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PubMed2006

Methodological quality of randomized controlled trials of spinal manipulation and mobilization in tension-type headache, migraine, and cervicogenic headache.

STUDY DESIGN: Literature review of quality of clinical trials. OBJECTIVE: To determine the methodological quality of published randomized controlled trials that used spinal manipulation and/or mobilization to treat patients with tension-type headache (TTH), cervicogenic headache (CeH), and migraine (M) in the last decade. BACKGROUND: TTH, CeH, and M are the most prevalent types of headaches seen in adults. Individuals who have headaches frequently use physical therapy, manual therapy, or chiropractic care. Randomized controlled trials are considered an optimal method with which to assess the efficacy of any intervention. METHODS: Computerized literature searches were performed in MEDLINE, EMBASE, COCHRANE, AMED, MANTIS, CINHAL, and PEDro databases. Randomized controlled trials in which spinal manipulation and/or mobilization had been used for TTH, CeH, and M published in a peer-reviewed journal as full text, and with at least 1 clinically relevant outcome measure (ie, headache intensity, duration, or frequency) were reviewed. The methodological quality of the studies was assessed independently by 2 reviewers using a set of predefined criteria. RESULTS: Only 8 studies met all the inclusion criteria. One clinical trial evaluated spinal manipulation and mobilization together, and the remaining 7 assessed spinal manipulative therapy. No controlled trials analyzing exclusively the effects of spinal mobilization were found. Methodological scores ranged from 35 to 56 points out of a theoretical maximum of 100 points, indicating an overall poor methodology of the studies. Only 2 studies obtained a high-quality score (greater than 50 points). No significant differences in quality scores were found based on the type of headache investigated. Methodological quality was not associated with the year of publication (before 2000, or later) nor with the results (positive, neutral, negative) reported in the studies. The most common flaws were a small sample size, the absence of a placebo control group, lack of blinded patients, and no description of the manipulative procedure. CONCLUSIONS: There are few published randomized controlled trials analyzing the effectiveness of spinal manipulation and/or mobilization for TTH, CeH, and M in the last decade. In addition, the methodological quality of these papers is typically low. Clearly, there is a need for high-quality randomized controlled trials assessing the effectiveness of these interventions in these headache disorders.

Headache Disorders↗
PubMedDate not supplied

Biomechanics of spinal manipulative therapy.

BACKGROUND CONTEXT: Modern scientific investigations into spinal manipulative therapy (SMT) began in 1975. Conditions often treated include acute and chronic low back pain, radicular pain, neck pain, and some forms of headache. The field of spinal manipulation has often been treated by the literature, incorrectly, as being homogeneous. Much of the confusion regarding this form of treatment can be traced to the ambiguity surrounding the procedures themselves. This report summarizes the clinical biomechanics of SMT and evidence for its associated manipulable lesion is reviewed. Finally, a classification system based on biomechanics is proposed that may facilitate more detailed research in the future. PURPOSE: A categorization system for SMT was sought that would be more objective than is clinically available. Such a system may serve as a means to strengthen future studies, determine operating principles, applicability, treatment effectiveness, and nature of the manipulable lesion. STUDY DESIGN: Literature synthesis. METHODS: A search of the indexed biomechanical and medical literature as well as a hand search of published works was conducted. The criteria for article selection consisted of studies that included measurements of mechanical characteristics of treatment techniques used under the general headings of SMT or manual therapy. A second set of studies was identified that explored the biomechanics of buckling behavior of vertebral segments as a model of the manipulable lesion. Quantitative characteristics of SMT were extracted and grouped to form a basis for classification. RESULTS: A total of 31 articles were identified that contained quantitative data on the biomechanical properties of SMT methods. An additional seven studies were found that quantified spinal buckling behavior. Common features of SMT procedures lead to a matrix that biomechanically characterizes the types of procedures in use. Buckling behavior was compared qualitatively with clinical observations to form a plausible and evidence-based hypothesis of the manipulable lesion. CONCLUSIONS: There currently are a number of named systems of manual procedures. No current triage system is available that predicts which patient has the greater likelihood of benefiting from manual treatment or the procedure type. The biomechanical parameters of SMT form a systematic characterization of manual procedures. Such a system may be used in future studies to test hypotheses of treatment effect from quantitatively defined procedures.

Biomechanical Phenomena↗
PubMed2006

Review conclusions by Ernst and Canter regarding spinal manipulation refuted.

In the April 2006 issue of the Journal of Royal Society of Medicine, Ernst and Canter authored a review of the most recent systematic reviews on the effectiveness of spinal manipulation for any condition. The authors concluded that, except for back pain, spinal manipulation is not an effective intervention for any condition and, because of potential side effects, cannot be recommended for use at all in clinical practice. Based on a critical appraisal of their review, the authors of this commentary seriously challenge the conclusions by Ernst and Canter, who did not adhere to standard systematic review methodology, thus threatening the validity of their conclusions. There was no systematic assessment of the literature pertaining to the hazards of manipulation, including comparison to other therapies. Hence, their claim that the risks of manipulation outweigh the benefits, and thus spinal manipulation cannot be recommended as treatment for any condition, was not supported by the data analyzed. Their conclusions are misleading and not based on evidence that allow discrediting of a large body of professionals using spinal manipulation.

Editorial↗
PubMedDate not supplied

The types and frequencies of improved nonmusculoskeletal symptoms reported after chiropractic spinal manipulative therapy.

OBJECTIVE: To investigate the frequency and types of improved nonmusculoskeletal symptoms reported after chiropractic spinal manipulative therapy. DESIGN: Retrospective information obtained by chiropractors through standardized interview of patients on return visit within 2 weeks of previous treatment. SETTING: The private practice of 87 Swedish chiropractors (response rate 81%). SUBJECTS: Twenty consecutive (presumably naive) patients per chiropractor (1504 valid questionnaires returned, 86% of optimal number of replies). INTERVENTION: Spinal manipulation with or without additional therapy provided by chiropractors. MAIN OUTCOME MEASURES: Self-reported improved nonmusculoskeletal symptoms (reactions). RESULTS: At least I reaction was reported after the previous treatment in 21% to 25% of cases. Of these responses, 26% were related to the airway passages (usually reported as "easier to breathe"), 25% were related to the digestive system (mostly reported as "improved function"), 14% were classified under eyes/vision (usually reported as "improved vision"), and 14% under heart/ circulation (about half of these reported as "improved circulation"). The number of spinal areas treated was positively associated with the number of reactions. CONCLUSION: A minority of chiropractic patients report having positive nonmusculoskeletal reactions after spinal manipulative therapy but such reports cluster predominantly around specific symptoms. It would be interesting to find out if these can be verified objectively and, if so, to investigate if they are caused by the treatment or if they are signs of natural variations in human physiology.

Adolescent↗
PubMedDate not supplied

Treatment of severe glaucomatous visual field deficit by chiropractic spinal manipulative therapy: a prospective case study and discussion.

OBJECTIVE: To discuss the case of a patient with severely reduced visual fields arising from terminal glaucomatous retinal damage and the treatment of this condition by spinal manipulation. CLINICAL FEATURES: A 25-year-old uniocular female patient with congenital glaucoma sought chiropractic treatment for spinal pain, headache, and classic migraine. Advanced optic disk cupping was present, and loss of vision was near complete. A 3-degree island of central vision and a small area of peripheral light sensitivity had remained relatively stable for 3 years after a trabeculectomy procedure that had resulted in intraocular hypotony. INTERVENTION AND OUTCOME: It was considered possible that chiropractic spinal manipulative therapy may have a positive outcome in visual performance. Before commencing chiropractic spinal manipulative therapy, an ophthalmologic examination was performed, and visual performance was monitored through a course of treatment. Immediately after the first treatment, significant visual field improvement was recorded in the remaining eye. Maximal improvement of vision was achieved after 1 week (4 treatment sessions). Total monocular visual field had increased from approximately 2% to approximately 20% of normal. Corrected central acuity had improved from 6/12 to 6/9. Independent reexamination by the patient's regular ophthalmic surgeon confirmed the results. CONCLUSION: Recovery of vision in this patient was an unexpected and remarkable outcome, raising the question of whether chiropractic spinal manipulative therapy may be of value in the management of glaucomatous visual field loss. More intensive research is required.

Adult↗
PubMedDate not supplied

The step phenomenon in the recovery of vision with spinal manipulation: a report on two 13-yr-olds treated together.

OBJECTIVE: To discuss the immediate increment of improvement in vision that occurs when the spine is manipulated. CLINICAL FEATURES: Two juvenile patients (13-yr-old female cousins) were found to have constricted visual fields and diminished visual acuities. INTERVENTION AND OUTCOME: Spinal manipulation was associated with recovery of normal vision over seven treatment sessions. It was noted that significant improvement in vision occurred immediately after the spinal manipulation treatments. Full recovery of vision was attained by series of these steps. In addition, both patients reported significant constitutional benefits after the treatment in addition to the improved vision. CONCLUSION: The change in visual function immediately related to spinal manipulation has been described as the "step phenomenon." The step phenomenon raises questions about the nature of the condition that may be treated by spinal manipulation and the method of action of the treatment. A vascular hypothesis is mentioned that could explain these events. The consistent occurrence of the step phenomenon indicates that spinal manipulation may have an effect on brain function.

Adolescent↗
PubMed1996

Complications of spinal manipulation: a comprehensive review of the literature.

BACKGROUND: Spinal manipulative therapy (SMT) is a frequently applied therapy for back and neck pain. Serious complications of SMT are presented primarily in case reports. Many patients seen by physicians also seek care from therapists applying manipulative techniques. Therefore, background information on the risks of SMT is essential for physicians. METHODS: Relevant case reports, surveys, and review articles were identified using a comprehensive search of online and bibliographical databases. For every case, a record was made of first author, publication year, country, age and sex of the patient, background of the manipulator, preexisting conditions, type of complication, and course of the complication. Based on case reports and surveys, an estimation was made of the risk for the most frequently reported complications: vertebrobasilar accidents (VBAs) and cauda equina syndrome (CES). RESULTS: We derived 295 complications of spinal manipulations from the literature: 165 VBAs; 61 cases with disc herniation or progression to CES; 13 cerebral complications other than VBAs; and 56 other types of complications. The average age of patients with VBA was 38 years. Vertebrobasilar accidents occur mainly after a cervical manipulation with a rotatory component. Estimates of VBA range from 1 per 20,000 patients to 1 per 1 million cervical manipulations. The incidence of CES is estimated to be less that 1 per 1 million treatments. CONCLUSIONS: It is difficult to estimate the incidence of SMT complications, as they are probably underreported in the literature. Most non-VBA complications can be prevented by excluding patients with contraindications for SMT. Patients who develop complications such as CES should be treated as soon as possible. VBAs, however, are difficult to prevent and treat. Referral for SMT should not be made to practitioners applying rotatory cervical manipulation. Information about the risk of VBA should be included in an informed consent procedure for cervical manipulation with thrust techniques.

Back Pain↗
PubMed2005

Effect of spinal manipulation duration on low threshold mechanoreceptors in lumbar paraspinal muscles: a preliminary report.

STUDY DESIGN: Electrophysiologic recordings were obtained from low threshold primary afferent neurons innervating lumbar multifidus and longissimus muscles in the anesthetized cat. OBJECTIVE: The purpose of this study was to classify sensory nerve endings in lumbar paraspinal muscles and characterize their responses to biomechanical loads applied over a range of durations that encompass those occurring during spinal manipulation. SUMMARY OF BACKGROUND DATA: Neural responses arising from the mechanical input during spinal manipulation are thought to contribute to this maneuver's therapeutic effects. Because manual therapies are distinguished to a large extent on the basis of the speed with which they are applied, it is important to understand how their rate of application affects the signaling properties of primary afferent neurons innervating paraspinal tissues. If alterations in sensory input do contribute to the mechanism of spinal manipulation's therapeutic effect, it seems reasonable to expect that these primary afferents would respond to spinal manipulation in some unique fashion. METHODS: Experiments were performed on 6 adult cats. A L4-L5 laminectomy was performed and the L6 dorsal roots exposed. The L6-L7 vertebrae and associated paraspinal tissues remained intact bilaterally, including lumbodorsal fascia, multifidus, longissimus, iliocostalis muscles, and deeper tissues. Forceps were clamped tightly onto the lateral surfaces of the L6 spinous process through a thin narrow, slit in the lumbodorsal fascia. Single unit afferent activity was recorded from fine filaments teased from the L6 dorsal root. Instantaneous discharge frequency was calculated. Afferents were classified based on von Frey threshold, conduction velocity, and responses to direct muscle stimulation and to succinylcholine injection. Spinal manipulative-like loads were applied to the L6 vertebra (posterior to anterior) using a programmable electronic feedback control system. Force-time profiles were half-sine waves with durations of 25, 50, 100, 200, 400, and 800 milliseconds delivered at constant magnitudes of 33%, 66%, or 100% body weight. RESULTS: The 6 afferents were classified as low threshold mechanoreceptors based on von Frey thresholds being less than 6 g. Five afferents were Group I or II muscle proprioceptors and one afferent was a Group III muscle mechanoreceptor. The receptive field for 2 of the 6 afferents was in the multifidus muscle and the receptive field of the remaining 4 afferents was in the longissimus muscle. In general, the mean instantaneous discharge frequency for all 6 afferents increased abruptly as the duration of the impulse approached 100 milliseconds. An increase in loading magnitude (33% vs. 66% vs. 100% body weight) did not appear to systematically affect the discharge from the 6 low threshold mechanoreceptors. CONCLUSIONS: This preliminary report suggests that abrupt changes in neural discharge (instantaneous frequency) of low threshold muscle mechanoreceptors of the lumbar spine occur as the duration of a biomechanical load approaches that typically used during spinal manipulation. These changes could comprise part of the mechanism contributing to this intervention's physiologic effects. Further studies are warranted to better understand the signaling properties of a wider range of sensory receptors as well as determine the central effects of these high frequency discharges.

Anesthesia↗
PubMed2003

Chronic spinal pain: a randomized clinical trial comparing medication, acupuncture, and spinal manipulation.

STUDY DESIGN: A randomized controlled clinical trial was conducted. OBJECTIVE: To compare medication, needle acupuncture, and spinal manipulation for managing chronic (>13 weeks duration) spinal pain because the value of medicinal and popular forms of alternative care for chronic spinal pain syndromes is uncertain. SUMMARY OF BACKGROUND DATA: Between February 1999 and October 2001, 115 patients without contraindication for the three treatment regimens were enrolled at the public hospital's multidisciplinary spinal pain unit. METHODS: One of three separate intervention protocols was used: medication, needle acupuncture, or chiropractic spinal manipulation. Patients were assessed before treatment by a sports medical physician for exclusion criteria and by a research assistant using the Oswestry Back Pain Disability Index (Oswestry), the Neck Disability Index (NDI), the Short-Form-36 Health Survey questionnaire (SF-36), visual analog scales (VAS) of pain intensity and ranges of movement. These instruments were administered again at 2, 5, and 9 weeks after the beginning of treatment. RESULTS: Randomization proved to be successful. The highest proportion of early (asymptomatic status) recovery was found for manipulation (27.3%), followed by acupuncture (9.4%) and medication (5%). Manipulation achieved the best overall results, with improvements of 50% (P = 0.01) on the Oswestry scale, 38% (P = 0.08) on the NDI, 47% (P < 0.001) on the SF-36, and 50% (P < 0.01) on the VAS for back pain, 38% (P < 0.001) for lumbar standing flexion, 20% (P < 0.001) for lumbar sitting flexion, 25% (P = 0.1) for cervical sitting flexion, and 18% (P = 0.02) for cervical sitting extension. However, on the VAS for neck pain, acupuncture showed a better result than manipulation (50% vs 42%). CONCLUSIONS: The consistency of the results provides, despite some discussed shortcomings of this study, evidence that in patients with chronic spinal pain, manipulation, if not contraindicated, results in greater short-term improvement than acupuncture or medication. However, the data do not strongly support the use of only manipulation, only acupuncture, or only nonsteroidal antiinflammatory drugs for the treatment of chronic spinal pain. The results from this exploratory study need confirmation from future larger studies.

Acupuncture Therapy↗
PubMed2000

[Spinal manipulation in the treatment of common low back pain].

Although the best designed studies have shown promising results, the efficacy of spinal manipulations has not as yet been proved. The mode of action may involve mechanical changes in the disk and facet joints, but neurological mechanisms probably play the key role. Complications of cervical spinal manipulations are rare. To protect patients, French legislation requires that spinal manipulations should only be performed by licensed physicians, who are capable of establishing the accurate diagnosis before undertaking manipulations.

Cervical Vertebrae↗
PubMed2005

Ophthalmological adverse effects of (chiropractic) upper spinal manipulation: evidence from recent case reports.

OBJECTIVE: Upper spinal manipulation (USM) is frequently used by chiropractors and other health care professionals to treat minor complaints. This systematic review aimed to summarize ophthalmological adverse effects of USM recently reported in the medical literature. METHODS: Five electronic databases were searched for all case reports of ophthalmological adverse effects after USM published between January 1995 and April 2003. No language restrictions were applied. Key data from the primary publications thus located were extracted and critically evaluated. RESULTS: Fourteen case reports were found. Clinical symptoms and signs were diverse and included loss of vision, ophthalmoplegia, diplopia and Horner's syndrome. The underlying mechanism was arterial wall dissection in most cases. The eventual outcome varied and often included permanent deficits. Causality was frequently deemed likely or certain. CONCLUSION: Upper spinal manipulation is associated with ophthalmological adverse effects of unknown frequency. Ophthalmologists should be aware of its risks. Rigorous investigations must be conducted to establish reliable incidence figures.

Complementary Therapies↗
PubMed1987

A benefit of spinal manipulation as adjunctive therapy for acute low-back pain: a stratified controlled trial.

Fifty-four subjects volunteered to participate in a controlled study contrasting spinal manipulation with spinal mobilization without the rotational forces and leverage required to move facet joints. All suffered from regional low-back pain for less than 1 month, were ages 18-40, had never previously undergone any form of spinal manipulation, and denied a prior episode of backache within the previous 6 months. Randomization was stratified at outset into those who suffered for less than 2 weeks and those whose discomfort had persisted for 2-4 weeks. Outcome was monitored by a questionnaire assessing functional impairment. A treatment effect of manipulation was demonstrated only in the strata with more prolonged illness at entry. In the first week following manipulation, these patients improved to a greater degree (P = .009, t test) and more rapidly (P less than .025, Wilcoxon rank-sum test).

Acute Disease↗
PubMed1989

Spinal manipulation for back pain.

It appears that the lack of good scientific research regarding spinal manipulation has fueled skepticism and deterred many physicians from learning its indications, contraindications, and techniques. Overall, there is sufficient evidence supporting spinal manipulative therapy in the short-term management of back pain. Further research is required to evaluate its long-term effectiveness and to better define the most appropriate indications for its use. With the recent increase in scientific research and improved studies in the future, spinal manipulation should be better understood by the medical profession as another option for the treatment of back pain.

Back Pain↗
PubMed2003

A review of the evidence for the effectiveness, safety, and cost of acupuncture, massage therapy, and spinal manipulation for back pain.

BACKGROUND: Few treatments for back pain are supported by strong scientific evidence. Conventional treatments, although widely used, have had limited success. Dissatisfied patients have, therefore, turned to complementary and alternative medical therapies and providers for care for back pain. PURPOSE: To provide a rigorous and balanced summary of the best available evidence about the effectiveness, safety, and costs of the most popular complementary and alternative medical therapies used to treat back pain. DATA SOURCES: MEDLINE, EMBASE, and the Cochrane Controlled Trials Register. STUDY SELECTION: Systematic reviews of randomized, controlled trials (RCTs) that were published since 1995 and that evaluated acupuncture, massage therapy, or spinal manipulation for nonspecific back pain and RCTs published since the reviews were conducted. DATA EXTRACTION: Two authors independently extracted data from the reviews (including number of RCTs, type of back pain, quality assessment, and conclusions) and original articles (including type of pain, comparison treatments, sample size, outcomes, follow-up intervals, loss to follow-up, and authors' conclusions). DATA SYNTHESIS: Because the quality of the 20 RCTs that evaluated acupuncture was generally poor, the effectiveness of acupuncture for treating acute or chronic back pain is unclear. The three RCTs that evaluated massage reported that this therapy is effective for subacute and chronic back pain. A meta-regression analysis of the results of 26 RCTs evaluating spinal manipulation for acute and chronic back pain reported that spinal manipulation was superior to sham therapies and therapies judged to have no evidence of a benefit but was not superior to effective conventional treatments. CONCLUSIONS: Initial studies have found massage to be effective for persistent back pain. Spinal manipulation has small clinical benefits that are equivalent to those of other commonly used therapies. The effectiveness of acupuncture remains unclear. All of these treatments seem to be relatively safe. Preliminary evidence suggests that massage, but not acupuncture or spinal manipulation, may reduce the costs of care after an initial course of therapy.

Acupuncture Therapy↗
PubMed1992

The effect of spinal manipulation on pain and prostaglandin levels in women with primary dysmenorrhea.

OBJECTIVE: The primary objectives of this study were to compare the effect of spinal manipulation vs. sham manipulation on a) circulating plasma levels of the prostaglandin F2a metabolite, 15-keto-13,14-dihydroprostaglandin (KDPGF2a), b) perceived abdominal and back pain and c) perceived menstrual distress in women with primary dysmenorrhea. DESIGN: This randomized clinical pilot study investigated the outcome measures before and after either a spinal manipulation treatment (SMT) or a sham manipulation. SETTING: All subjects were treated at the National College Chiropractic clinic, a private chiropractic clinic in the suburban Chicago area. PARTICIPANTS: Forty-five women with a history of primary dysmenorrhea were recruited from the local community. The volunteers ranged in age from 20-49 (mean age = 30.3 yr), and were entered into the study between April 1990 and January 1991. Twenty-four were randomly assigned to the spinal manipulation group and 21 were assigned to the sham group. INTERVENTIONS: Subjects treated with spinal manipulation were placed in a side-lying position with the bottom leg straight and the top leg flexed at the knee and hip. They received a high-velocity, short lever, low-amplitude thrust to all clinically relevant vertebral levels within T10 and L5-S1 and the sacroiliac joints. In the sham manipulation, subjects were placed in a side-lying position with both hips and knees flexed. Their manipulation consisted of a similar thrust administered to the midline base of the sacrum. OUTCOME MEASURES: Perceived abdominal and back pain were measured with a visual analog scale, and menstrual distress was measured with the Menstrual Distress Questionnaire. Both were administered 15 min before and 60 min after treatment. Blood samples were collected by venipuncture for the determination of plasma levels of KDPGF2a at the same times. The plasma was then assayed for KDPGF2a by radioimmunoassay. RESULTS: Analysis of covariance and paired Student's t tests were used for the statistical evaluation. Immediately after treatment, the perception of pain and the level of menstrual distress were significantly reduced by SMT. This reduction was associated with a significant reduction in plasma levels of KDGPF2a in the SMT group. A significant and similar reduction in plasma KDPGF2a also occurred in the sham group, indicating that a placebo effect was associated with a single sham intervention. CONCLUSIONS: This randomized pilot study suggests that SMT may be an effective and safe nonpharmacological alternative for relieving the pain and distress of primary dysmenorrhea. However, the large change in KDPGF2a observed in both treatment groups clearly indicates that further studies with more subjects, studied over a longer time frame, are needed to resolve the question of a placebo effect.

Abdominal Pain↗
PubMed1990

Experimental measurement of the force exerted during spinal manipulation using the Thompson technique.

The purpose for conducting this study was to quantify the forces exerted by a chiropractor on a patient during spinal manipulative therapy. Six patients received three treatments each from two chiropractors for a sacroiliac joint fixation. The Thompson technique was used to treat the patients. The force characteristics of the spinal manipulation were analyzed with respect to the following five points: preloading force, peak force, duration of manipulation, impulse of manipulation and point of application of the peak force. The results obtained indicated that all treatments have certain common characteristics; for example, a preload force is always followed by a large thrusting force. The values for the preload force, peak force, duration and impulse were found to have large standard deviations for a given adjuster and between patients. The location of the point of application of the peak force relative to a low back reference system appeared to be very consistent. However, it was not on the posterior superior iliac spines (PSIS) as expected, but always slightly medial to this point. This is the first study to report force results which were measured directly during spinal manipulative therapy in a clinical situation. In further studies, the results of this investigation will be compared to results obtained from a large population of patients and chiropractic adjusters. Differences in the force characteristics between chiropractors will be compared to clinical and objective measures of the rehabilitation process of the patients in order to find an "optimal" way of performing spinal manipulative therapies.

Adult↗
PubMed1988

Immunoreactive ACTH, beta-endorphin, and cortisol levels in plasma following spinal manipulative therapy.

This study examines the possibility of a humorally mediated analgesic response to spinal manipulative therapy by determination of plasma levels of beta-endorphin, adrenocorticotropic hormone (ACTH), and cortisol before and after intervention. Forty male subjects (20 symptomatic, 20 asymptomatic) were allocated into four equal groups. Two treatment groups were given spinal manipulative therapy, and two groups underwent a sham procedure. Blood samples were taken via indwelling butterfly needles pre- and postintervention in all four groups, and levels of immunoreactive ACTH, immunoreactive beta-endorphin, and cortisol determined by radioimmunoassay. No differences in ACTH or beta-endorphin were found between sham and treated groups, or between pre- and postintervention in any group; cortisol levels fell over the course of the study in all groups. The findings thus appear to exclude a humoral role for beta-endorphin in mediating the analgesic response to spinal manipulative therapy; in addition, they suggest that such therapy is not a stressor that activates the hypothalamo-pituitary-adrenal axis.

Adolescent↗