine system has not yet been investigated. The aim of this trial is to compare the effects on salivary cortisol levels and clinical outcomes of cervical manipulation versus cervical mobilization or sham manipulation in patients with chronic mechanical neck pain. Randomized controlled trial. University of Alcala de Henares: outpatient (referrals from office workers). A total of 83 patients with chronic mechanical neck pain. Participants were randomized to receive one session of cervical manipulation, cervical mobilization, or sham manipulation. The measured variables were salivary cortisol levels, neck pain and disability, pressure pain thresholds (PPT), and cervical range of motion (ROM). They were obtained at baseline, immediately after treatment (except neck disability), and at one-week follow-up (except cortisol). A significant and comparable increase in cortisol levels was observed immediately after cervical manipulation and mobilization (both P<0.001). Neck disability improved to a similar degree in the cervical manipulation and mobilization groups at the one-week follow-up (both P<0.001). Neck pain was reduced immediately after cervical manipulation (P<0.001), cervical mobilization (P=0.001), and sham manipulation (P<0.001). There were no significant changes in most ROM directions after either treatment. No significant interaction effect was observed for PPT. Cervical manipulation and mobilization resulted in a similar increase in cortisol concentrations immediately post-treatment in people with chronic mechanical neck pain. Supraspinal mechanisms may thus play a role in the hypoalgesic effects that follow the application of both interventions. The increase in cortisol levels was similar with cervical manipulation and mobilization so induced stress levels can be similar in both interventions.

Effect of Spinal Manipulation on Pain Sensitivity, Postural Sway, and Healthrelated Quality of Life among Patients with Non-specific Chronic Low Back Pain: A Randomised Control Trial

Effect of Spinal Manipulation on Pain Sensitivity, Postural Sway, and Healthrelated Quality of Life among Patients with Non-specific Chronic Low Back Pain: A Randomised Control Trial

Effects of spinal manipulation and myofascial techniques on heart rate variability: A systematic review

BackgroundThe analysis of heart rate variability is important to the investigation of stimuli from the autonomic nervous system. Osteopathy is a form of treatment that can influence this system in healthy individuals as well as those with a disorder or disease. ObjectivesThe aim of the present study was to perform a systematic review of the literature regarding the effect of spinal manipulation and myofascial techniques on heart rate variability. MethodsSearches were performed of the Pubmed, Scielo, Lilacs, PEDro, Ibesco, Cochrane and Scopus databases for relevant studies. The PEDro scale was used to assess the methodological quality of each study selected. ResultsA total of 505 articles were retrieved during the initial search. After an analysis of the abstracts, nine studies were selected for the present review. ConclusionBased on the findings, osteopathy exerts an influence on the autonomic nervous system depending on the stimulation site and type. A greater parasympathetic response was found when stimulation was performed in the cervical and lumbar regions, whereas a greater sympathetic response was found when stimulation was performed in the thoracic region.

Immediate effects of spinal manipulation on dynamic electromyographic activity of nonspecific chronic low back pain subjects

Immediate effects of spinal manipulation on dynamic electromyographic activity of nonspecific chronic low back pain subjects

Effect of Spinal Manipulation on Specific Changes in Segmental Instability, Pain Sensitivity and Health-Related Quality of Life among Patients with Chronic Non-specific Low Back Pain- A Randomized Clinical Trial

Effect of Spinal Manipulation on Specific Changes in Segmental Instability, Pain Sensitivity and Health-Related Quality of Life among Patients with Chronic Non-specific Low Back Pain- A Randomized Clinical Trial

Effect of Spinal Manipulation on Pelvic Floor Functional Changes in Pregnant and Nonpregnant Women: A Preliminary Study

ObjectiveThe aim of this study was to investigate whether a single session of spinal manipulation of pregnant women can alter pelvic floor muscle function as measured using ultrasonographic imaging. MethodsIn this preliminary, prospective, comparative study, transperineal ultrasonographic imaging was used to assess pelvic floor anatomy and function in 11 primigravid women in their second trimester recruited via notice boards at obstetric caregivers, pregnancy keep-fit classes, and word of mouth and 15 nulliparous women recruited from a convenience sample of female students at the New Zealand College of Chiropractic. Following bladder voiding, 3-/4-dimensional transperineal ultrasonography was performed on all participants in the supine position. Levator hiatal area measurements at rest, on maximal pelvic floor contraction, and during maximum Valsalva maneuver were collected before and after either spinal manipulation or a control intervention. ResultsLevator hiatal area at rest increased significantly (P < .05) after spinal manipulation in the pregnant women, with no change postmanipulation in the nonpregnant women at rest or in any of the other measured parameters. ConclusionSpinal manipulation of pregnant women in their second trimester increased the levator hiatal area at rest and thus appears to relax the pelvic floor muscles. This did not occur in the nonpregnant control participants, suggesting that it may be pregnancy related.