The effect of direction specific thoracic spine manipulation on the cervical spine: a randomized controlled trial

Karas, Steve; Hunt, Megan J. Olson; Temes, Bill; Thiel, Martín; Swoverland, Trenton; Windsor, Brett

doi:10.1080/10669817.2016.1260674

Cited by 9 publications

(5 citation statements)

References 38 publications

(53 reference statements)

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“…1 , we screened 3,288 articles, from which nine were included for analysis 23 – 31 . One additional article was found using backward citation tracking 32 , which resulted in ten included studies. All articles were in English and published between 2003 and 2020.…”

Section: Resultsmentioning

confidence: 99%

“…All articles were in English and published between 2003 and 2020. All but three authors 25 – 27 reported if there were any conflicts of interest, and four reported that they received funding 23 , 24 , 31 , 32 . We contacted the authors of three articles 30 , 33 , 34 with insufficient data to estimate effect sizes.…”

Section: Resultsmentioning

confidence: 99%

“…Four studies did not report between-group estimates. Therefore, we calculated effect sizes from the reported within-group differences 25 , 26 , 30 , 32 . No outcomes were excluded due to having more than 20% missing data.…”

Section: Resultsmentioning

confidence: 99%

“…Figure 2 shows that only one study was assessed as having high RoB 28 , four as moderate RoB 27 , 29 , 31 , 32 , and five as low RoB 23 – 26 , 30 . Items that commonly were deficient were “naïve study subjects” (to SMT) and “other sources of bias” (statistical analysis was performed blinded) (Fig.…”

Section: Resultsmentioning

confidence: 99%

“…Only one study of moderate RoB examined whether SMT outcomes differed when applied at the same vertebral level 32 . The candidate site was determined by a clinician using palpation for movement restriction, and the control SMT was applied at the same vertebra but in counter-direction.…”

Section: Resultsmentioning

confidence: 99%

See 4 more Smart Citations

The importance of selecting the correct site to apply spinal manipulation when treating spinal pain: Myth or reality? A systematic review

Nim

Downie

O’Neill

et al. 2021

Sci Rep

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The concept that spinal manipulation therapy (SMT) outcomes are optimized when the treatment is aimed at a clinically relevant joint is commonly assumed and central to teaching and clinical use (candidate sites). This systematic review investigated whether clinical effects are superior when this is the case compared to SMT applied elsewhere (non-candidate sites). Eligible study designs were randomized controlled trials that investigated the effect of spinal manipulation applied to candidate versus non-candidate sites for spinal pain. We obtained data from four different databases. Risk of bias was assessed using an adjusted Cochrane risk of bias tool, adding four items for study quality. We extracted between-group differences for any reported outcome or, when not reported, calculated effect sizes from the within-group changes. We compared outcomes for SMT applied at a ‘relevant’ site to SMT applied elsewhere. We prioritized methodologically robust studies when interpreting results. Ten studies, all of acceptable quality, were included that reported 33 between-group differences—five compared treatments within the same spinal region and five at different spinal regions. None of the nine studies with low or moderate risk of bias reported statistically significant between-group differences for any outcome. The tenth study reported a small effect on pain (1.2/10, 95%CI − 1.9 to − 0.5) but had a high risk of bias. None of the nine articles of low or moderate risk of bias and acceptable quality reported that “clinically-relevant” SMT has a superior outcome on any outcome compared to “not clinically-relevant” SMT. This finding contrasts with ideas held in educational programs and clinical practice that emphasize the importance of joint-specific application of SMT.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

The importance of selecting the correct site to apply spinal manipulation when treating spinal pain: Myth or reality? A systematic review

Nim

Downie

O’Neill

et al. 2021

Sci Rep

View full text Add to dashboard Cite

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Modernizing patient-centered manual therapy: Findings from a Delphi study on orthopaedic manual therapy application

Damian

Griswold

Learman

et al. 2023

Musculoskeletal Science and Practice

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A randomized controlled trial comparing different sites of high-velocity low amplitude thrust on sensorimotor integration parameters

Niazi,

Navid,

Merkle

et al. 2024

Sci Rep

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Increasing evidence suggests that a high-velocity, low-amplitude (HVLA) thrust directed at a dysfunctional vertebral segment in people with subclinical spinal pain alters various neurophysiological measures, including somatosensory evoked potentials (SEPs). We hypothesized that an HVLA thrust applied to a clinician chosen vertebral segment based on clinical indicators of vertebral dysfunction, in short, segment considered as “relevant” would significantly reduce the N30 amplitude compared to an HVLA thrust applied to a predetermined vertebral segment not based on clinical indicators of vertebral dysfunction or segment considered as “non-relevant”. In this double-blinded, active-controlled, parallel-design study, 96 adults with recurrent mild neck pain, ache, or stiffness were randomly allocated to receiving a single thrust directed at either a segment considered as “relevant” or a segment considered as “non-relevant" in their upper cervical spine. SEPs of median nerve stimulation were recorded before and immediately after a single HVLA application delivered using an adjusting instrument (Activator). A linear mixed model was used to assess changes in the N30 amplitude. A significant interaction between the site of thrust delivery and session was found (F1,840 = 9.89, p < 0.002). Pairwise comparisons showed a significant immediate decrease in the N30 complex amplitude after the application of HVLA thrust to a segment considered “relevant” (− 16.76 ± 28.32%, p = 0.005). In contrast, no significant change was observed in the group that received HVLA thrust over a segment considered “non-relevant” (p = 0.757). Cervical HVLA thrust applied to the segment considered as “relevant” altered sensorimotor parameters, while cervical HVLA thrust over the segment considered as “non-relevant” did not. This finding supports the hypothesis that spinal site targeting of HVLA interventions is important when measuring neurophysiological responses. Further studies are needed to explore the potential clinical relevance of these findings.

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The effect of direction specific thoracic spine manipulation on the cervical spine: a randomized controlled trial

Abstract: 1b.

Cited by 9 publications

References 38 publications

The importance of selecting the correct site to apply spinal manipulation when treating spinal pain: Myth or reality? A systematic review

The importance of selecting the correct site to apply spinal manipulation when treating spinal pain: Myth or reality? A systematic review

Modernizing patient-centered manual therapy: Findings from a Delphi study on orthopaedic manual therapy application

A randomized controlled trial comparing different sites of high-velocity low amplitude thrust on sensorimotor integration parameters

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