Spinal Manipulative Therapy Has an Immediate Effect on Thermal Pain Sensitivity in People With Low Back Pain: A Randomized Controlled Trial

Bialosky, Joel E.; Bishop, Mark D.; Robinson, Michael E.; Zeppieri, Giorgio; George, Steven Z.

doi:10.2522/ptj.20090058

Cited by 137 publications

(138 citation statements)

References 71 publications

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“…6,21,29 Recently, Bialosky et al 4 suggested that the placebo effect may also be part of the mechanism of manual therapy, and that the failure of a manual therapy intervention to perform better than a placebo does not necessarily indicate a failed intervention, if both outperform the natural history of the condition. The present study was not able to include a nontreatment group by which to compare the natural history of the condition.…”

Section: Discussionmentioning

confidence: 99%

Thoracic Spine Manipulation in Individuals With Subacromial Impingement Syndrome Does Not Immediately Alter Thoracic Spine Kinematics, Thoracic Excursion, or Scapular Kinematics: A Randomized Controlled Trial

Kardouni

Pidcoe²,

Shaffer³

et al. 2015

Journal of Orthopaedic & Sports Physical Therapy

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Study Design Randomized controlled trial. Objectives To determine if thoracic spinal manipulative therapy (SMT) alters thoracic kinematics, thoracic excursion, and scapular kinematics compared to a sham SMT in individuals with subacromial impingement syndrome, and also to compare changes in patient-reported outcomes between treatment groups. Background Prior studies indicate that thoracic SMT can improve pain and disability in individuals with subacromial impingment syndrome. However, the mechanisms underlying these benefits are not well understood. Methods Participants with shoulder impingement symptoms (n = 52) were randomly assigned to receive a single session of thoracic SMT or sham SMT. Thoracic and scapular kinematics during active arm elevation and overall thoracic excursion were measured before and after the intervention. Patient-reported outcomes measured were pain (numeric pain-rating scale), function (Penn Shoulder Score), and global rating of change. Results Following the intervention, there were no significant differences in changes between groups for thoracic kinematics or excursion, scapular kinematics, and patient-reported outcomes (P>.05). Both groups showed an increase in scapular internal rotation during arm raising (mean, 0.9°; 95% confidence interval [CI]: 0.3°, 1.6°; P = .003) and lowering (0.8°; 95% CI: 0.0°, 1.5°; P = .041), as well as improved pain reported on the numeric pain-rating scale (1.2 points; 95% CI: 0.3, 1.8; P<.001) and function on the Penn Shoulder Score (9.1 points; 95% CI: 6.5, 11.7; P<.001). Conclusion Thoracic spine extension and excursion did not change significantly following thoracic SMT. There were small but likely not clinically meaningful changes in scapular internal rotation in both groups. Patient-reported pain and function improved in both groups; however, there were no significant differences in the changes between the SMT and the sham SMT groups. Overall, patient-reported outcomes improved in both groups without meaningful changes to thoracic or scapular motion. Level of Evidence Therapy, level 1b-. J Orthop Sports Phys Ther 2015;45(7):527–538. Epub 21 May 2015. doi:10.2519/jospt.2015.5647

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Section: Discussionmentioning

confidence: 99%

Thoracic Spine Manipulation in Individuals With Subacromial Impingement Syndrome Does Not Immediately Alter Thoracic Spine Kinematics, Thoracic Excursion, or Scapular Kinematics: A Randomized Controlled Trial

Kardouni

Pidcoe²,

Shaffer³

et al. 2015

Journal of Orthopaedic & Sports Physical Therapy

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“…Previous studies have demonstrated increased sensitivity to mechanical stimulation and receptive field expansion in dorsal horn neurons following injection of bradykinen into the lumbar multifidus [69,70]. By recording pain threshold following repeated stimuli to peripheral C-fibers, a number of studies have also reported wind-up related, central sensitization in patients with low back pain [71][72][73] TMJ pain [74] shoulder pain [75] and fibromyalgia [76]. Subacute or chronic C-fiber mediated pain increases the release of glutamate and substance-P from sensory afferents in spine, leading to hypersensitivity of second order, dorsal horn neurons.…”

Section: The Transition Of Peripheral Pain To Central-mediated Chronimentioning

confidence: 99%

Peripheral and Spinal Mechanisms of Pain and Dry Needling Mediated Analgesia: A Clinical Resource Guide for Health Care Professionals

Butts¹,

Dunning²

2016

Int J Phys Med Rehabil

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There are a number of biochemical, biomechanical, endocrinological and neurovascular mechanisms underpinning the anti-nociceptive and anti-inflammatory effects of dry needling (DN). While myofascial trigger points likely play a role in peripheral pain, a diagnostic tool for localizing them has not been validated, and DN studies that have targeted trigger points to elicit localized twitch responses have reported mixed results. Therefore, the mechanism responsible for DN-mediated analgesia may be more complicated. DN activates opioid-based pain reduction, mediated by endogenous cannabinoids and the sympathetic nervous system, and non-opioid pain relief via serotonin and norepinephrine from the brain stem. DN also triggers the hypothalamic-pituitary-adrenal axis centrally and the corticotropin releasing hormone-proopiomelanocortin-corticosteroid axis locally to inhibit cox-2, reducing inflammatory cytokines. Recent studies demonstrate that DN combined with mechanical and/or electrical stimulation may reverse PKC-mediated peripheral hyperalgesic priming by normalizing nociceptive channels, to include TRPV, ASIC, TTX and P2X/Y. Electrical DN (EDN) stimulates immune cells, fibroblasts and keratinocytes to release CGRP and substance-P, altering the stimulation of TTX receptors to reverse hyperalgesia. It also encourages the supraoptic nucleus to release oxytocin to quiet ASIC receptors peripherally and stimulate opioid interneurons spinally. Moreover, EDN inhibits ERK1/2 kinase pathways of inflammation in the spinal cord and stimulates Aδ fibers and N/OFQ to reverse C-fiber mediated central changes. Mechanotransduction of fibroblasts and peripheral nerves via TRPV1 and P2X/Y-mediated intracellular Ca 2+ wave propagation and subsequent activation of the nucleus accumbens inhibits spinal pain transmission via glycinergic and opioidergic interneurons. The increased ATP is metabolized to adenosine, which activates P1 purinergic receptors, events considered key to DN analgesia and rho kinase-based tissue remodeling. Mechanotransduction-mediated release of histamine further explains analgesia secondary to needling points distal to pain. DN-mediated analgesia is dependent on a number of synergistic physiologic events involving biochemical and mechanical processes in neural, connective and muscle tissue.

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“…The publication of 'guidelines for the management of LBP' recommends the use of MT and exercise for the condition (CSP, 2006;van Tulder et al 2006;Savigny et al, 2009 andChou et al, 2009). Furthermore, these guidelines are supported by studies demonstrating clear patient-reported benefits (Goodsell et al, 2000, Bialosky et al 2009band van Middelkoop et al, 2011. However, there continues to be debate within the literature regarding how best to quantify effects and how to determine the magnitude and the clinical significance of observed treatment responses (Potter et al 2005;Theodore, 2010).…”

Section: Introductionmentioning

confidence: 99%

A randomised, independent groups study investigating the sympathetic nervous system responses to two manual therapy treatments in patients with LBP

et al. 2015

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Spinal Manipulative Therapy Has an Immediate Effect on Thermal Pain Sensitivity in People With Low Back Pain: A Randomized Controlled Trial

Abstract: Inhibition of Adelta fiber-mediated pain perception was similar for all groups. However, inhibition of temporal summation was observed only in participants receiving SMT, suggesting a modulation of dorsal horn excitability that was observed primarily in the lumbar innervated area.

Cited by 137 publications

References 71 publications

Thoracic Spine Manipulation in Individuals With Subacromial Impingement Syndrome Does Not Immediately Alter Thoracic Spine Kinematics, Thoracic Excursion, or Scapular Kinematics: A Randomized Controlled Trial

Thoracic Spine Manipulation in Individuals With Subacromial Impingement Syndrome Does Not Immediately Alter Thoracic Spine Kinematics, Thoracic Excursion, or Scapular Kinematics: A Randomized Controlled Trial

Peripheral and Spinal Mechanisms of Pain and Dry Needling Mediated Analgesia: A Clinical Resource Guide for Health Care Professionals

A randomised, independent groups study investigating the sympathetic nervous system responses to two manual therapy treatments in patients with LBP

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