Spinal Manipulation Research Articles

Guideline-concordant utilization of magnetic resonance imaging in adults receiving chiropractic manipulative therapy vs other care for radicular low back pain: a retrospective cohort study.

BackgroundLumbar magnetic resonance imaging (LMRI) is often performed early in the course of care, which can be discordant with guidelines for non-serious low back pain. Our primary hypothesis was that adults receiving chiropractic spinal manipulative therapy (CSMT) for incident radicular low back pain (rLBP) would have reduced odds of early LMRI over 6-weeks’ follow-up compared to those receiving other care (a range of medical care, excluding CSMT). As a secondary hypothesis, CSMT recipients were also expected to have reduced odds of LMRI over 6-months’ and 1-years’ follow-up.MethodsA national 84-million-patient health records database including large academic healthcare organizations (TriNetX) was queried for adults age 20–70 with rLBP newly-diagnosed between January 31, 2012 and January 31, 2022. Receipt or non-receipt of CSMT determined cohort allocation. Patients with prior lumbar imaging and serious pathology within 90 days of diagnosis were excluded. Propensity score matching controlled for variables associated with LMRI utilization (e.g., demographics). Odds ratios (ORs) of LMRI over 6-weeks’, 6-months’, and 1-years’ follow-up after rLBP diagnosis were calculated.ResultsAfter matching, there were 12,353 patients per cohort (mean age 50 years, 56% female), with a small but statistically significant reduction in odds of early LMRI in the CSMT compared to other care cohort over 6-weeks’ follow-up (9%, 10%, OR [95% CI] 0.88 [0.81–0.96] P = 0.0046). There was a small but statistically significant increase in odds of LMRI among patients in the CSMT relative to the other care cohort over 6-months’ (12%, 11%, OR [95% CI] 1.10 [1.02–1.19], P < 0.0174) and 1-years’ follow-up (14%, 12%, OR [95% CI] 1.21 [1.13–1.31], P < 0.0001).ConclusionsThese results suggest that patients receiving CSMT for newly-diagnosed rLBP are less likely to receive early LMRI than patients receiving other care. However, CSMT recipients have a small increase in odds of LMRI over the long-term. Both cohorts in this study had a relatively low rate of early LMRI, possibly because the data were derived from academic healthcare organizations. The relationship of these findings to other patient care outcomes and cost should be explored in a future randomized controlled trial.RegistrationOpen Science Framework (https://osf.io/t9myp). Supplementary InformationThe online version contains supplementary material available at 10.1186/s12891-022-05462-y.

CAROTID ARTERY DISSECTION FOLLOWING CERVICAL SPINE MANIPULATION: AN ASSOCIATION OR CAUSATIVE RELATIONSHIP

TYPE: Late Breaking Case Report TOPIC: Cardiovascular Disease INTRODUCTION: Spinal manipulation is a hallmark practice of chiropractic providers and sometimes by physiotherapists, and osteopaths. It is a controversial and potentially dangerous procedure.1 Associations have been observed between chiropractic maneuvers and cervical artery dissection, although it remains difficult to prove causal relationship.2-4 We report a case of carotid artery dissection following chiropractic manipulation in a young male with no risk factors for carotid artery dissection. CASE PRESENTATION: This is a 40-year-old male with medical history of migraine headaches and cervicalgia, evaluated for a sudden onset of headache, associated with nausea, vomiting, blurred vision, and dizziness, two months after a chiropractic manipulation. He also reported rigorous exercise and sexual intercourse prior to the headache onset. Vital sign is significant for a 10/10, non-radiating right-sided headache. Neurological examination revealed right ptosis and miosis. Labs were unremarkable. CTA of neck showed tapering of the right ICA with near occlusion at the skull base. He was started on acetylsalicylic acid and clopidogrel, and subsequently discharged home to follow-up with Neurologist. Six-month follow-up revealed resolution of his symptoms and resolved right ICA dissection thrombosis. DISCUSSION: Spinal manipulation is commonly practiced by chiropractic and other providers. Even though it remains difficult to prove causal relationship between spinal manipulation and carotid artery dissection, several cases have been reported in the literature. Potential consequence of cervical artery dissection is stroke, which have increased morbidity and mortality.5 CONCLUSIONS: Our case highlights the dangers of chiropractic manipulation and provides a thorough review of the literature relating to chiropractic manipulation and carotid artery dissection. DISCLOSURE: Nothing to declare. KEYWORD: Cervical spine manipulation

자발 및 유발 근전도

Intraoperative electromyography (EMG) is known to record compound muscle action potential (CMAP) in response to spontaneous or stimulated cranial nerve or spinal root activation. EMG can detect cranial nerve or spinal nerve root irritation (known as free-running EMG), and may involve electrical stimulation of neural elements or hardware to assess function (known as stimulated or triggered EMG). EMG has a low positive predictive value with high sensitivity, which is particularly useful in the early detection and prevention of pending nerve injury. EMG is one the most useful modalities of intraoperative neuromonitoring (IONM) for monitoring neural function along with sensory and motor evoked potentials during surgery associated with spinal manipulation and cranial nerve involvement.

Association between chiropractic spinal manipulative therapy and benzodiazepine prescription in patients with radicular low back pain: a retrospective cohort study using real-world data from the USA

ObjectivesAlthough chiropractic spinal manipulative therapy (CSMT) and prescription benzodiazepines are common treatments for radicular low back pain (rLBP), no research has examined the relationship between these interventions. We hypothesise that...

The influence of flexion distraction spinal manipulation on patients with lumbar spinal stenosis: A prospective, open-label, single-arm, pilot study

ObjectiveEvaluate chiropractic care including flexion distraction spinal manipulation for improving function, symptoms and performance-based mobility in patients with lumbar spinal stenosis (LSS) using a pretest-posttest design. MethodsData were collected at baseline, midpoint and final visits prior to care on each visit. Objective data included Timed Up and Go, Five Times Sit to Stand, and balance (force plate). An additional balance assessment was also conducted after care on the baseline visit. Subjective data included: Activities-Specific Balance Confidence Scale, Zurich Claudication Questionnaire, and pain ratings. Balance data were securely transferred via iDrive; the others were collected via REDCap. ResultsTwelve patients (mean age = 83.5 years ± 5.71) completed the average midpoint visit at 9 visits and the final visit at 13.7 visits. Timed Up and Go and Five Times Sit to Stand Test decreased by 5.2 and 6.7 s at midpoint and 5.4 and 5.7 s at the final visit, respectively compared to the baseline visit (p < 0.05). Baseline visit pre-post reductions were found in anterior-posterior sample entropy and mean frequency of postural sway (p < 0.05). No balance change was found between baseline and mid or final visits. All subjective measures had statistically and clinically meaningful improvement. ConclusionSignificant improvement in objective and subjective outcomes were found after a pragmatic course of care including spinal manipulation in LSS patients.

Vertebral stabilisation for thoracolumbar vertebral instability associated with cranial and caudal articular process anomalies in pugs: Seven cases (2010-2019).

To describe the diagnostic findings, surgical technique and outcomes in seven pugs with thoracolumbar vertebral instability due to articular process anomalies. Records (2010 to 2019) of pugs with thoracolumbar vertebral instability associated with articular process anomalies that underwent decompressive laminectomy and vertebral stabilisation were reviewed. Data on preoperative and postoperative neurologic status, diagnostic findings, surgical techniques and outcomes were retrieved. Seven dogs were presented with ambulatory or non-ambulatory paraparesis. Caudal articular process anomalies (three dogs) and concomitant cranial and caudal articular process anomalies (four dogs) were noted. Myelography (six dogs) or magnetic resonance imaging (one dog) showed none to severe spinal cord compression. Dynamic myelography in six dogs demonstrated nine distinct sites of spinal cord dimension reduction positioned in extension and/or flexion (mean reduction: 16.0%, range: 8.5 to 24.0%). These dynamic compressions were located at sites with articular process anomalies (seven sites) and sites with no articular process anomalies (two sites). Vertebral instability was confirmed by intraoperative spinal manipulation in all dogs. All dogs remained ambulatory with improved (five dogs) or static (two dogs) neurological deficits at the last follow-up (median: 16 months; range: 1.5 to 66 months). Dynamic myelography and/or intraoperative spinal manipulation demonstrated vertebral instabilities at sites with or without articular process anomalies on imaging. Decompressive laminectomy with vertebral stabilisation resulted in long-term neurological improvement in most dogs.

Pressure pain thresholds in a real-world chiropractic setting: topography, changes after treatment, and clinical relevance?

BackgroundChanges in pain sensitivity are a commonly suggested mechanism for the clinical effect of spinal manipulative therapy (SMT). Most research has examined pressure pain thresholds (PPT) and has primarily been conducted in controlled experimental setups and on asymptomatic populations. Many important factors are likely to differ between research and clinical settings, which may affect PPT changes following SMT. Therefore, we planned to investigate PPT before and after clinical chiropractic care and investigate relationships with various potentially clinically-relevant factors.MethodsWe recruited participants from four Danish chiropractic clinics between May and August 2021. A total of 129 participants (72% of the invited) were included. We measured PPT at eight pre-determined test sites (six spinal and two extra-spinal) immediately before (pre-session) and immediately after (post-session) the chiropractic consultation.We used regression analyses to investigate PPT changes, including the following factors: (i) vertebral distance to the nearest SMT site, (ii) rapid clinical response, (iii) baseline PPT, (iv) number of SMTs performed, (v) at the region of clinical pain compared to other regions, and (vi) if other non-SMT treatment was provided. We also performed topographic mapping of pre-session PPTs.ResultsAfter the consultation, there was a non-significant mean increase in PPT of 0.14 kg (95% CIs = − 0.01 to 0.29 kg). No significant associations were found with the distance between the PPT test site and nearest SMT site, the clinical response of participants to treatment, the pre-session PPT, the total number of SMTs performed, or the region/s of clinical pain. A small increase was observed if myofascial treatment was also provided. Topographic mapping found greater pre-session PPTs in a caudal direction, not affected by the region/s of clinical pain.ConclusionsThis study of real-world chiropractic patients failed to demonstrate a substantial local or generalized increase in PPT following a clinical encounter that included SMT. This runs counter to prior laboratory research and questions the generalizability of highly experimental setups investigating the effect of SMT on PPT to clinical practice.

Editorial Expression of Concern: Breaking the diagnosis: ankylosing spondylitis evidenced by cervical fracture following spine manipulation.

Editorial Expression of Concern: Breaking the diagnosis: ankylosing spondylitis evidenced by cervical fracture following spine manipulation.

Spinal Kinematic Assessment of Chiropractic Side-Posture Adjustments: Development of a Motion Capture System

ObjectiveThe purpose of this study was to develop a protocol and a data analysis system for the assessment of postures and movements of doctors of chiropractic during side-posture adjustments (SPAs), otherwise known as side-posture chiropractic spinal manipulation. MethodsFor this study, an experienced chiropractor performed Gonstead-style lumbar SPAs on 10 participants. We used an inertial measurement unit system to record spinal angular motions and analyzed data with a custom application written in Microsoft Excel. ResultsData collection was successful for all trials. We identified postural angles at the time of set-up and thrust and maximum and minimum angles in a period centered on the thrust. All spinal regions of the chiropractor were flexed during the entire period; otherwise, movement patterns were characterized by biphasic wavelike motions, which begin before the time of the thrust and finish afterward. Within each region and plane of motion, patterns were qualitatively similar between participants, but time of thrust was not consistent within the patterns. There was a wide range of angular velocities, and the fastest was measured in the chiropractor's cervical and thoracic regions. ConclusionIn this study, we developed a protocol and a data analysis system for assessment of chiropractors’ postures and movements during SPAs. The protocol may be useful to future investigators who wish to use similar methods for educational purposes or to examine the role of optimal or suboptimal movement patterns in occupational injuries of doctors of chiropractic.

Outcome of Limping Radicular Pain Due to Lumber Disc Herniation Treated with Lateral Recess Decompression without Discectomy: A Longitudinal Study

Aim: To assess the outcome of limping radicular pain due to lumber disc herniation treated with lateral recess compression without discectomy Study design: A longitudinal study Place and Duration: This study was conducted at People's University of Medical and Health Sciences for Women Nawabshah Pakistan from January 2020 to January 2021. Methodology: A total of 65 patients were selected for standalone lateral access decompression with a tube shaped retractors. All patients selected were having limping radicular pain. Study investigated the disc consistency and the existence of sequestrated pieces. VAS and ODI scores methods were used to examine the condition. Age, gender, bodyweight, duration of illness, profession, usage of painkillers, preoperative VAS score, and Pain and disability Index version (ODI) score were all collected from the participants Results: The stand alone lateral access decompression was carried out from 60 patients out of 65. The 5 patients that were endured were in need of sequestrated disc removal. The average age was 53 years (40-68years), the ratio of male and female was 1.41:1.21, and the average follow-up period was 4 years (3.1–5.7 years). Pre-surgical and post-surgical scores as well as the ODI scores were observed. Overall, 93 percent of patients were improved by the surgery. Conclusion: For the patients that are having limping radical pain, decompression without the surgery of discectomy turns out to be medically beneficial for them. It can be performed without spinal cord or nerve root manipulation and mobilization and intervertebral disc extraction, that results in decrease chance of postoperative neurodefecit, spinal nerves injuries and discitis. Which enhances postoperative rapid recovery. Keywords: radical pain, limping. Discectomy, lateral recess compression

Presence of Tumor Necrosis Factor-Alpha in Urine Samples of Patients With Chronic Low Back Pain Undergoing Chiropractic Care: Preliminary Findings From a Prospective Cohort Study.

Background and aimsLow back pain is the leading cause of years lived with disability worldwide. Chiropractors employ different interventions to treat low back pain, including spinal manipulative therapy, although the mechanisms through which chiropractic care improves low back pain are still unclear. Clinical research and animal models suggest that spinal manipulation might modulate plasma levels of inflammatory cytokines, which have been involved in different stages of low back pain. More specifically, serum levels of Tumor Necrosis Factor-alpha (TNF-α) have been found to be elevated in patients with chronic low back pain. We aimed to investigate whether urine from chronic low back pain patients could be an appropriate medium to measure concentrations of TNF-α and to examine possible changes in its levels associated to chiropractic care.MethodsUrine samples were collected from 24 patients with chronic low back pain and TNF-α levels were analyzed by ELISA before and after 4–6 weeks of care compared to a reference value obtained from 5 healthy control subjects, by means of a Welch’s t-test. Simultaneously, pain intensity and disability were also evaluated before and after care. Paired t-tests were used to compare mean pre and post urinary concentrations of TNF-α and clinical outcomes.ResultsSignificantly higher baseline levels of urinary TNF-α were observed in chronic low back pain patients when compared to our reference value (p < 0.001), which were significantly lower after the period of chiropractic treatment (p = 0.03). Moreover, these changes were accompanied by a significant reduction in pain and disability (both p < 0.001). However, levels of urinary TNF-α were not correlated with pain intensity nor disability.ConclusionThese results suggest that urine could be a good milieu to assess TNF-α changes, with potential clinical implications for the management of chronic low back pain.

Dry needling and upper cervical spinal manipulation in patients with temporomandibular disorder: A multi-center randomized clinical trial

ABSTRACT Objective To compare the effects of dry needling and upper cervical spinal manipulation with interocclusal splint therapy, diclofenac, and temporomandibular joint (TMJ) mobilization in patients with temporomandibular disorder (TMD). Methods One hundred-twenty patients with TMD were randomized to receive six treatment sessions of dry needling plus upper cervical spinal manipulation (n = 62) or interocclusal splint therapy, diclofenac, and joint mobilization to the TMJ (n = 58). Results Patients receiving dry needling and upper cervical spinal manipulation experienced significantly greater reductions in jaw pain intensity over the last 7 days (VAS: F = 23.696; p < 0.001) and active pain-free mouth opening (F = 29.902; p < 0.001) than those receiving interocclusal splint therapy, diclofenac, and TMJ mobilization at the 3-month follow-up. Conclusion Dry needling and upper cervical spinal manipulation was more effective than interocclusal splint therapy, diclofenac, and TMJ mobilization in patients with TMD.

Evidence-Based Imaging Guidelines for Chiropractic Biomechanical Spine Care, Reconsideration of X-Ray Exposure Risks, and Practical Applications of Research Evidence

First, the perceived risks of very low dose radiation exposures from x-rays in health care must be reconsidered with regard to their effects in humans. Second, a more practical application of data analyses from research is needed than the prevailing current approach. And third, the biomechanical conditions of previously injured spines in patients who present for chiropractic spine care should, when possible, be examined by imaging prior to applying forces from spinal manipulation or adjustments to ensure optimal safety and effectiveness.

Temporomandibular disorder in individuals with spinal cord injuries

Objective This study evaluated Temporomandibular Disorder (TMD) in individuals with Spinal Cord Injuries (SCI) compared to individuals without physical disabilities. Design Cross-sectional. Setting International Fair of Technologies in Rehabilitation and Accessibility (REATECH) and School of Dentistry at the University of São Paulo (USP), Brazil. Participants In total, 19 patients with SCI and 19 patients without SCI (36.9 ± 11.4 years old) were examined by a calibrated examiner. Methods using the following parameters: cervical spine mobility, palpation of muscle groups of the head and neck, functional manipulation of the lateral and medial pterygoids, and joint palpation (Diagnostic Criteria). The pattern and amplitude of mandibular movements were determined during screening using the Helkimo index. Statistical analyses Student's t-test, chi-square, Fisher's exact and Shapiro–Wilk test were used. Results The groups did not differ in the presence of noise, pain, temporomandibular joint palpation, locking, dislocation, jaw pain, muscle sensitivity, or in pain, mobility of the cervical spine and functional manipulation. With respect to the jaw mobility index, the groups differed in range of movement (P = 0.020) and maximum right lateral movement (P = 0.007), with the worst values in the SCI group. The groups also differed in relation to lateral flexion in cervical mobility, in which the group without SCI presented better results (P = 0.046). Conclusion The Spinal Cord Injuries group showed higher levels of TMD in terms of range of movement, lateral flexion, and maximum right lateral movement, than the individuals without physical disabilities, demonstrating a clinical significance between cervical and mandibular disability in this group.

Non-pharmacological management of pediatric functional abdominal pain disorders: Current evidence and future perspectives.

Functional abdominal pain disorders (FAPDs) are an important and prevalent cause of functional gastrointestinal disorders among children, encompassing the diagnoses of functional dyspepsia, irritable bowel syndrome, abdominal migraine, and the one not previously present in Rome III, functional abdominal pain not otherwise specified. In the absence of sufficiently effective and safe pharmacological treatments for this public problem, non-pharmacological therapies emerge as a viable means of treating these patients, avoiding not only possible side effects, but also unnecessary prescription, since many of the pharmacological treatments prescribed do not have good efficacy when compared to placebo. Thus, the present study provides a review of current and relevant evidence on non-pharmacological management of FAPDs, covering the most commonly indicated treatments, from cognitive behavioral therapy to meditation, acupuncture, yoga, massage, spinal manipulation, moxibustion, and physical activities. In addition, this article also analyzes the quality of publications in the area, assessing whether it is possible to state if non-pharmacological therapies are viable, safe, and sufficiently well-based for an appropriate and effective prescription of these treatments. Finally, it is possible to observe an increase not only in the number of publications on the non-pharmacological treatments for FAPDs in recent years, but also an increase in the quality of these publications. Finally, the sample selection of satisfactory age groups in these studies enables the formulation of specific guidelines for this age group, thus avoiding the need for adaptation of prescriptions initially made for adults, but for children use.

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

Differing Characteristics of Human-Shaped Visual Stimuli Affect Clinicians’ Dosage of a Spinal Manipulative Thrust on a Low-Fidelity Model: A Cross-Sectional Study

ObjectiveThe purpose of this study was to determine whether chiropractic clinicians modulate spinal manipulation (SM) thrust characteristics based on visual perception of simulated human silhouette attributes. MethodsWe performed a cross-sectional within-participant design with 8 experienced chiropractors. During each trial, participants observed a human-shaped life-sized silhouette of a mock patient and delivered an SM thrust on a low-fidelity thoracic spine model based on their visual perception. Silhouettes varied on the following 3 factors: apparent sex (male or female silhouette), height (short, average, tall), and body mass index (BMI) (underweight, healthy, obese). Each combination was presented 6 times for a total of 108 trials in random order. Outcome measures included peak thrust force, thrust duration, peak preload force, peak acceleration, time to peak acceleration, and rate of force application. A 3-way repeated measures analysis of variance model was used to for each variable, followed by Tukey's honestly significant difference on significant interactions. ResultsPeak thrust force was reduced when apparent sex of the presented silhouette was female (F1,7 = 5.70, P = .048). Thrust duration was largely invariant, except that a BMI by height interaction revealed a longer duration occurred for healthy tall participants than healthy short participants (F4,28 = 4.34, P = .007). Compared to an image depicting obese BMI, an image appearing underweight lead to reduced peak acceleration (F2,5 = 6.756, P = .009). Clinician time to peak acceleration was reduced in short compared to tall silhouettes (t7 = 2.20, P = .032). ConclusionVisual perception of simulated human silhouette attributes, including apparent sex, height, and BMI, influenced SM dose characteristics through both kinetic and kinematic measures. The results suggest that visual information from mock patients affects the decision-making of chiropractic clinicians delivering SM thrusts.

Effectiveness of manual therapy in the treatment of cervicogenic headache: A systematic review.

The aim of this study was to identify the manual therapy (MT) methods and techniques that have been evaluated for the treatment of cervicogenic headache (CH) and their effectiveness. MT seems to be one of the options with the greatest potential for the treatment of CH, but the techniques to be applied are varied and there is no consensus on which are the most indicated. A systematic search in Scopus, Medline, PubMed, Cinahl, PEDro, and Web of Science with the terms: secondary headache disorders, physical therapy modalities, musculoskeletal manipulations, cervicogenic headache, manual therapy, and physical therapy. We included articles published from 2015 to the present that studied interventions with MT techniques in patients with CH. Two reviewers independently screened 365 articles for demographic information, characteristics of study design, study-specific intervention, and results. The Oxford 2011 Levels of Evidence and the Jadad scale were used. Of a total of 14 articles selected, 11 were randomized control trials and three were quasi-experimental studies. The techniques studied were: spinal manipulative therapy, Mulligan's Sustained Natural Apophyseal Glides, muscle techniques, and translatory vertebral mobilization. In the short-term, the Jones technique on the trapezius and ischemic compression on the sternocleidomastoid achieved immediate improvements, whereas adding spinal manipulative therapy to the treatment can maintain long-term results. The manual therapy techniques could be effective in the treatment of patients with CH. The combined use of MT techniques improved the results compared with using them separately. This review has methodological limitations, such as the inclusion of quasi-experimental studies and studies with small sample sizes that reduced the generalizability of the results obtained.

Force Distribution Within Spinal Tissues During Posterior to Anterior Spinal Manipulative Therapy: A Secondary Analysis.

BackgroundPrevious studies observed that the intervertebral disc experiences the greatest forces during spinal manipulative therapy (SMT) and that the distribution of forces among spinal tissues changes as a function of the SMT parameters. However, contextualized SMT forces, relative to the ones applied to and experienced by the whole functional spinal unit, is needed to understand SMT’s underlying mechanisms.AimTo describe the percentage force distribution between spinal tissues relative to the applied SMT forces and total force experienced by the functional unit.MethodsThis secondary analysis combined data from 35 fresh porcine cadavers exposed to a simulated 300N SMT to the skin overlying the L3/L4 facet joint via servo-controlled linear motor actuator. Vertebral kinematics were tracked optically using indwelling bone pins. The functional spinal unit was then removed and mounted on a parallel robotic platform equipped with a 6-axis load cell. The kinematics of the spine during SMT were replayed by the robotic platform. By using serial dissection, peak and mean forces induced by the simulated SMT experienced by spinal structures in all three axes of motion were recorded. Forces experienced by spinal structures were analyzed descriptively and the resultant force magnitude was calculated.ResultsDuring SMT, the functional spinal unit experienced a median peak resultant force of 36.4N (IQR: 14.1N) and a mean resultant force of 25.4N (IQR: 11.9N). Peak resultant force experienced by the spinal segment corresponded to 12.1% of the total applied SMT force (300N). When the resultant force experienced by the functional spinal unit was considered to be 100%, the supra and interspinous ligaments experienced 0.3% of the peak forces and 0.5% of the mean forces. Facet joints and ligamentum flavum experienced 0.7% of the peak forces and 3% of the mean forces. Intervertebral disc and longitudinal ligaments experienced 99% of the peak and 96.5% of the mean forces.ConclusionIn this animal model, a small percentage of the forces applied during a posterior-to-anterior SMT reached spinal structures in the lumbar spine. Most SMT forces (over 96%) are experienced by the intervertebral disc. This study provides a novel perspective on SMT force distribution within spinal tissues.

The Changes of Brain Function After Spinal Manipulation Therapy in Patients with Chronic Low Back Pain: A Rest BOLD fMRI Study.

ObjectiveTo investigate the changes of regional homogeneity (Reho) values before and after spinal manipulative therapy (SMT) in patients with chronic low back pain (CLBP) through rest blood-oxygen-level-dependent functional magnetic resonance imaging (BOLD fMRI).MethodsPatients with CLBP (Group 1, n = 20) and healthy control subjects (Group 2, n = 20) were recruited. The fMRI was performed three times in Group 1 before SMT (time point 1, TP1), after the first SMT (time point 2, TP2), after the sixth SMT (time point 3, TP3), and for one time in Group 2, which received no intervention. The clinical scales were finished in Group 1 every time before fMRI was performed. The Reho values were compared among Group 1 at different time points, and between Group 1 and Group 2. The correlation between Reho values with the statistical differences and the clinical scale scores were calculated.ResultsThe bilateral precuneus and right mid-frontal gyrus in Group 1 had different Reho values compared with Group 2 at TP1. The Reho values were increased in the left precuneus and decreased in the left superior frontal gyrus in Group 1 at TP2 compared with TP1. The Reho values were increased in the left postcentral gyrus and decreased in the left posterior cingulate cortex and the superior frontal gyrus in Group 1 at TP3 compared with TP1. The ReHo values of the left precuneus in Group 1 at TP1 were negatively correlated with the pain degree at TP1 and TP2 (r = −0.549, −0.453; p = 0.012, 0.045). The Reho values of the middle temporal gyrus in Group 1 at TP3 were negatively correlated with the changes of clinical scale scores between TP3 and TP1 (r = 0.454, 0.559; p = 0.044, 0.01).ConclusionPatients with CLBP showed abnormal brain function activity, which was altered after SMT. The Reho values of the left precuneus could predict the immediate analgesic effect of SMT.