Peter Jun1, Isabelle Pagé2, Albert Vette3, Greg Kawchuk4. 1. 1Faculty of Rehabilitation Medicine, University of Alberta, Corbett Hall, 8205 114 Street NW, Edmonton, Alberta T6G 2G4 Canada. 2. 2Faculty of Rehabilitation Medicine, University of Alberta, Corbett Hall, 8205 114 Street NW, Edmonton, Alberta T6G 2G4 Canada. 3. 3Department of Mechanical Engineering, University of Alberta, Donadeo Innovation Centre for Engineering, 9211-116 Street, Edmonton, Alberta T6G 1H9 Canada. 4. 4Department of Physical Therapy, University of Alberta, Corbett Hall, 8205 114 Street NW, Edmonton, Alberta T6G 2G4 Canada.
Abstract
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.
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.
Authors: Arnold Y L Wong; Eric C Parent; Sukhvinder S Dhillon; Narasimha Prasad; Gregory N Kawchuk Journal: Spine (Phila Pa 1976) Date: 2015-09-01 Impact factor: 3.468
Authors: Arnold Y L Wong; Eric C Parent; Narasimha Prasad; Christopher Huang; K Ming Chan; Gregory N Kawchuk Journal: Clin Biomech (Bristol, Avon) Date: 2016-03-31 Impact factor: 2.063
Authors: Sidney M Rubinstein; Annemarie de Zoete; Marienke van Middelkoop; Willem J J Assendelft; Michiel R de Boer; Maurits W van Tulder Journal: BMJ Date: 2019-03-13