Effects of manual therapies on stability in people with musculoskeletal pain: a systematic review

Abstract

Introduction: Chronic musculoskeletal pain is associated with reduced balance performance and falls risk. Manual therapies are commonly used interventions for musculoskeletal pain. There is emerging evidence that manual therapies may improve balance. The aim of this systematic review was to examine the effectiveness of manual therapies for musculoskeletal pain on measures of static and dynamic stability.Methods: Six electronic databases were searched using pre-defined eligibility criteria and two independent reviewers assessed all identified records. Risk of bias was assessed using the 12-item Cochrane Risk of Bias assessment by two authors independently and any discrepancies resolved through consensus. Meta-analysis was conducted when three or more studies used the same outcome measures including gait speed, timed up and go test, step test and sit-to-stand test.Results: Twenty-six studies were included in the analysis. Both spinal and extremity musculoskeletal pain conditions were represented. Manual therapies included manipulation, mobilisation and massage. The most common intervention compared to manual therapy was exercise. Outcome measures included both clinical and objective measures of stability. Overall the risk of bias was reported as generally low or unclear.Conclusion: Improvement in stability measures were reported in studies comparing manual therapy in the short term, but not long-term follow-up. There was no clear association between significant pain reduction and measures of stability. Further prospective studies are recommended to investigate whether manual therapies should be part of an integrative healthcare plan for risk of falls management and when a transition from manual therapy to more active interventions should occur for long term management.

Evidence (-based medicine) in manual medicine/manual therapy—a summary review

“…31 studies used balance tests, stabilography and a dizziness handicap inventory. The results show no correlation between pain reduction and stability, which limits the ability to generalize [32,66].…”

Comparison of the effectiveness of spinal stabilization exercises and chiropractic spinal manipulation in healthy individuals: randomized controlled trial

“…In a systematic review by Kendall et al; the effect of manual therapy on stability in individuals with musculoskeletal pain was investigated. In the systematic review that included 26 studies; it has been reported that manual therapies improve stability in short-term studies, but are not effective in long-term follow-ups [42]. When the studies in the literature are examined, it is thought that there may be some changes in the central processing of sensory information with spinal manipulation, but it does not change the main balance control scheme from the upper centers [43].…”

Immediate impact of extremity manipulation on dual task performance: a randomized, crossover clinical trial

“…Nonetheless, we feel these results are exciting as they represent some of the initial steps in understanding a non-invasive means of potentially altering an individual's sensory integrative state. As manual therapy, including extremity manipulation, may have a role to play in improving postural stability [38], we feel this work could lead to new and beneficial therapies aimed at preserving movement and coordination, and mitigating falls and fall risk in affected populations.…”