Spinal Manipulation Research Articles

Analysis of Biomechanical Characteristics of Therapist's Ground Reaction and Contact Hand Force and Time According to Table Height During Spinal Manipulation

Analysis of Biomechanical Characteristics of Therapist's Ground Reaction and Contact Hand Force and Time According to Table Height During Spinal Manipulation

How to locate the fistula orifice of spinal extradural arachnoid cyst: Surgical experience and clinical outcome

BackgroundIn clinical practice, spinal extradural arachnoid cysts (SEAC) are relatively rare. The key to the treatment of SEAC is recognize and close the dural defects (fistula orifice), but there is currently no convenient method to locate and identify the fistula. We propose a method for predicting the location of lumbar/thoracolumbar SEAC fistula based on surgical experience, subsequently closing the fistula through posterior unilateral interlaminar fenestration. Evaluating its surgical efficacy and investigated its effect on patient prognosis.MethodsA stepped approach based on clinical experience is proposed. A retrospective analysis was performed on 6 patients diagnosed with thoracolumbar SEAC disease and treated with posterior unilateral interlaminar fenestration through the position by pre-estimated fistula orifice in our hospital’s Department of Neurosurgery between January 2017 and January 2022.ResultsAll patients who received this treatment experienced significantly lower postoperative VAS pain scores and ODI index compared to their corresponding preoperative values (P < 0.01). During the ongoing follow-up after surgery, no unstable vertebral column, adverse effects, or complications were reported.ConclusionsThe use of posterior unilateral interlaminar fenestration for the treatment of large SEAC in the adult lumbar/thoracolumbar segment can reduce spinal cord manipulation and enhance spine stability. The disease can be treated by sealing the fistula orifice through a small fenestra, the position of which is assessed before surgery. This surgical method reduces trauma and improves the prognosis of patients with large SEAC.

Urinary TNF-α as a potential biomarker for chronic primary low back pain.

Over two thirds of individuals with low back pain (LBP) may experience recurrent or persistent symptoms in the long term. Yet, current data do not allow to predict who will develop chronic low back pain and who will recover from an acute episode. Elevated serum levels of the proinflammatory cytokine tumor necrosis factor-α (TNF-α) have been associated with poor recovery and persistent pain following an acute episode of LBP. Inflammatory cytokines may also mediate mechanisms involved in nociplastic pain, and thus, have significant implications in chronic primary low back pain (CPLBP). This study aimed to investigate the potential of urinary TNF-α levels for predicting outcomes and characterizing clinical features of CPLBP patients. Twenty-four patients with CPLBP and 24 sex- and age-matched asymptomatic controls were recruited. Urinary TNF-α concentrations were measured at baseline and after 4 weeks, during which CPLBP patients underwent spinal manipulative therapy (SMT). Concentrations of TNF-α were found to be elevated in baseline urine samples of CPLBP patients compared to asymptomatic controls. Moreover, these values differed among patients depending on their pain trajectory. Patients with persistent pain showed higher levels of TNF-α, when compared to those with episodic CPLBP. Furthermore, baseline TNF-α concentrations and their changes after 4 weeks predicted alterations in pain intensity and disability following SMT in patients with CPLBP. These findings warrant further research on the potential use of urinary TNF-α concentrations as a prognostic biomarker for CPLBP.

The Role of Manual Therapies in the Treatment of Headache Disorders.

A comprehensive headache treatment plan typically requires both medication and non-medication treatment strategies. Manual therapies offer another therapeutic approach to headache treatment. This article reviews the evidence for manual therapies in the treatment of headache disorders. Current evidence shows potential benefit from myofascial trigger point injections, myofascial release, and massage for the treatment of various headache types. There is also evidence for strain counterstrain technique, ischemic compression, and spinal manipulative therapies for cervicogenic headache. Although larger randomized clinical trials are necessary for many of these modalities, recent findings show that manual therapies could be an important tool for the treatment of some headache disorders.

Physiotherapy combined with dry needling among patients with chronic low back pain: Study protocol for a randomized controlled clinical trial

BackgroundChronic low back pain (CLBP) is an extremely common public health concern responsible for pain-related disability. CLBP is challenging to manage despite having a plethora of treatment options. Physiotherapy is a guideline-recommended treatment for CLBP. Furthermore, some forms of complementary medicines, such as dry needling, spinal manipulation, Tai Chi, and yoga are also recommended for CLBP treatment. We hypothesized that the combined treatment would be more effective when managing CLBP. Therefore, this randomized clinical trial aims to examine the impact of combined therapy of dry needling and physiotherapy compared to the treatment effect of only physiotherapy among patients with CLBP. MethodsThe study is a two-armed single-center, randomized controlled clinical superiority trial where participants are randomized to combined therapy of usual care physiotherapy and dry needling or only usual care physiotherapy (1:1). Individuals who are 18 years or older and experiencing LBP with or without leg pain for a minimum of three months will be considered eligible for the study. Pain severity, pain affective and physical interference, activity limitation, and insomnia symptoms of patients with CLBP will be measured at the baseline after four, 12 and 24-week treatment started. ConclusionFinding a better management strategy for managing CLBP is an ongoing challenge. Most of the novel techniques that try to manage CLBP are limitedly tested. This study will allow testing of the combined effect of usual care physiotherapy and dry needling when managing CLBP in terms of clinical efficacy. If the combined therapy is proven significantly effective, compared to usual care physiotherapy alone will provide plausible evidence of an effective treatment option to manage CLBP. Trial registrationClinical Trial Registry-India; trial registration number- CTRI/2022/09/045625.

Bibliometric Analysis of Functional Magnetic Resonance Imaging Studies on Manual Therapy Analgesia from 2002-2022.

Research on the brain mechanisms underlying manual therapy (MT)-induced analgesia has been conducted worldwide. However, no bibliometric analysis has been performed on functional magnetic resonance imaging (fMRI) studies of MT analgesia. To provide a theoretical foundation for the practical application of MT analgesia, this study examined the current incarnation, hotspots, and frontiers of fMRI-based MT analgesia research over the previous 20 years. All publications were obtained from the Science Citation Index-Expanded (SCI-E) of Web of Science Core Collection (WOSCC). We used CiteSpace 6.1.R3 to analyze publications, authors, cited authors, countries, institutions, cited journals, references, and keywords. We also evaluated keyword co-occurrences and timelines, and citation bursts. The search was conducted from 2002-2022 and was completed within one day on October 7, 2022. In total, 261 articles were retrieved. The total number of annual publications showed a fluctuating but overall increasing trend. Author B. Humphreys had the highest number of publications (eight articles) and J. E. Bialosky had the highest centrality (0.45). The United States of America (USA) was the country with the most publications (84 articles), accounting for 32.18% of all publications. Output institutions were mainly the University of Zurich, University of Switzerland, and the National University of Health Sciences of the USA. The Spine (118) and the Journal of Manipulative and Physiological Therapeutics (80) were most frequently cited. The four hot topics in fMRI studies on MT analgesia were "low back pain", "magnetic resonance imaging", "spinal manipulation", and "manual therapy." The frontier topics were "clinical impacts of pain disorders" and "cutting-edge technical capabilities offered by magnetic resonance imaging". fMRI studies of MT analgesia have potential applications. fMRI studies of MT analgesia have linked several brain areas, with the default mode network (DMN) garnering the most attention. Future research should include international collaboration and RCTs on this topic.

P.061 Stroke from cerebral artery dissection after cervical spine manipulation therapy in younger patient case report

Background: Cervical and lumber spine manipulation therapy is widely used treatment of spinal degenerative disc disease. Serous side affects can be associated with this treatment especially in cervical spine. Stroke represents an infrequent adverse reaction associated with cervical spine manipulation therapy. Methods: 34 year old lady presented to Emergency Department (ED) referring Hospital 20 minutes after having neck manipulation by a chiropractor, she complained of neck pain after the manipulation with syncope, half hour later developed visual field loss, with few episodes of emesis, and increasing headache. Results: The patient was started on Aspirin and admitted locally for observation. Computers tomography (CT) head , CT-Angiography showed left Vertebral artery (V3 segment) , MRI showed acute infarction within the both cerebellar hemisphere, after 3 days patient transferred to our unit, patient had posterior fossa decompressive craniotomy with external ventricular drainage (EVD), discharged to rehabilitation 2 weeks, 2 months follow-up patient improving. Conclusions: There is inceased evidence that shows increased association between spinal manipulation and adverse effects and dissection of vertebral arteries in younger population. Younger patients (&lt; 45 years) are particulary high risk, they should be informed of the risk of stroke or vascular injury from this procedure. No aggresive manipulation in younger population.

Effectiveness of spinal manipulation and biopsychosocial self-management compared to medical care for low back pain: a randomized trial study protocol

BackgroundChronic low back pain (cLBP) is widespread, costly, and burdensome to patients and health systems. Little is known about non-pharmacological treatments for the secondary prevention of cLBP. There is some evidence that treatments addressing psychosocial factors in higher risk patients are more effective than usual care. However, most clinical trials on acute and subacute LBP have evaluated interventions irrespective of prognosis.MethodsWe have designed a phase 3 randomized trial with a 2 × 2 factorial design. The study is also a Hybrid type 1 trial with focus on intervention effectiveness while simultaneously considering plausible implementation strategies. Adults (n = 1000) with acute/subacute LBP at moderate to high risk of chronicity based on the STarT Back screening tool will be randomized in to 1 of 4 interventions lasting up to 8 weeks: supported self-management (SSM), spinal manipulation therapy (SMT), both SSM and SMT, or medical care. The primary objective is to assess intervention effectiveness; the secondary objective is to assess barriers and facilitators impacting future implementation. Primary effectiveness outcome measures are: (1) average pain intensity over 12 months post-randomization (pain, numerical rating scale); (2) average low back disability over 12 months post-randomization (Roland-Morris Disability Questionnaire); (3) prevention of cLBP that is impactful at 10–12 months follow-up (LBP impact from the PROMIS-29 Profile v2.0). Secondary outcomes include: recovery, PROMIS-29 Profile v2.0 measures to assess pain interference, physical function, anxiety, depression, fatigue, sleep disturbance, and ability to participate in social roles and activities. Other patient-reported measures include LBP frequency, medication use, healthcare utilization, productivity loss, STarT Back screening tool status, patient satisfaction, prevention of chronicity, adverse events, and dissemination measures. Objective measures include the Quebec Task Force Classification, Timed Up & Go Test, the Sit to Stand Test, and the Sock Test assessed by clinicians blinded to the patients’ intervention assignment.DiscussionBy targeting those subjects at higher risk this trial aims to fill an important gap in the scientific literature regarding the effectiveness of promising non-pharmacological treatments compared to medical care for the management of patients with an acute episode of LBP and the prevention of progression to a severe chronic back problem.Trial registrationClinicalTrials.gov Identifier: NCT03581123.

The effectiveness of spinal manipulative therapy procedures for spine pain: protocol for a systematic review and network meta-analysis

BackgroundSpinal manipulative therapy (SMT) is a guideline-recommended treatment option for spinal pain. The recommendation is based on multiple systematic reviews. However, these reviews fail to consider that clinical effects may depend on SMT “application procedures” (i.e., how and where SMT is applied). Using network meta-analyses, we aim to investigate which SMT “application procedures” have the greatest magnitude of clinical effectiveness for reducing pain and disability, for any spinal complaint, at short-term and long-term follow-up. We will compare application procedural parameters by classifying the thrust application technique and the application site (patient positioning, assisted, vertebral target, region target, Technique name, forces, and vectors, application site selection approach and rationale) against: 1. Waiting list/no treatment; 2. Sham interventions not resembling SMT (e.g., detuned ultrasound); 3. Sham interventions resembling SMT; 4. Other therapies not recommended in clinical practice guidelines; and 5. Other therapies recommended in clinical practice guidelines. Secondly, we will examine how contextual elements, including procedural fidelity (whether the SMT was delivered as planned) and clinical applicability (whether the SMT is similar to clinical practice) of the SMT.MethodsWe will include randomized controlled trials (RCT) found through three search strategies, (i) exploratory, (ii) systematic, and (iii) other known sources. We define SMT as a high-velocity low-amplitude thrust or grade V mobilization. Eligibility is any RCT assessing SMT against any other type of SMT, any other active or sham intervention, or no treatment control on adult patients with pain in any spinal region. The RCTs must report on continuous pain intensity and/or disability outcomes. Two authors will independently review title and abstract screening, full-text screening, and data extraction. Spinal manipulative therapy techniques will be classified according to the technique application and choice of application sites. We will conduct a network-meta analysis using a frequentist approach and multiple subgroup and sensitivity analyses.DiscussionThis will be the most extensive review of thrust SMT to date, and will allow us to estimate the importance of different SMT application procedures used in clinical practice and taught across educational settings. Thus, the results are applicable to clinical practice, educational settings, and research studies.PROSPERO registration: CRD42022375836.

The effectiveness of spinal manipulation in patients with lower back pain due to spondylolisthesis

Objective: Evaluation of results of treatment of low back pain due to cervical spondylosis by chiropractic spine method combined with electro-acupuncture and infrared therapy. Subject and Methods: prospective clinical intervention study, comparing before and after with a control group. Results: After 15 days of treatment, spinal manipulation combined with electroacupuncture and infrared therapy reduced pain score by 83,9% according to VAS, improved lumbar spinal function by 60,1% according to ODI, good and good results at 91,4%; this result was trend of better than the control group. Conclusions: Chiropractic spine method combined with electro-acupuncture and infrared therapy has effective in patients with lower back pain due to spondylolisthesis

Comparative analysis of spinal stabilization techniques

Background: The purpose of this study was to compare different spinal stabilization techniques in terms of their effectiveness in providing stabilization and reducing pain. A systematic review was performed to identify relevant studies and analyze their findings. The studies were evaluated based on their methodological quality, sample size, and outcome measures. The results showed that the use of spinal bracing, spinal manipulation, and exercise-based treatments was found to be more effective than pharmacological interventions in providing spinal stabilization and reducing pain. The evidence suggests that a combination of these treatments may be more beneficial in providing adequate stabilization and reducing pain compared to a single intervention. Future research is needed to further explore the efficacy of different spinal stabilization techniques. Objective: The objective of this study was to compare and analyze the effectiveness of different spinal stabilization techniques in providing stabilization and reducing pain. Methodology: A systematic review was conducted department of orthopedic kth hospital Peshawar from jan 2020 to jan 2021 to identify relevant studies that evaluated the effectiveness of different spinal stabilization techniques in providing stabilization and reducing pain. The studies were evaluated based on their methodological quality, sample size, and outcome measures.

Reporting of adverse events associated with spinal manipulation in randomised clinical trials: an updated systematic review

ObjectivesTo describe if there has been a change in the reporting of adverse events associated with spinal manipulation in randomised clinical trials (RCTs) since 2016.DesignA systematic literature review.Data sourcesDatabases were...

Effect of Seated Cervical Spinal Manipulation on Autonomic Nervous System Activity as Measured by Heart Rate Variability and Plasma Norepinephrine Levels: A randomized Pre- and Poststudy

ObjectiveThe objective of this study was to determine whether seated cervical manipulation produced changes in autonomic nervous system activity, as measured by heart rate variability and plasma norepinephrine levels. MethodsNinety-five healthy young adults (ages 20-48 years) were recruited into a single-blinded physiological study, with 47 randomized to a seated cervical manipulation and 44 randomized to a sham procedure. Heart rate variability in the frequency domain, and plasma norepinephrine levels were measured prior to, immediately following, and 5 minutes following the intervention. ResultsElectrocardiograms were obtained from 39 subjects in the sham group and 43 subjects in the manipulation group. No statistically significant changes were found in measures of heart rate variability in the frequency domain in either the manipulation or sham groups. Blood samples were obtained from 22 subjects in the sham group and 27 subjects in the manipulation group. Plasma norepinephrine levels, as measured by spectrophotometry, declined in both groups from pre- to immediately postintervention, and they remained at decreased levels 5 minutes after the interventions. There were no statistically significant differences between groups in pre- or postintervention norepinephrine levels. ConclusionsMeasures of heart rate variability and plasma norepinephrine levels did not show that seated cervical manipulation produced short-term changes in autonomic nervous system activity compared to a sham procedure in healthy young adults.

Patients With a History of Spine Surgery Receiving Chiropractic Spinal Manipulation in US Academic Health Centers: A Cross-Sectional Cohort Study.

The number and characteristics of patients with previous spine surgery receiving chiropractic spinal manipulation (CSM) are largely unknown. This study aimed to explore the proportion of patients receiving CSM with a history of spine surgery, the characteristics of these patients, and the treatments received compared to a broader population of patients receiving CSM. We queried a 110-million-patient United States (US) network of aggregated records and claims data from patients attending integrated academic health centers (TriNetX, Inc.) on March 6, 2023, yielding data spanning 2013-2023. We identified two patient groups: (1) those receiving CSM and (2) a subset receiving CSM with prior spine surgery. We compared baseline characteristics and treatments received over a one-year follow-up after CSM. Of the 81,291 patients receiving CSM, 8,808 (10.8%) had at least one prior spine surgery. Patients with prior spine surgery receiving CSM were older, more often female, more often non-Hispanic/Latino and White, less often Black, had a greater body mass index, and had a higher prevalence of low back and neck pain compared to the broader CSM cohort (p<0.0001 for each). Those with prior spine surgery were also more likely to receive multiple medications, physiotherapy procedures, and spinal injections (p<0.0001 for each). Patients receiving CSM with a history of spine surgery comprise a substantial proportion of CSM patients in large US academic health centers. This subset of patients differs characteristically from the broader CSM population and more often receives medications, physiotherapy, and spinal injections. Further research is needed to examine the safety and efficacy of CSM in this population, given the high proportion of patients and limited research on this topic.

Investigating the hypoalgesic effects of spinal manipulative therapy using hidden pain conditioning and positive expectation in patients with chronic low back pain: protocol for a randomised controlled trial

IntroductionPlacebo effects are responses capable of modulating pain and influencing treatment response. Two mechanisms are commonly related to placebo effects: expectations and conditioning. However, the research in this field is...

EFFECT OF SPINAL THRUST MANIPULATION VERSUS MAITLAND MOBILIZATION AT T10-L1 IN PRIMARY DYSMENORRHEA - A RANDOMIZED CONTROLLED TRIAL

Background: Primary Dysmenorrhea refers to painful menstruation without any pelvic pathology. Women with this condition reported that menstruation have a negative impact on their quality of life. To compare the effect of Objective: Spinal thrust Manipulation versus Maitland Mobilization in subjects with primary Dysmenorrhea in terms of pain and Quality of life by using VAS and MOOS Questionnaire. Setting and design: A Randomized controlled study was conducted in tertiary health centre, Belagavi Methods: Forty-two females between 19-25 years of age with Primary Dysmenorrhea were recruited and were randomly allocated in three groups. All groups received hot moist pack and deep transverse massage as a conventional therapy, in addition Group B received spinal thrust manipulation and Group C received Maitland mobilization on their 21st, 23rd and 1st day of menstrual cycle. Patients were assessed at baseline and post intervention using VAS and MOOS Questionnaire. The Intra group analysis showed a Results: considerable amount of change in percentage of VAS in group B and MOOS in group C (p&lt;0.05). Inter group analysis of group A and B showed statistical differences in VAS. Group C showed statistical difference in MOOS score as compare to group A. Post HOC analysis showed no signicant differences in the variables. Conclusion: Spinal thrust manipulation and Maitland mobilization were equally effective in reducing pain and improving quality of life in subjects with primary dysmenorrhea

Changes in range of motion and neurological symptoms in patients with thoracolumbar junction syndrome treated with spinal manipulations

Changes in range of motion and neurological symptoms in patients with thoracolumbar junction syndrome treated with spinal manipulations

Effects of spinal manipulation or mobilization as an adjunct to neurodynamic mobilization for lumbar disc herniation with radiculopathy: a randomized clinical trial

ABSTRACT Objectives To determine the long-term clinical effects of spinal manipulative therapy (SMT) or mobilization (MOB) as an adjunct to neurodynamic mobilization (NM) in the management of individuals with Lumbar Disc Herniation with Radiculopathy (DHR). Design Parallel group, single-blind randomized clinical trial. Setting The study was conducted in a governmental tertiary hospital. Participants Forty (40) participants diagnosed as having a chronic DHR (≥3 months) were randomly allocated into two groups with 20 participants each in the SMT and MOB groups. Interventions Participants in the SMT group received high-velocity, low-amplitude manipulation, while those in the MOB group received Mulligans’ spinal mobilization with leg movement. Each treatment group also received NM as a co-intervention, administered immediately after the SMT and MOB treatment sessions. Each group received treatment twice a week for 12 weeks. Outcome Measures The following outcomes were measured at baseline, 6, 12, 26, and 52 weeks post-randomization; back pain, leg pain, activity limitation, sciatica bothersomeness, sciatica frequency, functional mobility, quality of life, and global effect. The primary outcomes were pain and activity limitation at 12 weeks post-randomization. Results The results indicate that the MOB group improved significantly better than the SMT group in all outcomes (p < 0.05), and at all timelines (6, 12, 26, and 52 weeks post-randomization), except for sensory deficit at 52 weeks, and reflex and motor deficits at 12 and 52 weeks. These improvements were also clinically meaningful for neurodynamic testing and sensory deficits at 12 weeks, back pain intensity at 6 weeks, and for activity limitation, functional mobility, and quality of life outcomes at 6, 12, 26, and 52 weeks of follow-ups. The risk of being improved at 12 weeks post-randomization was 40% lower (RR = 0.6, CI = 0.4 to 0.9, p = 0.007) in the SMT group compared to the MOB group. Conclusion This study found that individuals with DHR demonstrated better improvements when treated with MOB plus NM than when treated with SMT plus NM. These improvements were also clinically meaningful for activity limitation, functional mobility, and quality of life outcomes at long-term follow-up. Trial Registration Pan-African Clinical Trial Registry: PACTR201812840142310.

Spinal Manipulation and Seizure Management – Can Veterinary Spinal Manipulation Be used As An Adjunct Therapy for Managing Domestic Animals Experiencing Seizures?

Seizures and epilepsy are commonly observed in veterinary patients and are the direct result of many different causes, including but not limited to congenital disease, metabolic derangements, and traumatic injury. Treatment protocols in human medicine vary from standard treatments such as avoiding known triggers, anticonvulsant medications, vagal nerve stimulation, and surgical resection of seizure foci to more holistic approaches including acupuncture, dietary adjustment, nutritional supplements, and reflexology. Spinal manipulative therapy (SMT), or chiropractic adjustments, has also been suggested as possible adjunctive treatment for seizures in refractory human epileptics. To the authors' knowledge, there are no published reports of SMT as a therapy for seizures in domestic animals. The purpose of this paper is to review the use of SMT as an adjunctive treatment for seizures in humans and to open the consideration of its use as a potential additional therapy for seizures in domestic animals.

Improvement in the Contraction of the Transversus Abdominis Following Lumbo-Pelvic Manipulation – A Case Study

As a clinician, everyone undergoes a difficult time in clinical decision-making when attempting to apply a clinical prediction rule for manipulation (Flynn et al., 2002; Childs et al., 2004) to a patient with a history and physical examination consistent with clinical lumbar instability (Hicks et al., 2005). The effect on neural pathways associated with manipulation has been suggested as one possible mechanism that may improve muscle performance (Pickar, 2002) and patient symptoms. Support exists for an association between spinal manipulation and improved muscle function in the quadriceps (Suter et al., 1999), the erector spinae (Keller and Colloca, 2000), and the deep neck flexors (Sterling et al., 2001). Therefore, it is reasonable to hypothesize that spinal manipulation, by a reflexogenic mechanism, may improve the performance of the deep trunk stabilizers. In turn, improved relaxation and contractility of the lumbar multifidus and the transversus abdominis (TrA) theoretically could lead to improved functional stability of the spine through enhancement of the neurological and active subsystems as defined by Panjabi (1992a, b). This single case study describes changes observed in the TrA musculature pre- to post-manipulation in a patient that presented with a clinical paradox (symptoms suggestive of clinical lumbar instability but also meeting the clinical prediction rule to succeed with lumbar manipulation therapy). Real-time ultrasound imaging (USI) was used to describe the changes in the TrA musculature..