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At least 19 recordsLinked to original sources
PubMed2004

Determining cavitation location during lumbar and thoracic spinal manipulation: is spinal manipulation accurate and specific?

STUDY DESIGN: Sixty-four asymptomatic participants, ranging in age from 22 to 49 years, volunteered to act as patients for the study. Twenty-eight different clinicians performed thoracic and lumbar spinal manipulative procedures. The range of clinical experience was 1 to 43 years. OBJECTIVES: The purpose of this study is to first locate the joints that produce an audible sound in response to manipulation (cavitation) during spinal manipulative procedures so that the accuracy and specificity of manipulation can be assessed. SUMMARY OF BACKGROUND DATA: Clinicians utilizing spinal manipulative therapy (SMT) claim to be very specific and accurate with the delivery of their dynamic thrust. It has been suggested that the clinical success of SMT is dependent on the accurate delivery of that therapy to the target spinal joints. METHODS: Asymptomatic participants received SMT to either the thoracic or lumbar regions of their spine. Accelerometers were secured to the skin over the spinal column, and the relative time at which each accelerometer detected the vibration from the cavitation associated with the SMT was used to calculate the source of the vibration. The site of cavitation was then compared with the target location. RESULTS: For lumbar SMT, the average error from target of 124 cavitations in lumbar procedures was 5.29 cm (at least one vertebra away from target), with a range of 0 to 14 cm. Of these cavitations, 57 were deemed to be accurate and 67 were deemed to be inaccurate. The average error from target of 54 cavitations in the thoracic spine was 3.5 cm, with a range of 0 to 9.5 cm. Of these cavitations, 29 were deemed to be accurate and 25 were deemed to be inaccurate. In most cases, individual manipulative procedures were associated with multiple cavitations ranging from 2 to 6. CONCLUSIONS: In the lumbar spine, SMT was accurate about half the time. However, because most procedures were associated with multiple cavitations, in most cases, at least one cavitation emanated from the target joints. In the thoracic spine, SMT appears to be more accurate.

Acceleration↗
PubMed1996

Radiculomedullary complications of cervical spinal manipulation.

Spinal manipulation is commonly used by some therapists for the treatment of cervical pain. Flexion-extension of the cervical spine produces sliding movements of one vertebra over the one below it, which leads to physiological reduction in the antero-posterior diameter of the spinal canal. Spinal manipulation provokes movements that exceed the physiological limits of these articulations and thereby lead to a more significant reduction of the canal diameter. In patients with pre-existing stenosis of the canal or those with vertebral instability, these movements may cause (or aggravate) myelopathy. For this reason, a thorough neurological examination and cervical spine films should be considered mandatory in patients being considered for spinal manipulation. This report describes four patients with cervical myelopathy and/or radiculopathy caused or aggravated by spinal manipulation. In one patient, magnetic resonance scans before and after chiropractic treatment strongly suggests that the disc prolapse syndrome experienced by the patient was provoked by the spinal manipulation.

Aged↗
PubMed2001

Prospective investigations into the safety of spinal manipulation.

Spinal manipulation (SM) is a popular form of treatment of back and neck pain, as well as of other conditions. Uncertainty exists as to its safety. The aim of this systematic review was to summarize the data of all prospective investigations into the safety of SM. Five independent literature searches were carried out to identify all such studies. Data were extracted and validated according to pre-defined criteria. Five investigations met the inclusion criteria. The most valid studies suggest that about half of all patients will experience adverse events after chiropractic SM. These events are usually mild and transient. No reliable data exist about the incidence of serious adverse events. These data indicate that mild and transient adverse events seem to be frequent. Serious adverse events are probably rare but their incidence can only be estimated at present. Further prospective investigations are needed to define their incidence more closely.

Chiropractic↗
PubMed2005

Supplemental care with medication-assisted manipulation versus spinal manipulation therapy alone for patients with chronic low back pain.

OBJECTIVES: To measure changes in pain and disability for chronic low-back pain patients receiving treatment with medication-assisted manipulation (MAM) and to compare these to changes in a group only receiving spinal manipulation. STUDY DESIGN: Prospective cohort study of 68 chronic low-back pain patients. METHODS: Outcomes were measured using the 1998 Version 2.0 American Association of Orthopaedic Surgeons/Council of Musculoskeletal Specialty Societies/Council of Spine Societies Outcomes Data Collection Instruments. The primary outcome variable was change in pain and disability. All patients received an initial 4- to 6-week trial of spinal manipulation therapy (SMT), after which 42 patients received supplemental intervention with MAM and the remaining 26 patients continued with SMT. RESULTS: Low back pain and disability measures favored the MAM group over the SMT-only group at 3 months (adjusted mean difference of 4.4 points on a 100-point scale, 95% confidence interval [CI] -2.2 to 11.0). This difference attenuated at 1 year (adjusted mean difference of 0.3 points, 95% CI -8.6 to 9.2). The relative odds of experiencing a 10-point improvement in pain and disability favored the MAM group at 3 months (odds ratio 4.1, 95% CI 1.3-13.6) and at 1 year (odds ratio 1.9, 95% CI 0.6-6.5). CONCLUSION: Medication-assisted manipulation appears to offer some patients increased improvement in low back pain and disability. Further investigation of these apparent benefits in a randomized clinical trial is warranted.

Adult↗
PubMed1999

A feasibility study of chiropractic spinal manipulation versus sham spinal manipulation for chronic otitis media with effusion in children.

BACKGROUND: Pediatric otitis media with effusion is a common and costly condition. Although chiropractors have anecdotally claimed success in treating otitis media, there is little research to support their claims. OBJECTIVE: A pilot study was undertaken for the purpose of assessing the feasibility of conducting a full-scale randomized clinical trial investigating the efficacy of chiropractic spinal manipulative therapy (SMT) for children with chronic otitis media with effusion. METHODS: This study was a prospective, parallel-group, observer-blinded, randomized feasibility study. Twenty-two patients, ages 6 months to 6 years, received either active chiropractic SMT or placebo chiropractic SMT. Otoscopy and tympanometry were used to create a middle ear status profile, and daily diaries were collected. RESULTS: Five newspaper advertisements over 6 months generated 105 responses. Twenty patients subsequently qualified and were randomized into the study. Collection of tympanometric and otoscopic data proved to be challenging. Compliance with the treatment and evaluation protocols and daily diaries was excellent. There were no reports of serious side effects as a result of either the active or placebo chiropractic treatments. CONCLUSION: Recruitment for a randomized controlled trial is feasible and could be enhanced by medical collaboration. Patients and parents are able and willing to participate in a study comparing active SMT and placebo SMT. Parents were extremely compliant with the daily diaries, suggesting that similar quality-of-life and functional status measures can be successfully used in a larger trial. We found the objective outcomes assessment involving tympanometry and otoscopy extremely challenging and should be performed by experienced examiners in future studies.

Child↗
PubMed2005

Spinal manipulation and spinal mobilization influence different axial sensory beds.

Manipulation and mobilization are two forms of manual therapy commonly employed in the management of musculoskeletal disorders. Spinal manipulation and mobilization are often distinguished from one another by reference to certain biomechanical parameters such as peak force, duration and magnitude of translation. However, as of yet, there is relatively little research which distinguishes between them in terms of neurological mechanisms or clinical effectiveness. Theories concerning the mechanisms underlying the therapeutic effects of manipulation and mobilization commonly make reference to mechanical events such as the release of entrapped tissue or the disruption of intra-articular adhesions. Relatively less attention is given to neural effects. In this paper, we hypothesize that, at least in part, spinal manipulation preferentially influences a sensory bed which, in terms of anatomical location and function, is different from the sensory bed influenced by spinal mobilization techniques. More specifically, we hypothesize that manipulation may particularly stimulate receptors within deep intervertebral muscles, while mobilization techniques most likely affect more superficial axial muscles. In part, our rationale for this hypothesis is based on differences in mechanical advantage of the respective manual procedures on multi-segmental versus short intervertebral muscles.

Animals↗
PubMed1993

Forces exerted during spinal manipulative therapy.

Spinal manipulative therapy has been widely recognized in the medical fields as a conservative treatment modality for spinal dysfunction and pain. Spinal manipulative therapy consists of an application of a thrusting force on a specific part of the spine in a well-defined direction. The magnitude of this force has been associated with positive treatment effects, such as realigning vertebral bodies, mobilizing spinal joints, relaxing back musculature through reflex pathways, and producing a respiratory burst. However, direct force measurements during spinal manipulative therapy in a clinically relevant situation have not been performed to date. The purpose of this study was to measure the forces exerted onto patients during spinal manipulative therapy on various locations of the spinal column. Force measurements were obtained using a thin, flexible pressure mat. The results indicate that peak and preload forces are considerably smaller for spinal manipulative therapy performed on the cervical spine compared to corresponding values obtained on the thoracic spine and sacroiliac joint. Furthermore, for treatments on the thoracic spine and sacroiliac joint, a significant relation was found to exist between preload and peak forces.

Biomechanical Phenomena↗
PubMed2006

Increased multiaxial lumbar motion responses during multiple-impulse mechanical force manually assisted spinal manipulation.

BACKGROUND: Spinal manipulation has been found to create demonstrable segmental and intersegmental spinal motions thought to be biomechanically related to its mechanisms. In the case of impulsive-type instrument device comparisons, significant differences in the force-time characteristics and concomitant motion responses of spinal manipulative instruments have been reported, but studies investigating the response to multiple thrusts (multiple impulse trains) have not been conducted. The purpose of this study was to determine multi-axial segmental and intersegmental motion responses of ovine lumbar vertebrae to single impulse and multiple impulse spinal manipulative thrusts (SMTs). METHODS: Fifteen adolescent Merino sheep were examined. Tri-axial accelerometers were attached to intraosseous pins rigidly fixed to the L1 and L2 lumbar spinous processes under fluoroscopic guidance while the animals were anesthetized. A hand-held electromechanical chiropractic adjusting instrument (Impulse) was used to apply single and repeated force impulses (13 total over a 2.5 second time interval) at three different force settings (low, medium, and high) along the posteroanterior axis of the T12 spinous process. Axial (AX), posteroanterior (PA), and medial-lateral (ML) acceleration responses in adjacent segments (L1, L2) were recorded at a rate of 5000 samples per second. Peak-peak segmental accelerations (L1, L2) and intersegmental acceleration transfer (L1-L2) for each axis and each force setting were computed from the acceleration-time recordings. The initial acceleration response for a single thrust and the maximum acceleration response observed during the 12 multiple impulse trains were compared using a paired observations t-test (POTT, alpha = .05). RESULTS: Segmental and intersegmental acceleration responses mirrored the peak force magnitude produced by the Impulse Adjusting Instrument. Accelerations were greatest for AX and PA measurement axes. Compared to the initial impulse acceleration response, subsequent multiple SMT impulses were found to produce significantly greater (3% to 25%, P < 0.005) AX, PA and ML segmental and intersegmental acceleration responses. Increases in segmental motion responses were greatest for the low force setting (18%-26%), followed by the medium (5%-26%) and high (3%-26%) settings. Adjacent segment (L1) motion responses were maximized following the application of several multiple SMT impulses. CONCLUSION: Knowledge of the vertebral motion responses produced by impulse-type, instrument-based adjusting instruments provide biomechanical benchmarks that support the clinical rationale for patient treatment. Our results indicate that impulse-type adjusting instruments that deliver multiple impulse SMTs significantly increase multi-axial spinal motion.

Journal Article↗
PubMed2006

A pilot study comparing the effects of spinal manipulative therapy with those of extra-spinal manipulative therapy on quadriceps muscle strength.

OBJECTIVE: The objective of this study was to assess whether tibiofemoral joint manipulation is as effective as sacroiliac (SI) joint manipulation in increasing quadriceps muscle strength. DESIGN AND SETTING: Twenty subjects were divided into two groups of 10. After all base measurements of the maximum voluntary force of the quadriceps muscles were taken, subjects in group A received tibiofemoral joint manipulation and those in group B received ipsilateral SI joint manipulation. After these treatments, the maximum voluntary forces of the subjects' quadriceps muscles were retested. RESULTS: A significant improvement (P = .05) in quadriceps muscle strength was noted in the subjects who received an SI joint manipulation. CONCLUSION: This study showed a significant change within the SI joint manipulation group before and after the manipulation but did not show any significant difference between the groups (tibiofemoral joint vs SI joint manipulation) in increasing quadriceps muscle strength.

Adult↗
PubMed2005

Long-term follow-up of a randomized clinical trial assessing the efficacy of medication, acupuncture, and spinal manipulation for chronic mechanical spinal pain syndromes.

OBJECTIVE: To assess the long-term benefits of medication, needle acupuncture, and spinal manipulation as exclusive and standardized treatment regimens in patients with chronic (>13 weeks) spinal pain syndromes. STUDY DESIGN: Extended follow-up (>1 year) of a randomized clinical trial was conducted at the multidisciplinary spinal pain unit of Townsville's General Hospital between February 1999 and October 2001. PATIENTS AND METHODS: Of the 115 patients originally randomized, 69 had exclusively been treated with the randomly allocated treatment during the 9-week treatment period (results at 9 weeks were reported earlier). These patients were followed up and assessed again 1 year after inception into the study reapplying the same instruments (ie, Oswestry Back Pain Index, Neck Disability Index, Short-Form-36, and Visual Analogue Scales). Questionnaires were obtained from 62 patients reflecting a retention proportion of 90%. The main analysis was restricted to 40 patients who had received exclusively the randomly allocated treatment for the whole observation period since randomization. RESULTS: Comparisons of initial and extended follow-up questionnaires to assess absolute efficacy showed that only the application of spinal manipulation revealed broad-based long-term benefit: 5 of the 7 main outcome measures showed significant improvements compared with only 1 item in each of the acupuncture and the medication groups. CONCLUSIONS: In patients with chronic spinal pain syndromes, spinal manipulation, if not contraindicated, may be the only treatment modality of the assessed regimens that provides broad and significant long-term benefit.

Acetaminophen↗
PubMed2003

Mechanism of action of spinal manipulative therapy.

Spinal manipulative therapy (SMT) acts on the various components of the vertebral motion segment. SMT distracts the facet joints, with faster separation when a cracking sound is heard. Intradiscal pressure may decrease briefly. Forceful stretching of the paraspinal muscles occurs, which induces relaxation via mechanisms that remain to be fully elucidated. Finally, SMT probably has an inherent analgesic effect independent from effects on the spinal lesion. These changes induced by SMT are beneficial in the treatment of spinal pain but short-lived. To explain a long-term therapeutic effect, one must postulate a reflex mechanism, for instance the disruption of a pain-spasm-pain cycle or improvement of a specific manipulation-sensitive lesion, whose existence has not been established to date.

Biomechanical Phenomena↗
PubMed1986

Spinal manipulation and beta-endorphin: a controlled study of the effect of a spinal manipulation on plasma beta-endorphin levels in normal males.

The role of spinal manipulation in the relief of pain is becoming clearer and more demonstrable as time passes. One approach to this study is the effect of manipulation on the neurochemical mechanisms of antinociception. Chief among these is beta-endorphin, which has been found to produce a wide range of beneficial effects, especially analgesia. The intent of our study was to demonstrate the effect of spinal manipulation on plasma beta-endorphin levels. Three groups of male subjects were randomly created: the experimental, sham and control groups. All three groups were screened for symptomatology, present use of medications and the present use of innocuous stimulants, such as nicotine and caffeine. A standard protocol involving a 20-min pretest resting period, an intervention and a 40-min test period ensued. The experimental group received a manipulation in the region of the cervical spine; the placebo group received a sham maneuver with no dynamic thrust; the control group received no intervention. Samples were taken by venipuncture at -20, -5, +5, +10 and +30 min. The data were analyzed by repeated measures analysis of variance and by Scheffe's post-hoc multiple comparison tests. Plasma beta-endorphin levels were assessed by radioimmune assay technique (according to the method described by Harber and Sutton in 1984). The results of our study demonstrated a small, but statistically significant, increase in serum beta-endorphin levels in the experimental group at the 5-min postintervention point. The levels in the placebo and control groups demonstrated a steady decrease that was distinct from the response in the experimental group.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

Pressure pain threshold evaluation of the effect of spinal manipulation in the treatment of chronic neck pain: a pilot study.

Nine subjects with chronic mechanical neck pain syndromes were evaluated for pressure pain threshold (PPT) over standardized tender points in the paraspinal area surrounding a manipulable spinal lesion. The subjects were then allocated randomly to an intervention consisting of either an oscillatory mobilization of the cervical spine (n = 4), which was designated as the control procedure, or a rotational manipulation of the cervical spine (n = 5). An assessor-blinded re-evaluation of the pressure pain threshold levels was conducted after 5 min. In the group receiving a manipulation the mean increases in pressure pain threshold ranged from 40-56% with an average of 45%. In the control group no change in any of the pressure pain thresholds was found. These results were analyzed using ANOVA and were found to be statistically significant (p less than 0.0001). This study confirms that manipulation can increase local paraspinal pain threshold levels. The use of the pressure pain threshold meter allows for the determination of such a beneficial effect in the deeper tissues.

Adult↗
PubMedDate not supplied

Nonvascular complications following spinal manipulation.

BACKGROUND CONTEXT: Spinal manipulation is associated with various vascular and nonvascular complications. Most prior studies have focused on the vascular complications. PURPOSE: The purpose of this study is to better clarify the spectrum of nonvascular complications following spinal manipulation, and to help define the risks of manipulative treatment. STUDY DESIGN: Review of medical records and radiographic studies of appropriate subjects. PATIENT SAMPLE: Patients presenting to a neurosurgical practice over a 6-year period who suffered a qualitative worsening of symptoms immediately after spinal manipulative treatment. OUTCOME MEASURES: Neurological conditions were compared pre-manipulation, post-manipulation, and post-surgery. METHODS: Record review of 18 patients. RESULTS: Eighteen patients were identified who had received spinal manipulation and whose neurological condition immediately worsened. Injuries were sustained to the cervical, thoracic, and lumbar spine and resulted, variously, in myelopathy, paraparesis, cauda equina syndrome, and radiculopathy. Eighty-nine percent required surgery. Outcome was excellent in 50% and good in 37.5%. Three patients died from unrecognized malignancies. CONCLUSION: Spinal manipulation can be associated with significant complications, often requiring surgical intervention. Pretreatment scanning may help identify patients with significant risk factors, such as substantial disc herniations or occult malignancies. Prompt evaluation and intervention is necessary when symptoms worsen or neurological deficits develop.

Adult↗
PubMed1983

Spinal manipulative therapy.

Spinal manipulative therapy is growing in popularity and acceptance, as judged by the increasing number of practitioners in physical therapy and medicine and by the results of clinical trials. Manipulation is the skilled, gentle, passive movement of a joint (or spinal segment) either within or beyond its active range of motion. This definition is broad enough to encompass a great variety of techniques, ranging from the more traditional thrust to oscillation and distraction. Manipulation is rendered effective by a combination of mechanical, neurophysiologic, and biomechanical mechanisms.

Back Pain↗
PubMed2006

[Spinal manipulations in sciatica].

Spinal manipulations have been shown to be efficient for common low back pain; they remain an option in the treatment of symptomatic lumbar disk herniation. From data in the literature, the author discusses the interest of spinal manipulations with a "thrust" at the level of disk herniation and concludes that this therapy, performed by an experienced physician and under conditions of strict application, could be an option in the treatment of subacute and chronique disc herniation.

Humans↗
PubMed2002

Internal forces sustained by the vertebral artery during spinal manipulative therapy.

BACKGROUND: Spinal manipulative therapy (SMT) has been established as a clinically effective modality for the management of several musculoskeletal disorders. One major issue with the use of SMT is its safety, especially with respect to neck manipulation and the risk of stroke in the vertebrobasilar system. OBJECTIVES: Our objectives were to quantify the strains and forces sustained by the vertebral artery (VA) in situ during SMT. STUDY DESIGN: This was a cadaveric study. METHODS: Six VAs were obtained from 5 unembalmed postrigor cadavers. The cephalad/distal (C0-C1) and caudad/proximal (C6-subclavian artery) loops of the VA were carefully exposed and instrumented with a pair of piezoelectric ultrasonographic crystals. The strains between each crystal pair were recorded during range of motion testing and diagnostic tests and during a variety of SMT procedures. The VA was then dissected free and strained on a materials testing machine until mechanical failure occurred. RESULTS: SMT performed on the contralateral side of the cervical spine resulted in an average strain of 6.2% +/- 1.3% to the distal (C0-C1) loop of the VA and a 2.1% +/- 0.4% strain to the proximal (C6) loop. These values were similar to or lower than the strains recorded during diagnostic and range of motion testing. Failure testing demonstrated that the VAs could be stretched to 139% to 162% of their resting length before mechanical failure occurred. Therefore the strains sustained by the VA during SMT represent approximately one ninth of the strain at mechanical failure. CONCLUSIONS: SMT resulted in strains to the VA that were almost an order of magnitude lower than the strains required to mechanically disrupt it. We conclude that under normal circumstances, a single typical (high-velocity/low-amplitude) SMT thrust is very unlikely to mechanically disrupt the VA.

Aged↗