Spinal manipulation therapy: Is it all about the brain? A current review of the neurophysiological effects of manipulation

Gyer, Giles; Michael, Jimmy; Inklebarger, James; Tedla, Jaya Shanker

doi:10.1016/j.joim.2019.05.004

Cited by 61 publications

(52 citation statements)

References 105 publications

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“…Previous studies on pain relief by SM have reported effects on the peripheral nervous system, spinal cord mechanisms and supraspinal processes (Bialosky, Bishop, Price, et al, 2009;Gyer et al, 2019). In this section, the mechanisms of pain inhibition by SM will be reviewed critically, based on the location of the effect within the nociceptive system.…”

Section: Relief By Smmentioning

confidence: 99%

“…Both the preload and thrust phases impact paraspinal muscle responses (Nougarou et al, 2013;Reed et al, 2014) and load articular tissues, including the intervertebral discs, joint capsules and ligaments (Funabashi et al, 2017). Previous studies suggest that the mechanical force applied during SM alters spinal biomechanics and activates paraspinal sensory terminals Gyer et al, 2019;Pickar & Bolton, 2012). It has been proposed that this afferent fibre stimulation initiates a cascade of peripheral and central neurophysiological effects (Bialosky, Bishop, Price, et al, 2009;Pickar & Bolton, 2012).…”

Section: Introductionmentioning

confidence: 99%

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Neurophysiological mechanisms of chiropractic spinal manipulation for spine pain

Gevers‐Montoro

Provencher

Descarreaux

et al. 2021

European Journal of Pain

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Spine pain of musculoskeletal origin can affect the cervical, thoracic, or lumbar regions. Its duration may range from an acute episode of a few days or weeks to chronicity over several years (Borghouts et al., 1998;Urits et al., 2019). Low back pain (LBP) is the leading contributor to disability, followed closely by neck pain (NP;James et al., 2018;Urits et al., 2019). Together, back pain and NP are responsible for more than 10% of the total years lived with disability worldwide (James et al., 2018). Spine pain can originate from myofascial tissues, facet joints, intervertebral discs, spinal ligaments and other less common causes (Urits et al., 2019;Vlaeyen et al., 2018). However, it remains challenging to identify the source of pain in individual cases

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Section: Relief By Smmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Neurophysiological mechanisms of chiropractic spinal manipulation for spine pain

Gevers‐Montoro

Provencher

Descarreaux

et al. 2021

European Journal of Pain

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“…There is also emerging evidence that improving paraspinal muscle function with spinal adjustments can rapidly alter central neural function in a variety of ways (see Figs. 1, 2) (Alcantara et al 2013;Clark et al 2011;Gyer et al 2019;Haavik and Murphy 2012;Haavik-Taylor and Murphy 2007a;Henderson 2012;Hennenhoefer and Schmidt 2019;Kent 1996;Pickar 2002;Wirth et al 2019) and that these changes outlast the altered changes of input, i.e. that they are neural plastic changes.…”

Section: Overview Of the Contemporary Understanding Of The Mechanisms By Which Central Segmental Motor Control (Csmc) Problems Spinal Adjmentioning

confidence: 99%

The contemporary model of vertebral column joint dysfunction and impact of high-velocity, low-amplitude controlled vertebral thrusts on neuromuscular function

et al. 2021

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Purpose There is growing evidence that vertebral column function and dysfunction play a vital role in neuromuscular control. This invited review summarises the evidence about how vertebral column dysfunction, known as a central segmental motor control (CSMC) problem, alters neuromuscular function and how spinal adjustments (high-velocity, low-amplitude or HVLA thrusts directed at a CSMC problem) and spinal manipulation (HVLA thrusts directed at segments of the vertebral column that may not have clinical indicators of a CSMC problem) alters neuromuscular function. Methods The current review elucidates the peripheral mechanisms by which CSMC problems, the spinal adjustment or spinal manipulation alter the afferent input from the paravertebral tissues. It summarises the contemporary model that provides a biologically plausible explanation for CSMC problems, the manipulable spinal lesion. This review also summarises the contemporary, biologically plausible understanding about how spinal adjustments enable more efficient production of muscular force. The evidence showing how spinal dysfunction, spinal manipulation and spinal adjustments alter central multimodal integration and motor control centres will be covered in a second invited review. Results Many studies have shown spinal adjustments increase voluntary force and prevent fatigue, which mainly occurs due to altered supraspinal excitability and multimodal integration. The literature suggests physical injury, pain, inflammation, and acute or chronic physiological or psychological stress can alter the vertebral column’s central neural motor control, leading to a CSMC problem. The many gaps in the literature have been identified, along with suggestions for future studies. Conclusion Spinal adjustments of CSMC problems impact motor control in a variety of ways. These include increasing muscle force and preventing fatigue. These changes in neuromuscular function most likely occur due to changes in supraspinal excitability. The current contemporary model of the CSMC problem, and our understanding of the mechanisms of spinal adjustments, provide a biologically plausible explanation for how the vertebral column’s central neural motor control can dysfunction, can lead to a self-perpetuating central segmental motor control problem, and how HVLA spinal adjustments can improve neuromuscular function.

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“…Different effects have been observed after high-velocity, low-amplitude (HVLA) manipulation in different regions, such as peripheral joints [ 17 , 18 ], sacroiliac joints [ 19 , 20 ], and the spine [ 21 , 22 ], both on pain and functionality [ 21 , 22 , 23 , 24 ], as well as neurophysiological effects on cortical somatosensory integration and function due to transient cortical plastic changes [ 25 ], on the neuromuscular system [ 23 , 25 , 26 ], kinesthesia [ 21 ], and global postural control [ 26 ]. The neurophysiological effects after HVLA manipulation seem to be proven, although, the clinical relevance, in relation to the neurophysiological changes, is not completely known [ 23 ]. For this, as the systematic review by Honoré et al indicates, it would be important to review the previous studies considering the effect size, not only in regard to the immediate effects, but also the medium and long-term effects [ 27 ] because usual treatments for chronic neck pain achieve at most moderate effects in the short-term [ 28 ].…”

Section: Introductionmentioning

confidence: 99%

Immediate and Short-Term Effects of Upper Cervical High-Velocity, Low-Amplitude Manipulation on Standing Postural Control and Cervical Mobility in Chronic Nonspecific Neck Pain: A Randomized Controlled Trial

Gómez¹,

Escribá²,

Oliva-Pascual-Vaca

et al. 2020

JCM

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This study aimed to determine the immediate and short-term effects of a single upper cervical high-velocity, low-amplitude (HVLA) manipulation on standing postural control and cervical mobility in chronic nonspecific neck pain (CNSNP). A double-blinded, randomized placebo-controlled trial was performed. Forty-four patients with CNSNP were allocated to the experimental group (n = 22) or control group (n = 22). All participants were assessed before and immediately after the intervention, with a follow-up on the 7th and 15th days. In each evaluation, we assessed global and specific stabilometric parameters to analyze standing postural balance and performed the cervical flexion-rotation test (CFRT) to analyze upper cervical mobility. We obtained statistically significant differences, with a large effect size, in the limited cervical rotation and global stabilometric parameters. Upper cervical HVLA manipulation produced an improvement in the global stabilometric parameters, significantly decreasing the mean values of velocity, surface, path length, and pressure in all assessments (p < 0.001; ƞ 2 p = 0.323–0.856), as well as significantly decreasing the surface length ratio (L/S) on the 7th (−0.219 1/mm; p = 0.008; 95% confidence interval (CI): 0.042–0.395) and 15th days (−0.447 1/mm; p < 0.001; 95% CI: 0.265–0.629). Limited cervical rotation values increased significantly immediately after manipulation (7.409°; p < 0.001; 95% CI: 6.131–8.687) and were maintained during follow-up (p < 0.001). These results show that a single upper cervical HVLA manipulation produces an improvement in standing postural control and increases the rotational range of motion (ROM) in the upper cervical spine in patients with CNSNP.

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Spinal manipulation therapy: Is it all about the brain? A current review of the neurophysiological effects of manipulation

Cited by 61 publications

References 105 publications

Neurophysiological mechanisms of chiropractic spinal manipulation for spine pain

Neurophysiological mechanisms of chiropractic spinal manipulation for spine pain

The contemporary model of vertebral column joint dysfunction and impact of high-velocity, low-amplitude controlled vertebral thrusts on neuromuscular function

Immediate and Short-Term Effects of Upper Cervical High-Velocity, Low-Amplitude Manipulation on Standing Postural Control and Cervical Mobility in Chronic Nonspecific Neck Pain: A Randomized Controlled Trial

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