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

Bishop, Mark D.; Torres-Cueco, Rafael; Gay, Charles W.; Lluch-Girbés, Enrique; Beneciuk, Jason M.; Bialosky, Joel E.

doi:10.2217/pmt.15.39

Cited by 136 publications

(92 citation statements)

References 60 publications

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“…4,10,12 The immediate attenuation of pain facilitatory measures, as measured by temporal summation of heat pain (TSP), is believed to be a specific underlying therapeutic mechanism of SMT. 4 The existing literature clearly and consistently demonstrates SMT shows a favorable effect on pain facilitatory processes that exceeds comparative interventions and carefully constructed sham controls.…”

Section: Introductionmentioning

confidence: 99%

Comparison of 2 Lumbar Manual Therapies on Temporal Summation of Pain in Healthy Volunteers

Penza

Horn

George

et al. 2017

The Journal of Pain

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The purpose of this study was to compare the immediate change in temporal summation of heat pain (TSP) between spinal manipulation (SMT) and spinal mobilization (MOB) in healthy volunteers. Ninety-two volunteers (24 males; 23.8 ± 5.3 years) were randomized to receive SMT, MOB or no treatment (REST) for one session. Primary outcomes were changes in TSP, measured at the hand and foot, immediately following the session. A planned subgroup analysis investigated effects across empirically derived TSP clusters. Primary outcome: There were no differences in the immediate change in TSP measured at the foot between SMT and MOB, however both treatments were superior to the REST condition. Subgroup analysis: The response to a standard TSP protocol was best characterized by three clusters: 52% no change (n = 48, 52%); facilitatory response (n = 24, 26%), and inhibitory response (n = 20, 22%). There was a significant time by treatment group by cluster interaction for TSP measured at the foot. The inhibitory cluster showed the greatest attenuation of TSP following SMT and MOB when compared to REST. These data suggest lumbar manual therapies of different velocities produce a similar localized attenuation of TSP, compared to no treatment. Attenuation of localized pain facilitatory processes by manual therapies was greatest in pain-free individuals who demonstrate an inhibitory TSP response. Perspective The attenuation of pain facilitatory measures may serve an important underlying role in the therapeutic response to manual therapies. Identifying patients in pain who still have an inhibitory capacity (i.e. an inhibitory response subgroup) may be useful clinically in identifying the elusive “manual therapy” responder.

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Section: Introductionmentioning

confidence: 99%

Comparison of 2 Lumbar Manual Therapies on Temporal Summation of Pain in Healthy Volunteers

Penza

Horn

George

et al. 2017

The Journal of Pain

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“…For instance, spinal manipulation and mobilization have been shown to generate different physiological responses [49], and might therefore have different underlying mechanism(s) for changing spinal stiffness. Moreover, the varying inter-practitioner reliability of the manual intervention techniques [50] along with different measurement methods of spinal stiffness could have affected the outcomes as well. Studies were also excluded if not published in English, which may have resulted in missing relevant studies.…”

Section: Limitationsmentioning

confidence: 99%

Potential mechanisms for lumbar spinal stiffness change following spinal manipulative therapy: a scoping review

et al. 2020

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Introduction: In individuals having low back pain, the application of spinal manipulative therapy (SMT) has been shown to reduce spinal stiffness in those who report improvements in post-SMT disability. The underlying mechanism for this rapid change in stiffness is not understood presently. As clinicians and patients may benefit from a better understanding of this mechanism in terms of optimizing care delivery, the objective of this scoping review of current literature was to identify if potential mechanisms that explain this clinical response have been previously described or could be elucidated from existing data. Methods: Three literature databases were systematically searched (MEDLINE, CINAHL, and PubMed). Our search terms included subject headings and keywords relevant to SMT, spinal stiffness, lumbar spine, and mechanism. Inclusion criteria for candidate studies were publication in English, quantification of lumbar spinal stiffness before and after SMT, and publication between January 2000 and June 2019. Results: The search identified 1931 articles. Of these studies, 10 were included following the application of the inclusion criteria. From these articles, 7 themes were identified with respect to potential mechanisms described or derived from data: 1) change in muscle activity; 2) increase in mobility; 3) decrease in pain; 4) increase in pressure pain threshold; 5) change in spinal tissue behavior; 6) change in the central nervous system or reflex pathways; and 7) correction of a vertebral dysfunction. Conclusions: This scoping review identified 7 themes put forward by authors to explain changes in spinal stiffness following SMT. Unfortunately, none of the studies provided data which would support the promotion of one theme over another. As a result, this review suggests a need to develop a theoretical framework to explain rapid biomechanical changes following SMT to guide and prioritize future investigations in this important clinical area.

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“…A C C E P T E D ACCEPTED MANUSCRIPT modulation and muscle inhibition) (Bishop et al , 2015, Coronado et al , 2012, Voogt et al , 2015, make the quest for identification of a segmental dysfunction redundant. One caveat here, is that we still do not know whether, in those identified as likely responders to manual therapy, better outcomes can be achieved with more localised techniques.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

Reconceptualising manual therapy skills in contemporary practice

Rabey¹,

Hall

Hebron

et al. 2017

Musculoskeletal Science and Practice

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With conflicting evidence regarding the effectiveness of manual therapy calls have arisen within some quarters of the physiotherapy profession challenging the continued use of manual skills for assessment and treatment. A reconceptualisation of the importance of manual examination findings is put forward, based upon a contemporary understanding of pain science, rather than considering these skills only in terms of how they should "guide" manual therapy interventions. The place for manual examination findings within complex, multidimensional presentations is considered using vignettes describing the presentations of five people with low back pain. As part of multidimensional, individualised management, the balance of evidence relating to the effectiveness, mechanisms of action and rationale for manual skills is discussed. It is concluded that if manual examination and therapeutic skills are used in a manner consistent with a contemporary understanding of pain science, multidimensional patient profiles and a person-centred approach, their selective and judicious use still has an important role.

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

Cited by 136 publications

References 60 publications

Comparison of 2 Lumbar Manual Therapies on Temporal Summation of Pain in Healthy Volunteers

Comparison of 2 Lumbar Manual Therapies on Temporal Summation of Pain in Healthy Volunteers

Potential mechanisms for lumbar spinal stiffness change following spinal manipulative therapy: a scoping review

Reconceptualising manual therapy skills in contemporary practice

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