The effect on clinical outcomes when targeting spinal manipulation at stiffness or pain sensitivity: a randomized trial

Abstract The mechanisms underlying pain relief following spinal manipulative therapy (SMT) are not understood fully although biomechanical and neurophysiological processes have been proposed. As such, we designed this randomized trial to elucidate the contributions of biomechanical and neurophysiolo...

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Autores principales:	Casper Glissmann Nim, Gregory Neil Kawchuk, Berit Schiøttz-Christensen, Søren O’Neill
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2020
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/b26a882c8ea848cdb126e4ac8a971080
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spelling	oai:doaj.org-article:b26a882c8ea848cdb126e4ac8a9710802021-12-02T19:04:11ZThe effect on clinical outcomes when targeting spinal manipulation at stiffness or pain sensitivity: a randomized trial10.1038/s41598-020-71557-y2045-2322https://doaj.org/article/b26a882c8ea848cdb126e4ac8a9710802020-09-01T00:00:00Zhttps://doi.org/10.1038/s41598-020-71557-yhttps://doaj.org/toc/2045-2322Abstract The mechanisms underlying pain relief following spinal manipulative therapy (SMT) are not understood fully although biomechanical and neurophysiological processes have been proposed. As such, we designed this randomized trial to elucidate the contributions of biomechanical and neurophysiological processes. A total of 132 participants with low back pain were randomly assigned to receive SMT at either the lumbar segment measured as the stiffest or the segment measured as having the lowest pain threshold. The primary outcome was patient reported low back pain intensity following treatment. Secondary outcomes were biomechanical stiffness and neurophysiological pressure pain threshold. All outcomes were measured at baseline, after the fourth and final session and at 2-weeks follow-up. Data were analyzed using linear mixed models, and demonstrated that the SMT application site did not influence patient reported low back pain intensity or stiffness. However, a large and significant difference in pressure pain threshold was observed between groups. This study provides support that SMT impacts neurophysiological parameters through a segment-dependent neurological reflex pathway, although this do not seem to be a proxy for improvement. This study was limited by the assumption that the applied treatment was sufficient to impact the primary outcome.Casper Glissmann NimGregory Neil KawchukBerit Schiøttz-ChristensenSøren O’NeillNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 10, Iss 1, Pp 1-10 (2020)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Casper Glissmann Nim Gregory Neil Kawchuk Berit Schiøttz-Christensen Søren O’Neill The effect on clinical outcomes when targeting spinal manipulation at stiffness or pain sensitivity: a randomized trial
description	Abstract The mechanisms underlying pain relief following spinal manipulative therapy (SMT) are not understood fully although biomechanical and neurophysiological processes have been proposed. As such, we designed this randomized trial to elucidate the contributions of biomechanical and neurophysiological processes. A total of 132 participants with low back pain were randomly assigned to receive SMT at either the lumbar segment measured as the stiffest or the segment measured as having the lowest pain threshold. The primary outcome was patient reported low back pain intensity following treatment. Secondary outcomes were biomechanical stiffness and neurophysiological pressure pain threshold. All outcomes were measured at baseline, after the fourth and final session and at 2-weeks follow-up. Data were analyzed using linear mixed models, and demonstrated that the SMT application site did not influence patient reported low back pain intensity or stiffness. However, a large and significant difference in pressure pain threshold was observed between groups. This study provides support that SMT impacts neurophysiological parameters through a segment-dependent neurological reflex pathway, although this do not seem to be a proxy for improvement. This study was limited by the assumption that the applied treatment was sufficient to impact the primary outcome.
format	article
author	Casper Glissmann Nim Gregory Neil Kawchuk Berit Schiøttz-Christensen Søren O’Neill
author_facet	Casper Glissmann Nim Gregory Neil Kawchuk Berit Schiøttz-Christensen Søren O’Neill
author_sort	Casper Glissmann Nim
title	The effect on clinical outcomes when targeting spinal manipulation at stiffness or pain sensitivity: a randomized trial
title_short	The effect on clinical outcomes when targeting spinal manipulation at stiffness or pain sensitivity: a randomized trial
title_full	The effect on clinical outcomes when targeting spinal manipulation at stiffness or pain sensitivity: a randomized trial
title_fullStr	The effect on clinical outcomes when targeting spinal manipulation at stiffness or pain sensitivity: a randomized trial
title_full_unstemmed	The effect on clinical outcomes when targeting spinal manipulation at stiffness or pain sensitivity: a randomized trial
title_sort	effect on clinical outcomes when targeting spinal manipulation at stiffness or pain sensitivity: a randomized trial
publisher	Nature Portfolio
publishDate	2020
url	https://doaj.org/article/b26a882c8ea848cdb126e4ac8a971080
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The effect on clinical outcomes when targeting spinal manipulation at stiffness or pain sensitivity: a randomized trial

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