Manipulative Physiotherapy Research Articles

Case series: 3D printed orthopedic brace combined with traditional manipulative physiotherapy to treat new-onset scoliosis in adults.

IntroductionNew-onset scoliosis in adults is different from that in congenital and idiopathic scoliosis. We applied personalized custom 3D printed orthopedic braces combined with traditional manipulative physiotherapy to treat adult patients with new-onset scoliosis and observed the effectiveness of the treatment.Patient concernsNine patients aged 20–52 years presented with unequal height of hips and asymmetrical waist. One shoulder was obviously protruding or enlarged compared to the other; when lying on the bed, the legs were not equal in length, and when bending down, the back was not equal on the left and right.DiagnosisNew-onset scoliosis.InterventionsApplication of individual customized 3D printing brace combined with traditional treatment. Evaluation of clinical efficacy after treatment, including functional exercise test (FMS) before and after treatment, ability of daily living (ADL), visual analog pain score (VAS), and scoliosis angle (Cobb angle).OutcomesThe total effective treatment rate was 100.00% (9/9). The VAS score, Cobb angle of the spine, FMS test, and ADL test were significantly improved compared with those before treatment.ConclusionThe customized 3D printed orthopedic brace combined with traditional techniques to treat scoliosis and innovatively combined human bionic technology with traditional medicine to achieve the continuity and precise correction of scoliosis treatment is a clinically effective technique.

Evaluation of functional disability and pain in patients with chronic low back pain submitted to physiotherapy

Introduction: Chronic low back pain (CLBP) is one of the causes that usually result in mobility limitations in the economically active population due to musculo-skeletal disorders. It has, as main symptoms, pain and disability and should be seen as a public health problem. Objective: This study aimed to evaluate the Functional Disability (FD) and pain intensity in patients with CLBP, underwent to manipulative therapy and conventional physiotherapy at Getulio Vargas Hospital. Method: This was a randomized trial study with a control group, with a sample, participants with CLBP, who were divided into two groups: those who underwent manipulative physiotherapy (group 1) and those who underwent conventional therapy (group 2), and the both groups were subjected to two treatments at different times. The program lasted five weeks, and 2 weeks for each intervention, performing two weekly sessions, which average duration was 30 minutes and one week interval between treatments. There were collected sociodemographic data, data related to FD using the Disability questionnaire Roland-Morris (RMDQ) and data related to pain intensity using the Visual Analogue Scale (VAS). Results: The study included 14 patients with mean age of 51 + 9 years. They showed significant improvement in RMDQ (p <0.001) and VAS (p <0.001), after being subjected to manipulative group, also showing a significant treatment effect over conventional treatment in both RMDQ (p = 0.004) and EVA (p = 0.006). Conclusion: Through this study, it can be shown that patients with CLBP showed significant improvements in functional capacity, by reducing the FD and reduction of painful symptoms, after being subjected to a five-week-program of manipulative physiotherapy.

Effectiveness of acupuncture and manipulation in the management of individuals with sacroiliac joint disorders based on clinical prediction rules

Background: Despite being identified as a serious health concern, effective means of managing chronic LBP with SIJ disorders based on sound evidence still remains controversial. Aims: The purpose of this study is to compare the effects of combined treatment (acupuncture, manipulative therapy, AMG) with manipulative therapy (MTG) and standard physiotherapy (STG) alone based on Flyn et al.'s clinical prediction rule (CPR). Methods: Eighty-one participants with disorders of lower back pain and Sacroiliac joint (SIJ) were randomised into the 3 treatment groups. Outcome measures of pain intensity, functional disability and quality of life were carried out at baseline, after 6 weeks of treatment and at 3-month follow up. Participants were treated according to the treatment in the group to which they are randomised. Results: Participants in the AMG showed grater improvement than the others after six weeks of treatment. Paired t – test showed significant difference (t = 3.142, P = 0.004) in the mean percentage improvement between those who met the CPR (64.39 (13.0)) and those who did not (49.44 (7.89)). In the AMG, 21 (77.8%) participants recorded treatment success while 6 (22.2%) recorded treatment failure. One of the hip having more than 350 of internal rotation showed significant predictive value in association with treatment success (Wald test score = 37.887, P = 0.035 with an odd ratio value of 0.857). Conclusion: A combined treatment consisting of acupuncture, manipulative therapy and exercises will offer greater benefits to patients with lower back pain and SIJ disorders. The presence of at least 35 degrees of internal rotation in one of the hip joint is predictive factor of treatment success with manipulative therapy and acupuncture in patient with lower back and SIJ disorders.

Manipulative physiotherapy practice in the thoracic spine: a survey of current practice in the UK

Purpose: With the perceived relative safety of thoracic thrust joint manipulation (TTJM) and evidence to support its use in the management of neck and shoulder complaints, the thoracic spine is widely considered the most commonly manipulated spinal region. TTJM is however not without risk, where side effects and adverse events (AE) including injury to the spinal cord and haemothorax have been documented. With evidence of the value of pre-thrust examination in reducing AE in other regions this study aims to investigate UK practice in TTJM. Findings from this study will be used to guide clinical practice and future research.

Advancing clinical reasoning through postgraduate manipulative physiotherapy education: A mixed methods longitudinal case study

Advancing clinical reasoning through postgraduate manipulative physiotherapy education: A mixed methods longitudinal case study

Creating a learning culture for developing clinical reasoning through postgraduate manipulative physiotherapy education

Creating a learning culture for developing clinical reasoning through postgraduate manipulative physiotherapy education

Effects of Maitland Orthopedic Manipulative Physiotherapy and Stretching applied to Cervical Vertebra on Pain, Range of Motion, and Muscle Tone of Adults with Forward Neck posture

The purpose of this study is to investigate effects of Maitland orthopedic manipulative physiotherapy and stretching on pain, cervical range of motion, and muscle tone of adults with forward neck posture. A total 40 subjects were divided into a Maitland OMPT group(n=20) and a stretching group(n=20), performing joint mobilization exercise and stretching three times per week for six weeks. As for changes in pain, statistically significant decrease were found before and after the exercise within group comparison( p<.01), while no statistically significant difference was observed between-group comparison. In changes in cervical range of motion before and after the exercise, the Maitland OMPT group showed statistically significant increase(p<.01) in flexion, (left lateral flexion(p<.05), extension, left rotation, right rotation, and right lateral flexion, while the stretching group showed statistically significant increase(p<.05) in extension(p<.01), left rotation, left lateral flexion, right rotation, and right lateral flexion. However, no significant differences in between group comparison in flexion, extension, right rotation, left rotation, right lateral flexion and left lateral flexion. The results of measuring muscle tone changes showed that the Maitland OMPT group and the stretching group did not show significance in within and between group comparison(p<.05). In conclusion, the Maitland OMPT and stretching were effective on improving pain and range of motion.

Physiotherapists’ knowledge of pain: A cross-sectional correlational study of members of the South African Sports and Orthopaedic Manipulative Special Interest Groups

Background. Pain is the most common complaint for which patients seek the help of a physiotherapist. Furthermore, pain has been identified as the fifth vital sign, indicating the attention with which physiotherapists should be assessing pain. Previous studies have found deficits in pain knowledge among healthcare providers. Poor knowledge about pain is recognised to lead to poor assessment ability, and subsequently, to poor pain management.Objective. To investigate the pain knowledge of sports and orthopaedic manipulative physiotherapists in South Africa (SA).Methods. Data were collected online by means of a demographic questionnaire and Unruh’s Revised Pain Knowledge and Attitudes Questionnaire (RPKAQ). Participants were members of the Sports Physiotherapy Group and Orthopaedic Manipulative Physiotherapy Group of the South African Society of Physiotherapy.Results. The mean score for the RPKAQ was 65.5% (standard deviation (SD) ±8.6). Only 14.45% of the physiotherapists scored ≥75%. Lowest scores were obtained for the ‘assessment and measurement of pain’ (47.6%; SD ±15.6) and ‘developmental changes in pain perception’ (58.7%; SD ±20.8) sections of the RPKAQ, while the highest mean score was obtained for the ‘physiological basis of pain’ section (76.8%; SD±14.6). Gender, ethnicity (defined by home language), academic training and clinical experience did not contribute significantly to overall pain knowledge.Conclusion. There is an inadequate level of pain knowledge among members of the sports and orthopaedic manipulative physiotherapy groups in SA, particularly in the areas of the assessment and measurement of pain, and developmental changes in pain perception.

Physiotherapists’ knowledge of pain: A cross-sectional correlational study of members of the South African Sports and Orthopaedic Manipulative Special Interest Groups

Background. Pain is the most common complaint for which patients seek the help of a physiotherapist. Furthermore, pain has been identified as the fifth vital sign, indicating the attention with which physiotherapists should be assessing pain. Previous studies have found deficits in pain knowledge among healthcare providers. Poor knowledge about pain is recognised to lead to poor assessment ability, and subsequently, to poor pain management.Objective. To investigate the pain knowledge of sports and orthopaedic manipulative physiotherapists in South Africa (SA).Methods. Data were collected online by means of a demographic questionnaire and Unruh’s Revised Pain Knowledge and Attitudes Questionnaire (RPKAQ). Participants were members of the Sports Physiotherapy Group and Orthopaedic Manipulative Physiotherapy Group of the South African Society of Physiotherapy.Results. The mean score for the RPKAQ was 65.5% (standard deviation (SD) ±8.6). Only 14.45% of the physiotherapists scored ≥75%. Lowest scores were obtained for the ‘assessment and measurement of pain’ (47.6%; SD ±15.6) and ‘developmental changes in pain perception’ (58.7%; SD ±20.8) sections of the RPKAQ, while the highest mean score was obtained for the ‘physiological basis of pain’ section (76.8%; SD±14.6). Gender, ethnicity (defined by home language), academic training and clinical experience did not contribute significantly to overall pain knowledge.Conclusion. There is an inadequate level of pain knowledge among members of the sports and orthopaedic manipulative physiotherapy groups in SA, particularly in the areas of the assessment and measurement of pain, and developmental changes in pain perception.

Physiotherapists’ knowledge of pain: A cross-sectional correlational study of members of the South African Sports and Orthopaedic Manipulative Special Interest Groups

Background. Pain is the most common complaint for which patients seek the help of a physiotherapist. Furthermore, pain has been identified as the fifth vital sign, indicating the attention with which physiotherapists should be assessing pain. Previous studies have found deficits in pain knowledge among healthcare providers. Poor knowledge about pain is recognised to lead to poor assessment ability, and subsequently, to poor pain management.Objective. To investigate the pain knowledge of sports and orthopaedic manipulative physiotherapists in South Africa (SA).Methods. Data were collected online by means of a demographic questionnaire and Unruh’s Revised Pain Knowledge and Attitudes Questionnaire (RPKAQ). Participants were members of the Sports Physiotherapy Group and Orthopaedic Manipulative Physiotherapy Group of the South African Society of Physiotherapy.Results. The mean score for the RPKAQ was 65.5% (standard deviation (SD) ±8.6). Only 14.45% of the physiotherapists scored ≥75%. Lowest scores were obtained for the ‘assessment and measurement of pain’ (47.6%; SD ±15.6) and ‘developmental changes in pain perception’ (58.7%; SD ±20.8) sections of the RPKAQ, while the highest mean score was obtained for the ‘physiological basis of pain’ section (76.8%; SD±14.6). Gender, ethnicity (defined by home language), academic training and clinical experience did not contribute significantly to overall pain knowledge.Conclusion. There is an inadequate level of pain knowledge among members of the sports and orthopaedic manipulative physiotherapy groups in SA, particularly in the areas of the assessment and measurement of pain, and developmental changes in pain perception.

Beliefs and Practice Patterns in Spinal Manipulation and Spinal Motion Palpation Reported by Canadian Manipulative Physiotherapists

This practice survey describes how Fellows of the Canadian Academy of Manipulative Physiotherapy (FCAMPT) use spinal manipulation and mobilization and how they perceive their competence in performing spinal assessment; it also quantifies relationships between clinical experience and use of spinal manipulation. A cross-sectional survey was designed based on input from experts and the literature was administered to a random sample of the FCAMPT mailing list. Descriptive (including frequencies) and inferential statistical analyses (including linear regression) were performed. The response rate was 82% (278/338 eligible FCAMPTs). Most (99%) used spinal manipulation. Two-thirds (62%) used clinical presentation as a factor when deciding to mobilize or manipulate. The least frequently manipulated spinal region was the cervical spine (2% of patients); 60% felt that cervical manipulation generated more adverse events. Increased experience was associated with increased use of upper cervical manipulation among male respondents (14% more often for every 10 years after certification; β, 95%CI=1.37, 0.89-1.85, p<0.001) but not among female respondents. Confidence in palpation accuracy decreased in lower regions of the spine. The use of spinal manipulation/mobilization is prevalent among FCAMPTs, but is less commonly used in the neck because of a perceived association with adverse events.

A note to the musculoskeletal physiotherapist

Musculoskeletal (formerly manipulative) physiotherapy is widely used for the rehabilitation of patients with common musculoskeletal pain and related disability. As part of its progress from largely empirical beginnings to becoming basic sciences informed this sub-specialty of the physiotherapy profession has developed a profound interest in pain mechanisms, causal and therapeutic. It is of some concern, however, that the use of pain terminology and classification among the fraternity has tended to be typically idiosyncratic and at times inaccurate. This is not only confusing to followers of the wider medical science literature. It also compromises clear communication between the physiotherapist and fellow orthodox health care professionals. This 'note' restates the acknowledged pain terminology and its applicability to recognised pain categories.

Continuing Education for Advanced Manual and Manipulative Physiotherapists in Canada: A Survey of Perceived Needs

Our purpose was to determine advanced manual and manipulative physiotherapists' (AMPTs') current use and awareness of continuing education (CE) opportunities; to establish their perceived CE needs by identifying facilitators and barriers to participation; and to explore the association of demographics with CE needs. A questionnaire was e-mailed to 456 registered members of the Canadian Academy of Manipulative Physiotherapy. Data analyses using frequencies and percentages of total responses and t-tests for group comparisons were performed. One hundred thirty-three (29.2%) participants responded. Most lived in an urban region and worked predominantly in direct patient care. More respondents reported engaging in informal CE than in formal CE. Hands-on or practical workshops were the preferred CE format. Common barriers to CE included professional commitments and cost and time of travel; facilitators included interest in the topic and increasing knowledge and competency. AMPTs with less physical therapy experience found cost to be a greater barrier and were more interested in mentorship programs and CE as a means to obtain credentials. AMPTs' preferred CE formats are inconsistent with the CE opportunities in which they participate. CE initiatives for AMPTs should include hands-on training and should account for time and cost to make CE opportunities more readily available to them.

The clinical reasoning of musculoskeletal physiotherapists in relation to the assessment of vertebrobasilar insufficiency: A qualitative study

The aim of this study was to investigate the clinical reasoning processes of physiotherapists in relation to the assessment of vertebrobasilar insufficiency (VBI). Using a qualitative multiple case studies design 12 physiotherapists (mean = 12.89 years clinical experience, SD = 3.44) with an MSc in Manipulative Physiotherapy were shown 2 patient vignettes of a cervical spine disorder and associated symptoms of VBI sequentially in 4 sections and questioned as to their clinical reasoning processes via audio taped semi-structured interviews. Transcripts of the interviews were analysed for common themes. The therapists’ hypothesis generation in relation to VBI was mainly based on the subjective examination (SE) with no new patho-anatomic hypotheses being generated in the physical examination. The major indicators of VBI involvement were dizziness particularly if associated with other symptoms (visual disturbances, history of trauma and headache) and if exacerbated by cervical spine movements. Therapists demonstrated a lack of confidence in functional positional testing (FPT) and based decisions on the use of high velocity thrust techniques on subjective findings. The results of this study emphasise the importance of physiotherapists’ clinical reasoning process during the SE particularly in view of the questionable diagnostic utility of FPT.

Eficacia del tratamiento en la cefalea tensional

Objectives To identify the most effective treatments for chronic tension-type headache relief. Material and methods A systematic review was conducted in MEDLINE, PEDro, Cochrane and CINAHL databases. It included randomized controlled trials and meta-analysis with adult patients and a minimum of 15 subjects, with tension-type headache that were not migraines or headache secondary to other conditions. We selected studies published from January 1998 to October 2008, in English, including the terms Effectiveness, Tension-type headache, and Treatment. In this first search, 81 studies were found and reviewed. Subsequently, specific terms related to treatment—Pharmacology, Botulinum toxin A, Manual therapy, Physiotherapy, Physical therapy, Psychological, Osteopathy, Chiropractic and Acupuncture were included in our search. After this second search, 80 more studies were found and reviewed. Finally, 15 studies were found to meet the inclusion criteria and were selected to be analyzed in the present study. Results The 15 studies analyzed include treatments with botulinum toxin, antidepressants, antidepressants and stress control therapy, kinesitherapy, kinesitherapy and massage or relaxation therapy, massage, kinesitherapy and manipulative physiotherapy, connective tissue therapy, massage and heat therapy, osteopathy muscular relaxation, cranial osteopathy, chiropractic and acupuncture. Conclusions Treatment with botulinum toxin is the most frequently used among doctors, although there is significant controversy about its effectiveness. The most effective physiotherapy treatment consists of spinal manipulation, combined with cervical muscle stretching and massage. Tricyclic antidepressants are the most effective pharmacological treatment.

Defining the construct of masters level clinical practice in manipulative physiotherapy

The study is the first to have explored the behaviours indicative of the construct of masters level manipulative physiotherapy clinical practice. An exploratory case study was employed, using multiple methods of interviews and participant observation, informed by initial documentary analysis. One ‘case’ of a university postgraduate course in manipulative physiotherapy in the UK was selected. Purposive sampling identified the participants (clinical tutors and students). Data analysis was an iterative process developing inductive categories from the data through a constant comparative process. The identified analytic categories were subsequently linked to form theoretical propositions. Saturation of the data was achieved. Data collection was concurrent with a previously reported Delphi study and the findings of each showed convergence. A high level of clinical reasoning was identified as the most important behaviour associated with the construct for manipulative physiotherapy. This was then subdivided into core components of practice; prioritisation for example. This study provides a sound basis for future research by affording insight into the construct of masters level manipulative physiotherapy clinical practice. Convergence of data with the Delphi study supported validation of the construct. The trustworthiness of the findings appeared good, and therefore provides justification for use of the construct in informing curriculum development at masters level.

Primary care clinicians use variable methods to assess acute nonspecific low back pain and usually focus on impairments

This study investigated the assessment of acute (<12 weeks duration) nonspecific low back pain (NSLBP) by primary care clinicians. The aims were to determine the methods used, whether methods differ across professional disciplines, and the extent to which clinicians assess across domains of health. Survey data were gathered from 651 primary care clinicians from six professional disciplines (Physiotherapy, Manipulative Physiotherapy, Chiropractic, Osteopathy, General Medicine, and Musculoskeletal Medicine). Descriptive statistics (proportions and frequency of use distributions) were used to describe assessment technique use, Mann–Whitney U tests were used to determine between-discipline differences in the use of each assessment technique, and Bonferroni-adjusted inferential confidence intervals were constructed to allow visual comparison of the use of assessment techniques from five health domains. The results indicate that the methods used by different professional disciplines to assess NSLBP vary considerably, as 44 out of 48 assessment techniques showed significantly different utilisation rates across professions. Furthermore, assessment across domains of health in this condition was variable, as clinicians commonly assess physical impairments and pain and less commonly assess activity limitation and psychosocial function (100% of clinicians very frequently or often assess physical impairment, 99% [95%CI 98–100%] assess pain, 21% [95%CI 15–27%] assess activity limitation, and 7% [95%CI 3–11%] assess psychosocial function). Adoption of greater standardisation of assessment by clinicians may require demonstration of the capacity of this standardisation to improve patient outcomes.

A prospective study of patients with chronic back pain randomised to group exercise, physiotherapy or osteopathy

Objective To investigate the difference in outcome between patients treated with group exercise, physiotherapy or osteopathy. Design Prospective study of patients referred at random to one of three treatments, with follow-up 6 weeks after discharge and after 12 months. Setting National Health Service physiotherapy department at St Albans City Hospital, part of the West Hertfordshire Musculoskeletal Therapy Service. Participants Two hundred and thirty-nine patients aged 18–65 years recruited from referrals to the physiotherapy department with chronic low back pain. Interventions Eligible patients were randomised to group exercises led by a physiotherapist, one-to-one predominantly manipulative physiotherapy, or osteopathy. Main outcomes Oswestry Disability Index (ODI), EuroQol-5D, shuttle walking test and patients’ subjective responses to pain and treatment. Results All three treatments indicated comparable reductions in mean (95% confidence intervals) ODI at 6-week follow-up: group exercise, −4.5 (−0.9 to −8.0); physiotherapy, −4.1 (−1.4 to −6.9); and osteopathy, −5.0 (−1.6 to −8.4). Attendance rates were significantly lower among the group exercise patients. One-to-one therapies provided evidence of greater patient satisfaction. Conclusion The study supports the use of a variety of approaches for the treatment of chronic low back pain. Particular attention needs to be given to the problems of attracting enough participants for group sessions, as these can be difficult to schedule in ways that are convenient for different participants.

WITHDRAWN: Interventions for shoulder pain.

Shoulder pain is a common problem and although there are many accepted standard forms of conservative therapy for shoulder disorders including non-steroidal anti-inflammatory drugs, glucocorticosteroid injections, oral glucocorticosteroid medication, manipulation under anaesthesia, physical therapy, hydrodilatation (distension arthrography) and surgery, evidence of their efficacy is not well established. To review the efficacy of common interventions for shoulder pain. We searched the Cochrane Musculoskeletal Group trials register, Cochrane Controlled Trials Register, MEDLINE, EMBASE, CINAHL, and Science Citation Index) up to May 1998, and hand searched major textbooks, bibliographies of relevant literature, the fugitive literature, and the subject indices of relevant journals including: American College of Rheumatology;British College of Rheumatologists; the Biennial Conference of the Manipulative Physiotherapy Association of Australia;International Federation of Manual Therapists conference proceedings; British Orthopaedic Association;and American Orthopaedic Association. Each identified study was assessed for possible inclusion by two independent reviewers based on the blinded methods sections. The determinants for inclusion were that the trial include an intervention of interest (non-steroidal anti-inflammatory drugs, intra-articular or subacromial glucocorticosteroid injection, oral glucocorticosteroid treatment, physiotherapy, manipulation under anaesthesia, hydrodilatation, or surgery); that treatment allocation was randomized; and that the outcome assessment was blinded. Methodological quality was assessed by two independent, blinded reviewers. Data relating to selection criteria, outcome measurement and treatment effect was extracted from the blinded trials. Range of motion scores were entered as degrees of restriction to movement, and all pain and overall effect scores were transformed to 100 point scales. For continuous outcome measures, where standard deviation was not reported it was either calculated from the raw data or converted from standard error of the mean. If neither of these were reported, authors were contacted in an effort to obtain the missing values. Effect sizes were calculated and combined in a pooled analysis if study population, endpoint and intervention were comparable. Thirty one trials met inclusion criteria. Mean methodological quality score was 16.8 (9.5 - 22) out of possible score of 40. Selection criteria varied widely even for the same diagnostic label. There was no uniformity in outcome measures used and their measurement properties were rarely reported. Effect sizes for individual trials were small (-1.4 to 3.0). The results of only three studies investigating "rotator cuff tendonitis" could be pooled. Benefit of subacromial steroid injection over placebo for improving range of abduction (weighted difference between means (WMD) 35 degrees , 95% CI 14 to 55) was the only positive finding. There is little evidence to support or refute the efficacy of common interventions for shoulder pain. As well as, the need for further well designed clinical trials, more research is needed to establish a uniform method of defining shoulder disorders and developing outcome measures which are valid, reliable and responsive in these study populations.

Spinal manipulation for dysmenorrhoea

Background Dysmenorrhoea (occurrence of painful menstrual cramps of uterine origin) is a common gynaecological condition. The character of pain from musculoskeletal dysfunction can be very similar to gynaecological pain by presenting cyclicly and being altered by hormonal changes associated with menstruation. Medical treatment for dysmenorrhoea usually comprises anti-inflammatory drugs, oral contraceptives, or surgical intervention. Spinal manipulation is a non-medical intervention. It has been suggested that manipulation of the vertebrae may increase spinal mobility thus improving pelvic blood supply and facilitating pain relief. Objectives To determine the safety and efficacy of spinal manipulative interventions for the treatment of dysmenorrhoea when compared to each other, placebo, no treatment, or other medical treatment. Search methods In this update we searched the Cochrane Menstrual Disorders and Subfertility Group Trials Register (May 2009), CENTRAL (to second quarter, 2009), MEDLINE (1966 to May 2009), EMBASE (1980 to May 2009), CINAHL (1982 to May 2009), and PsycINFO (1806 to May 2009). Citation lists of review articles and included trials were examined. Selection criteria Any randomised controlled trials (RCTs) including spinal manipulative interventions (for example chiropractic, osteopathy, or manipulative physiotherapy) versus each other, placebo, no treatment, or another medical treatment were considered. Exclusion criteria were mild or infrequent dysmenorrhoea or dysmenorrhoea from an intrauterine device (IUD). Data collection and analysis Two trials of high velocity, low amplitude (HVLA) manipulation and one trial of the Toftness technique were included. Quality assessment and data extraction were performed independently by two review authors. No data were suitable for meta-analysis. Data were therefore reported as descriptive data. The outcome measures were pain relief or pain intensity and adverse effects. Main results Results from HVLA manipulation suggested that the technique was no more effective than sham manipulation for the treatment of dysmenorrhoea. One small trial indicated a difference in favour of HVLA manipulation however the one trial with an adequate sample size found no difference between HVLA and sham manipulation. There was no difference in adverse effects. The Toftness technique appeared more effective than sham treatment in one small trial but no conclusions could be made due to the size and other methodological limitations of the trial. Authors' conclusions There is no evidence to suggest that spinal manipulation is effective in the treatment of dysmenorrhoea. In the one trial reporting on adverse effects there was no greater risk of such events with spinal compared with sham manipulation.