The neurophysiological effects of a single session of spinal joint mobilization: does the effect last?

Abstract

Studies detailing the neurophysiological effects of spinal manual therapy have fueled a paradigm shift away from a strict biomechanical model. However, a recent systematic review of the temporal nature of a single session of spinal thrust manipulation found that the neurophysiological effects were only temporary. The objective of this review was to examine the temporal nature of neurophysiological effects after one session of spinal mobilization. Studies eligible for this review had to report on the temporal component of the neurophysiological effects of a single session of joint mobilization of the spine in human subjects. In order to be sure that the temporal nature of these effects was captured, the studies had to monitor neurophysiological effects for a time beyond the immediate post-treatment period. This systematic review followed the methodology for preferred reporting items for systematic reviews and meta-analyses. In order to assess the quality, strength, and importance of the included studies, the grading of recommendations assessment, development and evaluation system was used. Results of this review showed that the neurophysiological effects of a single session of spinal mobilization are mostly 5 minutes or less. An exception to these findings is hypoalgesia which may last up to 24 hours, based on one study. Continued research on small samples of healthy subjects with irrelevant immediate outcomes like salivary rate, skin conductance, and skin temperature should give way to randomized controlled trials on subjects with pain and decreased function.

What Effect can Manual Therapy have on a Patient’s Pain Experience?

“…Decreases heart rate variability [52], salivary amylase [53] and salivary cortisol and insulin levels [52] are also noted after MT. These changes are similar to those observed in animals upon the artificial stimulation of higher centers responsible for descending pain modulation such as the PGA or RVM [54]. Additionally, hypoalgesia through the application of MT is obtained both locally and remotely from the site of application of the stimulus [35] and the duration of the hypoalgesia achieved with MT may last up to 24 h [54].…”

Using Functional Magnetic Resonance Imaging to Determine if Cerebral Hemodynamic Responses to Pain Change Following Thoracic Spine Thrust Manipulation in Healthy Individuals

“…This study did not aim to investigate long-term responses, as a recent systematic review has reported that the neurophysiological effects of a single manipulation may not exceed 5 minutes in duration. 25 Nevertheless, despite the limitations of the study, the results should cultivate additional inquiry into the theories concerning the supraspinal mechanisms associated with manipulation and how such mechanisms may contribute to successful outcomes in specific patient populations.…”

The relative effectiveness of segment specific level and non-specific level spinal joint mobilization on pain and range of motion: results of a systematic review and meta-analysis

“…14 In addition, a third systematic review that included both randomized and non-randomized controlled trials concluded that a single session of spinal mobilization may have little or no clinically meaningful or lasting effect. 15 The study by…”