Spinal Manipulation Research Articles

The association between students' confidence and ability to modulate spinal manipulation force-time characteristics of specific target forces: a cross-sectional study.

Spinal manipulative therapy (SMT) is a guideline-recommended care for musculoskeletal pain taught in various undergraduate programs. Visual feedback through force-sensing tables can improve modulation of SMT force-time characteristics and, potentially, students' confidence, both factors important for clinical competence and patient outcomes. However, it is unclear if a link exists between students' confidence and ability in SMT force-time modulation. We aim to investigate this relationship and whether it was moderated by experience. This cross-sectional study recruited first- to third-year Canadian Memorial Chiropractic College students. Participants provided information about their confidence in performing SMT using different impulse forces of 200N, 400N, and 800N with a pre-established pre-load and a time-to-peak force < 150ms. SMT impulse forces of 200N, 400N, and 800N were targeted on a Human Analogue Mannequin positioned prone on a force-sensing table. We described the confidence levels and SMT force-time characteristics and assessed their association using linear mixed models. We re-ran the models interacting with SMT experience. The order of the three SMT impulse forces was randomly performed. Participants and outcome assessors were blinded to force-time characteristics recordings. One-hundred-and-forty-nine participants provided usable data. Participants were confident in delivering 200N and 400N impulse forces. However, confidence decreased for 800N forces. Accordingly, participants performed impulse forces close to the 200N and 400N but had difficulty accurately modulating to 800N forces. A positive association was found between confidence and the ability to modulate their force-time characteristics, especially keeping the same pre-load force, keeping the time to peak force < 150ms, and providing the 800N impulse force. This association was not moderated by experience. Students were more confident in their abilities to perform lower SMT forces but lacked confidence in their abilities to perform higher (800N) forces. This aligned with their skills, as many struggled to apply 800N force. However, students who had higher confidence levels generally performed better overall. There was substantial variability in SMT force-time characteristics, which may have implications for adverse events and patient satisfaction. Some of this variability could be attributed to students' confidence. Thus, further investigations are necessary in undergraduate settings to implement and optimize these findings. https://osf.io/6f7d5.

Variability and repeatability of spinal manipulation force-time characteristics in thoracic spinal manipulation on a manikin.

As part of multimodal therapy, spinal manipulation (SM) is a recommended and effective treatment for musculoskeletal pain. However, the underlying physiological mechanisms for pain relief are largely unknown. SM thrusts can be described and quantified using force-time characteristics (e.g. preload force, peak force, thrust speed, thrust duration, and thrust impulse). If these biomechanical parameters of SM are important for clinical outcomes, a large variability in the delivery of SM could lead to inconsistent responses and could thereby potentially mask a significant clinical effect. Our goal was to determine variability, and repeatability of thoracic spinal manipulation (SM) force-time profiles in a sample of Swiss chiropractors. All interventions were performed on a human analogue manikin. Participating chiropractors received three case scenarios with the following scenarios: 50-year-old male patient, 30-year-old male athlete, and a 70-year-old female patient, each presenting with uncomplicated musculoskeletal thoracic pain. Clinicians were asked to perform three consecutive thoracic SM thrusts for each of the scenarios and repeated the same interventions after 24-48h. Eighty-one chiropractors participated in the study, including 32 females (39.5%) with a mean age of 45.22 ± 12.96years. The variability in SM force-time characteristics between clinicians was substantial, with preload forces ranging from 4.50 to 450.25 N and peak forces ranging from 146.08 to 1285.17 N. Significant differences between case scenarios were observed for peak force (p < 0.0001), maximum thrust speed (p = 0.0002), and thrust impulse (p = 0.0004). Except for thrust duration, repeatability within and between sessions was fair to excellent (ICCs between 0.578 and 0.957). Substantial variability in application of SM was evident across clinicians and between case scenarios. Despite substantial clinician-dependent variability, the high repeatability of thoracic SM thrusts suggests a level of standardization in SM delivery, indicating that chiropractors might have 'their' individual force-time profile that they are capable to reproduce. Further research based on these findings should explore how to enhance the consistency, effectiveness, and safety of thoracic SM delivered clinically to humans.

Fatigue and Sleep-related Impairment as Predictors of the Effect of Nonpharmacological Therapies for Active duty Service Members With Chronic Pain: A Secondary Analysis of a Pragmatic Randomized Clinical Trial.

First-line treatments for chronic pain include selected complementary and integrative health therapies, including spinal manipulation, acupuncture, yoga, and massage; and standard rehabilitative care, including physical and occupational therapies. This study aimed to uncover critical factors that contribute to pain impact and the effectiveness of complementary and integrative health therapies and standard rehabilitative care among people with chronic pain, with a focus on the role of sleep-related impairment. We conducted a secondary analysis of data from a pragmatic randomized clinical trial of 280 U.S. active duty service members with chronic pain. Our study's multiple mediation analysis examined the indirect effect of complementary and integrative health therapies on pain impact through fatigue (β = - 0.43; 95% CI, -0.99 to -0.07). When stratified by sleep-related impairment, participants with T scores above the median of 62 demonstrated a significant negative indirect effect of complementary and integrative health therapies through fatigue (β = - 0.80; 95% CI, -2.31 to -0.14). This negative indirect effect was not significant for participants with sleep-related impairment T scores below the median (β = - 0.64; 95% CI, -1.48 to 0.07). These findings suggest that complementary and integrative health therapies are particularly effective in reducing pain impact for individuals with higher levels of sleep-related impairment, and that the effect of complementary and integrative health therapies is supported primarily by reducing fatigue.

Research hotspots and frontiers in non-specific low back pain: a bibliometric analysis.

Extensive research has been conducted worldwide on non-specific low back pain (NSLBP), some researchers published a bibliometric analysis of NSLBP in 2020, but there have been no supplements or updates since then. Therefore, this study aimed to analyze the research hotspots and frontiers in NSLBP over the last decade. Primary sources on NSLBP were obtained from the Web of Science Core Collection database from 2014 to 2023. CiteSpace V6.2. R7 (64-bit) and VOSviewer 1.6.19 software were used to analyze the number and centrality of journals, countries, institutions, authors, references, and keywords, and the functions of co-occurrence and clustering were applied to draw a visual knowledge map. In the past decade, the annual publication volume of studies on NSLBP has shown an overall upward trend year by year, with obvious temporal stages and great development potential. In total, 2,103 articles contained six types of literature, with the highest proportion being original research articles (1,633 articles, 77.65%), published in 200 journals. BMC Musculoskeletal Discourses (90 articles, 4.28%) had the highest number of publications, and the British Medical Journal had the highest impact factor (105.7). Furthermore, the United States of America (329 articles, 15.64%) had the highest publication volume, the University of Sydney (139 articles, 6.61%) was the research institution with the highest production, Maher, Chris G (36 articles, 1.71%) was the author with the most published articles, and Hoy, D (571 articles, 27.15%) was the most frequently cited author. The most cited of articles is "Non-specific low back pain" published in the LANCET, with 1,256 citations. This article summarizes the current research status of NSLBP and predicts future research hotspots and frontiers. In recent years, adolescents have become a high-risk group for NSLBP. Pain neuroscience education, motor control, spinal manipulative therapy, and acupuncture are effective means to treat NSLBP. Biomechanics and trunk muscles as entry points are effective ideas for the treatment of NSLBP pain. Furthermore, anxiety, neck pain, non-specific musculoskeletal pain, fibromyalgia, and musculoskeletal disorders are diseases that are closely related to NSLBP. In the future, attention should be paid to the design of research plans, increasing the research intensity of randomized controlled trials, strengthening follow-up, and the timely updating of guidelines, which will result in higher quality and high-level scientific evidence for research on NSLBP.

An Additive Effect of Instrument-Assisted Soft Tissue Mobilization with Spinal Manipulation in Cervicogenic Headache: a Randomized Controlled Trial

An Additive Effect of Instrument-Assisted Soft Tissue Mobilization with Spinal Manipulation in Cervicogenic Headache: a Randomized Controlled Trial

Regional Sensorimotor Effects of Chiropractic Spinal Manipulation: Preliminary Results From an Experimental Study.

The purpose of this study was to assess the effects of different spinal manipulation (SM) techniques and target segments on a specific dermatome and myotome, when compared with a remote spinal cord segment that served as a control location. Twenty-nine healthy volunteers were randomized to receive instrumental (Activator IV, Activator Methods International Ltd) or manual SM at the C6, C1, and T4 vertebral segments in 3 independent sessions. Pressure pain thresholds (PPTs) and muscle strength were examined at the C6 (test) and L4 (control) dermatomes and myotomes, at baseline and after intervention. Linear mixed-effects models were used to analyze changes over time and interindividual variability. Pressure pain thresholds significantly increased at both proximal and distal C6 dermatome locations (P < .05), irrespective of the technique and segment of application (P > .2). No significant changes were observed at the L4 dermatome. Muscle strength remained unchanged throughout the study. Multilevel modeling revealed significant associations between increased PPTs along the C6 dermatome (P < .001), whereas the combination of technique and target segment predicted PPT increases at the proximal C6 dermatome. These findings support regional, rather than segmental mechanisms underlying the sensory effects of SM. Specifically, significant increases in PPTs along the C6 dermatome suggest localized effects on pain sensitivity, which may depend on the target spinal region. Further investigation is needed to better understand these regional changes of SM and their potential clinical implications.

Tendential and unscientific opinion regarding spinal manipulative therapy in the pediatric population

Tendential and unscientific opinion regarding spinal manipulative therapy in the pediatric population

Chiropractor Perceptions of Non-registered Practitioners Utilizing Spinal Manipulative Therapy in Hong Kong: A Cross-Sectional Survey.

Objective This study aimed to explore registered chiropractors' perceptions of the use of spinal manipulative therapy (SMT) by non-registered practitioners in Hong Kong, assessing the associated risks, adverse events, and patient management approaches. Method A cross-sectional survey was conducted among registered chiropractors in Hong Kong using an online questionnaire. The survey, distributed via chiropractic associations from January 26to March 20, 2024, gathered data on the practitioners' experiences with patients previously treated by non-registered practitioners, including the types of adverse events observed and subsequent interventions required. Descriptive statistics were used to analyze the data. A total of 134 valid responses were received. Results Among respondents, a significant proportion (91%) of chiropractors reported observing adverse effects in patients treated by non-registered practitioners, with the most common issues being the aggravation of existing symptoms (95.5%) and new or unexpected complaints (82.8%). The most frequently required interventions included imaging (97%), medication (58.2%), and specialist referrals (59%). Respondents indicated that these adverse events could often have been prevented if proper training and certification were in place. Common reasons cited by patients for seeking care from non-registered practitioners included a lack of awareness about licensed care (90.3%) and cost considerations (80.6%). Conclusion The study highlights concerns reported by registered chiropractors regarding the safety of SMT performed by non-registered practitioners in Hong Kong. These concerns emphasize the need for enhanced public education on potential risks and stricter regulatory oversight. Although direct data on the occurrence of adverse events was not collected, the findings suggest that many risks could potentially be mitigated with proper training, underscoring the importance of credentialed care in ensuring patient safety.

Effects of High-Velocity Spinal Manipulation on Quality of Life, Pain and Spinal Curvature in Children with Idiopathic Scoliosis: A Systematic Review.

Scoliosis is a condition that involves deformation of the spine in the coronal plane and commonly appears in childhood or adolescence, significantly limiting a person's life. The cause is multifactorial, and treatment aims to improve the spinal curvature, prevent major pathologies, and enhance aesthetics. The objective of this review was to determine whether high-velocity low-amplitude (HVLA) spinal manipulation is more effective than other treatments for children with idiopathic scoliosis (IS). The PubMed, Web of Science, Scopus and PEDro databases were searched for both clinical trials and cohort studies. Methodological quality was assessed via the PEDro scale (for clinical trials) and the Newcastle-Ottawa scale (for observational studies). The protocol of this systematic review was registered in PROSPERO (CRD42024532442). Five studies were selected for review. The results indicated moderate improvements in pain and the Cobb angle and limited improvements in quality of life. HVLA spinal manipulation does not seem to have significant effects on reducing spinal deformity in IS patients, nor does it significantly impact quality of life. However, this therapy may have significant effects on reducing pain in these patients.

The effect of chiropractic spinal manipulation on the H-reflex and muscle strength in children with cerebral palsy: A feasibility study

Background Children with cerebral palsy (CP) have deficits in various aspects of motor control, including motor neuron excitability, which can affect muscle strength, gait, and ability to perform activities of daily living. Previous research on chiropractic spinal manipulation in healthy adults, athletes, and a brain-injured population has indicated improvements in motor neuron excitability, muscle strength, and various aspects of motor control. Thus, chiropractic spinal manipulation may improve motor control in children with CP. Methods Children with spastic diplegic CP, aged 8-13 years, were recruited for a randomized, controlled feasibility study. Feasibility was assessed in terms of recruitment strategy and rate, data collection procedures, equipment, intervention, and compliance. Results Three children completed the data collection comprising pre- and post-measurements of the H reflex, V-wave, and muscle strength. The recruitment strategy and rate were not feasible. The data collection procedures were appropriate and complied with, except for the V-wave measurements. The H-reflex threshold decreased and s50 and slope increased in the participants who received chiropractic spinal manipulation; the opposite was seen in the control group. The changes in MVC force were inconsistent between subjects. Conclusion This study answered some important feasibility questions regarding conducting a large-scale randomized controlled study with the same design. Some aspects proved feasible, such as H-reflex recordings, and some aspects, such as recruitment methods and V-wave recordings, need to be altered for future research in this area.

Chiropractic and Spinal Manipulation: A Review of Research Trends, Evidence Gaps, and Guideline Recommendations

Chiropractors diagnose and manage musculoskeletal disorders, commonly using spinal manipulative therapy (SMT). Over the past half-century, the chiropractic profession has seen increased utilization in the United States following Medicare authorization for payment of chiropractic SMT in 1972. We reviewed chiropractic research trends since that year and recent clinical practice guideline (CPG) recommendations regarding SMT. We searched Scopus for articles associated with chiropractic (spanning 1972–2024), analyzing publication trends and keywords, and searched PubMed, Scopus, and Web of Science for CPGs addressing SMT use (spanning 2013–2024). We identified 6286 articles on chiropractic. The rate of publication trended upward. Keywords initially related to historical evolution, scope of practice, medicolegal, and regulatory aspects evolved to include randomized controlled trials and systematic reviews. We identified 33 CPGs, providing a total of 59 SMT-related recommendations. The recommendations primarily targeted low back pain (n = 21) and neck pain (n = 14); of these, 90% favored SMT for low back pain while 100% favored SMT for neck pain. Recent CPG recommendations favored SMT for tension-type and cervicogenic headaches. There has been substantial growth in the number and quality of chiropractic research articles over the past 50 years, resulting in multiple CPG recommendations favoring SMT. These findings reinforce the utility of SMT for spine-related disorders.

Comparison of the effects of dry needling and spinal manipulative therapy versus spinal manipulative therapy alone on functional disability and endurance in patients with nonspecific chronic low back pain: An experimental study.

Low back pain (LBP) is a global musculoskeletal ailment. Over the past few years, dry needling (DN) has garnered interest from both physical therapists and patients. Physical therapy commonly employs spinal manipulation to alleviate persistent LBP and other musculoskeletal disorders. The aim of this study was to investigate the effects of spinal manipulation alone and in combination with DN on functional disability and endurance in individuals suffering from chronic nonspecific LBP. Patients of both genders who had chronic nonspecific LBP and who had not received physical therapy within the last 3 months were included in this single-blind, randomized controlled trial using purposive sampling. All participants were randomly assigned to either the experimental (SMT + DN) or control (SMT alone) group using computer-generated random numbers. The data were analyzed using the Statistical Package for Social Sciences (SPSS) version 23.0. For between-group comparisons, the Mann-Whitney U test was used. A P-value < .05 was considered to indicate statistical significance. The analysis of the difference between the 2 groups revealed that the mean ± standard deviation (SD) for the SMT alone group was 16.09 ± 3.963 at baseline and 12.66 ± 3.801 at 8 weeks, whereas for the DN + ST group, it was 13.67 ± 3.904 at baseline and 10.92 ± 3.534 at 8 weeks, with a P-value of .003. Thus, the RMDQ score improved gradually in both groups, and the mean endurance score reported for the ST group was 2.5 to 4.5, while that reported for the DN + ST group was 3.1 to 5.1. The results of this study showed that both therapies effectively reduced LBP. When comparing the effects of spinal manipulation alone to those of spinal manipulation combined with DN, the latter showed significantly greater benefits.

Brain plasticity following lumbar disc herniation treatment with spinal manipulation therapy based on resting-state functional magnetic resonance imaging

As a prevalent spine disorder, Lumbar disc herniation (LDH) has been affecting more than 2 % of the worldwide population and is characterised by uncertain causes and recurring episodes. Studying the brain activity of patients could potentially provide insights into its pathogenesis and significantly enhance therapy. Therefore, we here examined brain function in patients under Spinal Manipulative Therapy (SMT). By analysing regional homogeneity (ReHo) at different frequency bands, we identified the discrepancies in brain activity between LDH patients and healthy people, highlighting the frequency dependence of spontaneous low-frequency oscillations among patients with LDH. Choosing seeds based on the peak ReHo differences helped to elucidate the functional connectivity alterations in the brain regions of LDH. Overall, this study showed that SMT significantly reduced pain, improved dysfunction, and partially rectified aberrant local consistency and functional connection in patients with LDH, not only offering insights into the pathophysiology of LDH from a neurological standpoint, but also providing inspiration for the development of new therapies based on neurobiology.

Trends in Utilization and Cost of Nonpharmacological Pain Therapies in the United States Under Medicare Part B, 2000-2022.

Background: Many clinical practice guidelines for management of pain disorders now favor first-line use of nonpharmacological therapies (NPT). However, Medicare coverage of NPT is limited. Methods: Using a serial cross-sectional design, we examined temporal trends in the utilization and cost of NPT procedures commonly used to treat pain under Medicare. Results: Utilization and costs for physical therapy increased while those for spinal and osteopathic manipulation declined. Discussion: Future research on NPT under Medicare should focus on equity of patient access and comparative outcomes.

Brief Commentary Based on Article “A Case Report on Changes in Body Composition in an Adolescent Obese Patient Treated with Complex Korean Medicine Treatment with Modified Fasting, and Space Spinal Conduction Exercise and Manipulation”

Brief Commentary Based on Article “A Case Report on Changes in Body Composition in an Adolescent Obese Patient Treated with Complex Korean Medicine Treatment with Modified Fasting, and Space Spinal Conduction Exercise and Manipulation”

Minimally Invasive Transpedicular Approach with Stereotactic Navigation for Evacuation and Fusion of Thoracic Ventral Epidural Abscess of Thoracic Spine: an illustrative case

Background: Surgical treatment of ventral thoracic pathologies can be challenging due to anatomical restrictions limiting corridor access, need for extensive spinal cord manipulation and limited experience for most spine surgeons’ due rarity of ventral thoracic pathologies. There is growing evidence that creation of a ventrolateral operative corridor through minimal invasive (MIS) transpedicular approach is safe and effective for accessing and treating of ventral thoracic spinal lesions [ 1-6] However, poor visualization with difficulty of spinal cord manipulation due to tubular retractor restriction remains changeling for MIS transpedicular approach. Objective: The authors illustrate a case of concurrent utilization of MIS tubular approach and stereotactic navigation to ensures safe and effective removal of epidural abscess and subsequent fusion. Conclusion: Addressing any lesion located anteriorly to the dentate ligament can be challenging and often necessitates either an antero-lateral or an anterior approach. This choice may depend on various factors, including the availability of an access surgeon. Utilization of stereotactic navigation with MIS transpedicular approach for ventral thoracic lesions, allows for real time intraoperation localization and visualization increasing lesion targeting accuracy and less cord manipulation. It also provides immediate post instrumentation checks and less radiation exposure for operating personals.

A Comparison of the Instantaneous Effects of Spinal Manipulation and Mobilization Techniques Applied to L3 Level on Jumping, Agility, and Sprint Speed in Male Volleyball Players

A Comparison of the Instantaneous Effects of Spinal Manipulation and Mobilization Techniques Applied to L3 Level on Jumping, Agility, and Sprint Speed in Male Volleyball Players

The DECISION project: DiscrEte Choice experIment Spinal manipulative therapy for lOw back paiN: A study protocol

The smallest worthwhile effect (SWE) is the smallest beneficial effect of an intervention that justifies the costs, risks, and inconveniences. The objective is to establish the SWE of spinal manipulative therapy (SMT) for the treatment of low back pain (LBP), and to gain insight into how different attributes of the treatment are traded among each other when choosing SMT. Part 1. A mixed-methods study will be conducted to establish and prioritize a list of attributes influencing choices for those who consider SMT for the treatment of LBP. Individual interviews and consensus groups with chiropractors, manual therapists, and osteopaths and their patients will be conducted. Interviews and consensus groups will be voice-recorded and transcribed verbatim. Part 2. A Discrete Choice Experiment (DCE) will be conducted among people with LBP who have limited to no experience with SMT. Participants will be recruited through an online independent panel company. The survey will consist of several choice sets with attributes and their levels established from Part 1. The DCE will be preceded by a short survey to understand the clinical aspects (i.e. presentation, history and previous treatment for LBP) as well as socio-demographic characteristics of the participants.

Spinal manipulation and spinal mobilization on extensor strength and proprioception in patients with chronic low back pain: a scoping review

Spinal manipulation and spinal mobilization on extensor strength and proprioception in patients with chronic low back pain: a scoping review

Microsurgical Repair of Ventral Cerebrospinal Fluid Leaks in Spontaneous Intracranial Hypotension: Efficacy and Safety of Patch-Sealing Versus Suturing.

In patients with spontaneous intracranial hypotension (SIH), microsurgical repair is recommended in Type 1 (ventral) dural leaks, when conservative measures fail. However, there is lacking consensus on the optimal surgical technique for permanent and safe closure of ventral leaks. We performed a retrospective analysis of surgically treated SIH patients with Type 1 leaks at our institution between 2013 and 2023. Patients were analyzed according to the type of surgical technique: (1) Microsurgical suture vs (2) extradural and intradural patching (sealing technique). End points were resolution of spinal longitudinal epidural cerebrospinal fluid collection (SLEC), change in brain SIH-Score (Bern-Score), headache resolution after 3 months, surgery time, complications, and reoperation rates. In total, 85 (66% women) patients with consecutive SIH (mean age 47 ± 11 years) underwent transdural microsurgical repair. The leak was sutured in 53 (62%) patients (suture group) and patch-sealed in 32 (38%) patients (sealing group). We found no significant difference in the rates of residual SLEC and resolution of headache between suture and sealing groups (13% vs 22%, P = .238 and 89% vs 94%, P = .508). No changes were found in the postoperative Bern-Score between suture and sealing groups (1.4 [±1.6] vs 1.7 [±2.1] P = 1). Mean surgery time was significantly shorter in the sealing group than in the suture group (139 ± 48 vs 169 ± 51 minutes; P = .007). Ten patients of the suture and 3 of the sealing group had a complication (23% vs 9%, P = .212), whereas 6 patients of the suture and 2 patients of the sealing group required reoperation (11% vs 6%, P = .438). Microsurgical suturing and patch-sealing of ventral dural leaks in patients with SIH are equally effective. Sealing alone is a significantly faster technique, requiring less spinal cord manipulation and may therefore minimize the risk of surgical complications.