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Szabó P, Bonet S, Hetényi R, Hanna D, Kovács Z, Prisztóka G, Križalkovičová Z, Szentpéteri J. Systematic review: pain, cognition, and cardioprotection-unpacking oxytocin's contributions in a sport context. Front Physiol 2024; 15:1393497. [PMID: 38915776 PMCID: PMC11194439 DOI: 10.3389/fphys.2024.1393497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 05/13/2024] [Indexed: 06/26/2024] Open
Abstract
Introduction This systematic review investigates the interplay between oxytocin and exercise; in terms of analgesic, anti-inflammatory, pro-regenerative, and cardioprotective effects. Furthermore, by analyzing measurement methods, we aim to improve measurement validity and reliability. Methods Utilizing PRISMA, GRADE, and MECIR protocols, we examined five databases with a modified SPIDER search. Including studies on healthy participants, published within the last 20 years, based on keywords "oxytocin," "exercise" and "measurement," 690 studies were retrieved initially (455 unique records). After excluding studies of clinically identifiable diseases, and unpublished and reproduction-focused studies, 175 studies qualified for the narrative cross-thematic and structural analysis. Results The analysis resulted in five categories showing the reciprocal impact of oxytocin and exercise: Exercise (50), Physiology (63), Environment (27), Social Context (65), and Stress (49). Exercise-induced oxytocin could promote tissue regeneration, with 32 studies showing its analgesic and anti-inflammatory effects, while 14 studies discussed memory and cognition. Furthermore, empathy-associated OXTR rs53576 polymorphism might influence team sports performance. Since dietary habits and substance abuse can impact oxytocin secretion too, combining self-report tests and repeated salivary measurements may help achieve precision. Discussion Oxytocin's effect on fear extinction and social cognition might generate strategies for mental training, and technical, and tactical development in sports. Exercise-induced oxytocin can affect the amount of stress experienced by athletes, and their response to it. However, oxytocin levels could depend on the type of sport in means of contact level, exercise intensity, and duration. The influence of oxytocin on athletes' performance and recovery could have been exploited due to its short half-life. Examining oxytocin's complex interactions with exercise paves the way for future research and application in sports science, psychology, and medical disciplines. Systematic Review Registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=512184, identifier CRD42024512184.
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Affiliation(s)
- Péter Szabó
- Faculty of Sciences, Institute of Sports Science and Physical Education, University of Pécs, Pécs, Hungary
- Faculty of Humanities, University of Pécs, Pécs, Hungary
- Medical School, Institute of Transdisciplinary Discoveries, University of Pécs, Pécs, Hungary
| | - Sara Bonet
- Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Roland Hetényi
- RoLink Biotechnology Kft., Pécs, Hungary
- Hungarian National Blood Transfusion Service, Budapest, Hungary
- Szentágothai Research Centre, University of Pécs, Pécs, Hungary
- National Virology Laboratory, University of Pécs, Pécs, Hungary
| | - Dániel Hanna
- RoLink Biotechnology Kft., Pécs, Hungary
- Hungarian National Blood Transfusion Service, Budapest, Hungary
- Szentágothai Research Centre, University of Pécs, Pécs, Hungary
- National Virology Laboratory, University of Pécs, Pécs, Hungary
| | - Zsófia Kovács
- Faculty of Sciences, Institute of Sports Science and Physical Education, University of Pécs, Pécs, Hungary
| | - Gyöngyvér Prisztóka
- Faculty of Sciences, Institute of Sports Science and Physical Education, University of Pécs, Pécs, Hungary
| | - Zuzana Križalkovičová
- Faculty of Health Sciences, Institute of Physiotherapy and Sport Science, Department of Sport Science, Pécs, Hungary
| | - József Szentpéteri
- Medical School, Institute of Transdisciplinary Discoveries, University of Pécs, Pécs, Hungary
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Kerry R, Young KJ, Evans DW, Lee E, Georgopoulos V, Meakins A, McCarthy C, Cook C, Ridehalgh C, Vogel S, Banton A, Bergström C, Mazzieri AM, Mourad F, Hutting N. A modern way to teach and practice manual therapy. Chiropr Man Therap 2024; 32:17. [PMID: 38773515 PMCID: PMC11110311 DOI: 10.1186/s12998-024-00537-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 04/17/2024] [Indexed: 05/23/2024] Open
Abstract
BACKGROUND Musculoskeletal conditions are the leading contributor to global disability and health burden. Manual therapy (MT) interventions are commonly recommended in clinical guidelines and used in the management of musculoskeletal conditions. Traditional systems of manual therapy (TMT), including physiotherapy, osteopathy, chiropractic, and soft tissue therapy have been built on principles such as clinician-centred assessment, patho-anatomical reasoning, and technique specificity. These historical principles are not supported by current evidence. However, data from clinical trials support the clinical and cost effectiveness of manual therapy as an intervention for musculoskeletal conditions, when used as part of a package of care. PURPOSE The purpose of this paper is to propose a modern evidence-guided framework for the teaching and practice of MT which avoids reference to and reliance on the outdated principles of TMT. This framework is based on three fundamental humanistic dimensions common in all aspects of healthcare: safety, comfort, and efficiency. These practical elements are contextualised by positive communication, a collaborative context, and person-centred care. The framework facilitates best-practice, reasoning, and communication and is exemplified here with two case studies. METHODS A literature review stimulated by a new method of teaching manual therapy, reflecting contemporary evidence, being trialled at a United Kingdom education institute. A group of experienced, internationally-based academics, clinicians, and researchers from across the spectrum of manual therapy was convened. Perspectives were elicited through reviews of contemporary literature and discussions in an iterative process. Public presentations were made to multidisciplinary groups and feedback was incorporated. Consensus was achieved through repeated discussion of relevant elements. CONCLUSIONS Manual therapy interventions should include both passive and active, person-empowering interventions such as exercise, education, and lifestyle adaptations. These should be delivered in a contextualised healing environment with a well-developed person-practitioner therapeutic alliance. Teaching manual therapy should follow this model.
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Affiliation(s)
- Roger Kerry
- School of Health Sciences, Queens Medical Centre, University of Nottingham, Nottingham, NG7 2HA, UK
| | - Kenneth J Young
- Allied Health Research Unit, University of Central Lancashire, Preston, PR1 2HE, UK.
| | - David W Evans
- Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Edward Lee
- School of Health Sciences, Queens Medical Centre, University of Nottingham, Nottingham, NG7 2HA, UK
- Nottingham CityCare Partnership, Bennerley Rd, Nottingham, NG6 8WR, UK
| | - Vasileios Georgopoulos
- School of Health Sciences, Queens Medical Centre, University of Nottingham, Nottingham, NG7 2HA, UK
- School of Medicine, University of Nottingham, Queens Medical Centre, Nottingham, NG7 2HA, UK
| | - Adam Meakins
- Department of Orthopaedics, West Herts Hospitals Trust, Watford, WD18 0HB, UK
| | - Chris McCarthy
- School of Physiotherapy, Manchester Metropolitan University, Manchester, M15 6GX, UK
| | - Chad Cook
- Department of Orthopaedics, Duke University, 200 Morris Street, Durham, NC, 27701, USA
| | - Colette Ridehalgh
- School of Sport and Health Sciences, University of Brighton, Darley Rd, Eastbourne, BN20 7UR, UK
- Clinical Neuroscience, Trafford Building, Brighton and Sussex Medical School, University of Sussex, Brighton, BN1 9PX, UK
| | - Steven Vogel
- University College of Osteopathy, 275 Borough High St, London, SE1 1JE, UK
| | - Amanda Banton
- University College of Osteopathy, 275 Borough High St, London, SE1 1JE, UK
| | - Cecilia Bergström
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, S-90187, Umeå, Sweden
| | | | - Firas Mourad
- Department of health, LUNEX, Differdange, 4671, Luxembourg
- Luxembourg Health & Sport Sciences Research Institute A.s.b.l., 50, Avenue du Parc des Sports, Differdange, 4671, Luxembourg
| | - Nathan Hutting
- Department of Occupation and Health, School of Organization and Development, HAN University of Applied Sciences, Nijmegen, the Netherlands
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Haas A, Chung J, Kent C, Mills B, McCoy M. Vertebral Subluxation and Systems Biology: An Integrative Review Exploring the Salutogenic Influence of Chiropractic Care on the Neuroendocrine-Immune System. Cureus 2024; 16:e56223. [PMID: 38618450 PMCID: PMC11016242 DOI: 10.7759/cureus.56223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2024] [Indexed: 04/16/2024] Open
Abstract
In this paper we synthesize an expansive body of literature examining the multifaceted influence of chiropractic care on processes within and modulators of the neuroendocrine-immune (NEI) system, for the purpose of generating an inductive hypothesis regarding the potential impacts of chiropractic care on integrated physiology. Taking a broad, interdisciplinary, and integrative view of two decades of research-documented outcomes of chiropractic care, inclusive of reports ranging from systematic and meta-analysis and randomized and observational trials to case and cohort studies, this review encapsulates a rigorous analysis of research and suggests the appropriateness of a more integrative perspective on the impact of chiropractic care on systemic physiology. A novel perspective on the salutogenic, health-promoting effects of chiropractic adjustment is presented, focused on the improvement of physical indicators of well-being and adaptability such as blood pressure, heart rate variability, and sleep, potential benefits that may be facilitated through multiple neurologically mediated pathways. Our findings support the biological plausibility of complex benefits from chiropractic intervention that is not limited to simple neuromusculoskeletal outcomes and open new avenues for future research, specifically the exploration and mapping of the precise neural pathways and networks influenced by chiropractic adjustment.
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Affiliation(s)
- Amy Haas
- Research, Foundation for Vertebral Subluxation, Kennesaw, USA
| | - Jonathan Chung
- Research, Foundation for Vertebral Subluxation, Kennesaw, USA
| | - Christopher Kent
- Research, Sherman College, Spartanburg, USA
- Research, Foundation for Vertebral Subluxation, Kennesaw, USA
| | - Brooke Mills
- Research, Foundation for Vertebral Subluxation, Kennesaw, USA
| | - Matthew McCoy
- Research, Foundation for Vertebral Subluxation, Kennesaw, USA
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Kovanur Sampath K, Treffel L, P.Thomson O, Rodi JD, Fleischmann M, Tumilty S. Changes in biochemical markers following a spinal manipulation - a systematic review update. J Man Manip Ther 2024; 32:28-50. [PMID: 37671460 PMCID: PMC10795611 DOI: 10.1080/10669817.2023.2252187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 08/18/2023] [Indexed: 09/07/2023] Open
Abstract
OBJECTIVE The aim of this systematic review was to update the current level of evidence for spinal manipulation in influencing various biochemical markers in healthy and/or symptomatic population. METHODS This is a systematic review update. Various databases were searched (inception till May 2023) and fifteen trials (737 participants) that met the inclusion criteria were included in the review. Two authors independently screened, extracted and assessed the risk of bias in included studies. Outcome measure data were synthesized using standard mean differences and meta-analysis for the primary outcome (biochemical markers). The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) was used for assessing the quality of the body of evidence for each outcome of interest. RESULTS There was low-quality evidence that spinal manipulation influenced various biochemical markers (not pooled). There was low-quality evidence of significant difference that spinal manipulation is better (SMD -0.42, 95% CI - 0.74 to -0.1) than control in eliciting changes in cortisol levels immediately after intervention. Low-quality evidence further indicated (not pooled) that spinal manipulation can influence inflammatory markers such as interleukins levels post-intervention. There was also very low-quality evidence that spinal manipulation does not influence substance-P, neurotensin, oxytocin, orexin-A, testosterone and epinephrine/nor-epinephrine. CONCLUSION Spinal manipulation may influence inflammatory and cortisol post-intervention. However, the wider prediction intervals in most outcome measures point to the need for future research to clarify and establish the clinical relevance of these changes.
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Affiliation(s)
- Kesava Kovanur Sampath
- Centre for Health and Social Practice, Waikato Institute of Technology, Te Pukenga, Hamilton, New Zealand
- School of Public Health, University of Technology, ARCCIM, Sydney, Australia
| | - Loïc Treffel
- School of Public Health, University of Technology, ARCCIM, Sydney, Australia
- Institut Toulousain d’Ostéopathie, IRF’O, Toulouse, France
- INMG-PGNM, Univ Lyon1, Lyon, France
| | - Oliver P.Thomson
- School of Public Health, University of Technology, ARCCIM, Sydney, Australia
- Research Department, University College of Osteopathy, London, UK
| | - Jerry Draper Rodi
- School of Public Health, University of Technology, ARCCIM, Sydney, Australia
- Research Department, University College of Osteopathy, London, UK
- National Council for Osteopathic Research, London, UK
| | - Michael Fleischmann
- School of Public Health, University of Technology, ARCCIM, Sydney, Australia
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Australia
| | - Steve Tumilty
- Centre for Health, Activity, and Rehabilitation Research (CHARR), School of Physiotherapy, University of Otago, Dunedin, New Zealand
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Farrell G, Reily-Bell M, Chapple C, Kennedy E, Sampath K, Gisselman AS, Cook C, Katare R, Tumilty S. Autonomic nervous system and endocrine system response to upper and lower cervical spine mobilization in healthy male adults: a randomized crossover trial. J Man Manip Ther 2023; 31:421-434. [PMID: 36794952 PMCID: PMC10642313 DOI: 10.1080/10669817.2023.2177071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 01/26/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Cervical spine mobilizations may differentially modulate both components of the stress response, consisting of the autonomic nervous system and hypothalamic pituitary adrenal-axis, depending on whether the target location is the upper or lower cervical spine. To date, no study has investigated this. METHODS A randomized, crossover trial investigated the effects of upper versus lower cervical mobilization on both components of the stress response simultaneously. The primary outcome was salivary cortisol (sCOR) concentration. The secondary outcome was heart rate variability measured with a smartphone application. Twenty healthy males, aged 21-35, were included. Participants were randomly assigned to block-AB (upper then lower cervical mobilization, n = 10) or block-BA (lower than upper cervical mobilization, n = 10), separated by a one-week washout period. All interventions were performed in the same room (University clinic) under controlled conditions. Statistical analyses were performed with a Friedman's Two-Way ANOVA and Wilcoxon Signed Rank Test. RESULTS Within groups, sCOR concentration reduced thirty-minutes following lower cervical mobilization (p = 0.049). Between groups, sCOR concentration was different at thirty-minutes following the intervention (p = 0.018). CONCLUSION There was a statistically significant reduction in sCOR concentration following lower cervical spine mobilization, and between-group difference, 30 min following the intervention. This indicates that mobilizations applied to separate target locations within the cervical spine can differentially modulate the stress response.
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Affiliation(s)
- Gerard Farrell
- Centre for Health, Activity, and Rehabilitation Research, School of Physiotherapy, North Dunedin, New Zealand
| | - Matthew Reily-Bell
- Department of Physiology, HeartOtago, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
| | - Cathy Chapple
- Centre for Health, Activity, and Rehabilitation Research, School of Physiotherapy, North Dunedin, New Zealand
| | - Ewan Kennedy
- Centre for Health, Activity, and Rehabilitation Research, School of Physiotherapy, North Dunedin, New Zealand
| | - Kesava Sampath
- Centre for Health and Social Practice, Waikato Institute of Technology-Rotokauri Campus, Hamilton, Waikato, New Zealand
| | | | - Chad Cook
- Doctor of Physical Therapy Program, Duke University, Durham, North Carolina, USA
| | - Rajesh Katare
- Department of Physiology, HeartOtago, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
| | - Steve Tumilty
- Centre for Health, Activity, and Rehabilitation Research, School of Physiotherapy, North Dunedin, New Zealand
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Lutke Schipholt IJ, Coppieters MW, Reijm M, Bontkes HJ, Scholten-Peeters GGM. Immediate systemic neuroimmune responses following spinal mobilisation and manipulation in people with non-specific neck pain: a randomised placebo-controlled trial. Sci Rep 2023; 13:12804. [PMID: 37550491 PMCID: PMC10406885 DOI: 10.1038/s41598-023-39839-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 07/31/2023] [Indexed: 08/09/2023] Open
Abstract
Spinal mobilisation/manipulation is a common intervention for spinal pain, yet the working mechanisms are largely unknown. A randomised placebo-controlled trial was conducted to (1) compare the immediate neuroimmune responses following spinal mobilisation/manipulation and placebo spinal mobilisation/manipulation; (2) compare the immediate neuroimmune responses of those with a good outcome with those of a poor outcome following spinal mobilisation/manipulation; and (3) explore the association between neuroimmune responses and pain reduction. One hundred patients were randomly allocated to spinal mobilisation/manipulation or a placebo mobilisation/manipulation. Primary outcomes were whole blood in-vitro evoked released concentrations of IL-1β and TNF-α measured 10 min and 2 h after the intervention. Immediate effects were studied because successful mobilisation/manipulation is often associated with immediate pain reduction, and immediate neuroimmune responses are less affected by potential confounders than long-term responses. Secondary outcomes included multiple systemic inflammatory marker concentrations, phenotypic analysis of white blood cells and clinical outcomes. Outcomes were compared between the experimental and placebo group, and between people with a good and poor outcome in the experimental group. Estimates of intervention effects were based on intention-to-treat analyses, by using linear mixed-effect models. Although there was a substantial difference in pain reduction between groups (mean (SD) difference visual analogue scale: 30 (21) mm at 10 min and 32 (21) mm at 2 h (p < 0.001) in favour of mobilisation/manipulation, there were no differences in primary outcomes between groups or between people with a good and poor outcome (p ≥ 0.10). In conclusion, possible neuroimmune responses following spinal mobilisations/manipulation cannot be identified at a systemic level. Future research may focus on longer treatment duration and more localised neuroimmune responses.
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Affiliation(s)
- Ivo J Lutke Schipholt
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Program Musculoskeletal Health, Van Der Boechorststraat 9, 1081BT, Amsterdam, The Netherlands
- Laboratory Medical Immunology, Department of Clinical Chemistry, Amsterdam University Medical Centre, Location VUmc, Amsterdam, The Netherlands
| | - Michel W Coppieters
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Program Musculoskeletal Health, Van Der Boechorststraat 9, 1081BT, Amsterdam, The Netherlands
- School of Health Sciences and Social Work, Menzies Health Institute Queensland, Griffith University, Brisbane & Gold Coast, Australia
| | - Martine Reijm
- Laboratory Medical Immunology, Department of Clinical Chemistry, Amsterdam University Medical Centre, Location VUmc, Amsterdam, The Netherlands
| | - Hetty J Bontkes
- Laboratory Medical Immunology, Department of Clinical Chemistry, Amsterdam University Medical Centre, Location VUmc, Amsterdam, The Netherlands
| | - Gwendolyne G M Scholten-Peeters
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Program Musculoskeletal Health, Van Der Boechorststraat 9, 1081BT, Amsterdam, The Netherlands.
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Navarro-Santana MJ, Valera-Calero JA, Romanos-Castillo G, Hernández-González VC, Fernández-de-las-Peñas C, López-de-Uralde-Villanueva I, Plaza-Manzano G. Immediate Effects of Dry Needling on Central Pain Processing and Skin Conductance in Patients with Chronic Nonspecific Neck Pain: A Randomized Controlled Trial. J Clin Med 2022; 11:jcm11226616. [PMID: 36431093 PMCID: PMC9694175 DOI: 10.3390/jcm11226616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/01/2022] [Accepted: 11/07/2022] [Indexed: 11/11/2022] Open
Abstract
Although current evidence supports the use of dry needling for improving some clinical outcomes in people with neck pain, no previous research explored the effects of dry needling on the central processing of pain and autonomic nervous system in this population. Therefore, this clinical trial aimed to compare the effects of real and sham dry needling on autonomic nervous system function, pain processing as well as clinical and psychological variables in patients with chronic nonspecific neck pain. A double-blinded randomized clinical trial including 60 patients with neck pain was conducted. Patients were randomized to the real needling (n = 30) or sham needling (n = 30) group. Skin conductance (SC), pressure pain thresholds (PPTs), temporal summation (TS), conditioned pain modulation (CPM) as well as pain intensity, related-disability, catastrophism, and kinesiophobia levels were assessed by an assessor blinded to the allocation intervention. The results did not find significant group * time interactions for most outcomes, except for the global percentage of change of SC values (mean: F = 35.90, p < 0.001, ηp2 = 0.459; minimum: F = 33.99, p = 0.839, ηp2 = 0.371; maximum: F = 24.71, p < 0.001, ηp2 = 0.037) and PPTs at C5-C6 joint in the same side of needling (F = 9.982; p = 0.003; = 0.147), in favor of the dry needling group. Although the proportion of subjects experiencing moderate to large self-perceived improvement after the intervention was significantly higher (X2 = 8.297; p = 0.004) within the dry needling group (n = 18, 60%) than in the sham needling group (n = 7, 23.3%), both groups experienced similar improvements in clinical and psychological variables. Our results suggested that dry needling applied to patients with chronic nonspecific neck pain produced an immediate decrease in mechanical hyperalgesia at local sites and produced an increase in skin conductance as compared with sham needling. No changes in central pain processing were observed. A single session of sham or real dry needling was similarly effective for decreasing related disability, pain intensity, catastrophism, and kinesiophobia levels. Further studies are needed to better understand the clinical implications of autonomic nervous system activation on central sensitization and pain processing in the long-term after the application of dry needling.
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Affiliation(s)
| | - Juan Antonio Valera-Calero
- VALTRADOFI Research Group, Department of Physiotherapy, Faculty of Health, Universidad Camilo José Cela, Villanueva de la Cañada, Villanueva de la Cañada, 28692 Madrid, Spain
- Department of Physiotherapy, Faculty of Health, Universidad Camilo José Cela, Villanueva de la Cañada, 28692 Madrid, Spain
- Correspondence:
| | - Guillermo Romanos-Castillo
- Department of Physiotherapy, Faculty of Health, Universidad Camilo José Cela, Villanueva de la Cañada, 28692 Madrid, Spain
| | - Victor C. Hernández-González
- Department of Physiotherapy, Faculty of Health, Universidad Camilo José Cela, Villanueva de la Cañada, 28692 Madrid, Spain
| | - César Fernández-de-las-Peñas
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain
- Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia: Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain
| | | | - Gustavo Plaza-Manzano
- Department of Radiology, Rehabilitation and Physiotherapy, Universidad Complutense de Madrid, 28040 Madrid, Spain
- Grupo InPhysio, Instituto de Investigación Sanitaria San Carlos (IdISSC), 28040 Madrid, Spain
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Valera-Calero JA, Varol U. Correlation among Routinary Physical Activity, Salivary Cortisol, and Chronic Neck Pain Severity in Office Workers: A Cross-Sectional Study. Biomedicines 2022; 10:biomedicines10102637. [PMID: 36289898 PMCID: PMC9599052 DOI: 10.3390/biomedicines10102637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/11/2022] [Accepted: 10/17/2022] [Indexed: 11/21/2022] Open
Abstract
This study aimed to assess the correlation between different aspects of routinary physical activity with chronic neck pain severity indicators and salivary cortisol. This cross-sectional observational study included ninety-four office workers with non-specific chronic neck pain in the analyses. Pain related outcomes (pain intensity, pressure pain thresholds and disability), physical activity outcomes using the International Physical Activity Questionnaire, and salivary cortisol levels were evaluated. Pearson’s correlation analysis was used to investigate internal associations and regression models to explain and calculate which factors contribute to the variance of salivary cortisol and neck pain severity. Female sex (p < 0.01), sedentary behaviors (p < 0.05), and pain sensitivity (p < 0.05) were associated with greater cortisol levels (p < 0.05), but disability and pain intensity were not associated (p > 0.05). Worse disability, pain intensity, and pain pressure thresholds were also associated with lower routinary physical activity (p < 0.05). Regression models explained 20.6% of pain intensity (based on walking time to their workplace, age and pain sensitivity); 27.3% of disability (based on moderate physical activity at home, vigorous physical activity during leisure time and pain sensitivity); 54.2% of pain sensitivity (based on cycling time from home to their workplace, gender and vigorous activity during leisure time) and 38.2% of salivary cortisol concentration (based on systolic pressure, vigorous activity at work and both moderate and vigorous activity at home). Our results demonstrated the association between salivary cortisol concentration with moderate and vigorous physical activity, sitting time at work, and PPTs. However, salivary cortisol was not associated with disability or pain intensity.
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Affiliation(s)
- Juan Antonio Valera-Calero
- Department of Physiotherapy, Faculty of Health, Camilo Jose Cela University, 28962 Villanueva de la Cañada, Spain
- VALTRADOFI Research Group, Department of Physiotherapy, Faculty of Health, Camilo Jose Cela University, 28962 Villanueva de la Cañada, Spain
- Correspondence:
| | - Umut Varol
- VALTRADOFI Research Group, Department of Physiotherapy, Faculty of Health, Camilo Jose Cela University, 28962 Villanueva de la Cañada, Spain
- Escuela Internacional de Doctorado, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain
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Gorrell LM, Conway PJ, Onasch F, Herzog W. Electromyographic Responses of Neck, Back, and Limb Outlet Muscles Associated With High-Velocity, Low-Amplitude Manual Cervical and Upper Thoracic Spinal Manipulation of Individuals With Mild Neck Disability: A Descriptive Observational Investigation. J Manipulative Physiol Ther 2022; 45:33-44. [PMID: 35753874 DOI: 10.1016/j.jmpt.2022.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 03/18/2022] [Accepted: 03/18/2022] [Indexed: 10/17/2022]
Abstract
OBJECTIVES The purpose of this study was to investigate the extent of electromyographic responses associated with manual high-velocity, low-amplitude (HVLA) spinal manipulation systematically applied to the upper and lower cervical and upper thoracic spines in a cohort with mild neck disability. METHODS The study was a descriptive observational investigation, with all participants receiving the same interventions. Nineteen participants with mild neck disability received 6 manual HVLA manipulations to the cervical and upper thoracic spine. Bipolar surface electromyography electrode pairs were used to measure responses of 16 neck, back, and limb outlet muscles bilaterally. The number of electromyographic responses was then calculated. RESULTS Electromyographic responses associated with cervical and thoracic manipulation occurred in a median of 4 of the 16 (range: 1-14) recorded muscles. Cervical spinal manipulation was associated with the highest rates of electromyographic responses in neck muscles, whereas responses in back muscles were highest after upper thoracic manipulation. CONCLUSION Cervical spinal manipulation was associated with the highest rate of electromyographic responses in muscles of the cervical spine (sternocleidomastoid and splenius cervicis), whereas responses in back muscles (upper and middle trapezius, latissimus dorsi, and longissimus thoracis) were highest after upper thoracic manipulations. This result suggests that electromyographic muscular responses associated with spinal manipulation primarily occur locally (close to the target segment) rather than distally.
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Affiliation(s)
- Lindsay M Gorrell
- Integrative Spinal Research Group, Department of Chiropractic Medicine, Balgrist University Hospital, Zurich, Switzerland; University of Zurich, Zurich, Switzerland.
| | | | - Franziska Onasch
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Walter Herzog
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
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Kovanur Sampath K, Mani R, Katare R, Neale J, Cotter J, Tumilty S. Thoracic Spinal Manipulation Effect on Neuroendocrine Response in People With Achilles Tendinopathy: A Randomized Crossover Trial. J Manipulative Physiol Ther 2021; 44:420-431. [PMID: 34376321 DOI: 10.1016/j.jmpt.2021.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 09/13/2020] [Accepted: 06/15/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The purpose of the present study was to determine the neuroendocrine response after a thoracic spinal manipulation in people with Achilles tendinopathy. METHODS This was a randomized 2-sequence, 2-period crossover trial. A total of 24 participants, mean (standard deviation) age of 48 (7) years, with a diagnosis of Achilles tendinopathy (>3 mo) were randomly assigned into sequence 1 (sham intervention and then thoracic spinal manipulation) or sequence 2 (thoracic spinal manipulation and then sham intervention). The trial was conducted at a university laboratory with a washout period of 1 week. The primary outcome measure was the testosterone/cortisol (T/C) ratio (salivary samples). The secondary outcome measures included heart rate variability (measured with electrocardiography) and total oxygenation index (nmol/L) of calf muscle and Achilles tendon (measured with near-infrared spectroscopy). A 2-way mixed-model analysis of variance was performed. The statistic of interest was the condition by time interaction. RESULTS A statistically significant condition by time interaction was found for the T/C ratio (mean difference: -0.16; confidence interval: -0.33 to 0.006; interaction: P < .05) and the total oxygenation index (mean difference: 1.35; confidence interval: -1.3 to 4.1; interaction: P < .05) of calf muscle but not for Achilles tendon (P = .6); however, no difference was found for heart rate variability (P = .5). CONCLUSION In people with Achilles tendinopathy, thoracic spinal manipulation resulted in immediate increase in the total oxygenation index in the calf muscle followed by an increase in the T/C ratio 6 hours post-intervention.
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Affiliation(s)
- Kesava Kovanur Sampath
- Centre for Health, Activity, and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand.
| | - Ramakrishnan Mani
- Centre for Health, Activity, and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Rajesh Katare
- Department of Physiology-Heart Otago, University of Otago, Dunedin, New Zealand
| | - Joshua Neale
- Department of Physiology-Heart Otago, University of Otago, Dunedin, New Zealand
| | - James Cotter
- School of Physical Education, Sport and Exercise Science, Dunedin, New Zealand
| | - Steve Tumilty
- Centre for Health, Activity, and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
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The contemporary model of vertebral column joint dysfunction and impact of high-velocity, low-amplitude controlled vertebral thrusts on neuromuscular function. Eur J Appl Physiol 2021; 121:2675-2720. [PMID: 34164712 PMCID: PMC8416873 DOI: 10.1007/s00421-021-04727-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 05/20/2021] [Indexed: 02/08/2023]
Abstract
Purpose There is growing evidence that vertebral column function and dysfunction play a vital role in neuromuscular control. This invited review summarises the evidence about how vertebral column dysfunction, known as a central segmental motor control (CSMC) problem, alters neuromuscular function and how spinal adjustments (high-velocity, low-amplitude or HVLA thrusts directed at a CSMC problem) and spinal manipulation (HVLA thrusts directed at segments of the vertebral column that may not have clinical indicators of a CSMC problem) alters neuromuscular function.
Methods The current review elucidates the peripheral mechanisms by which CSMC problems, the spinal adjustment or spinal manipulation alter the afferent input from the paravertebral tissues. It summarises the contemporary model that provides a biologically plausible explanation for CSMC problems, the manipulable spinal lesion. This review also summarises the contemporary, biologically plausible understanding about how spinal adjustments enable more efficient production of muscular force. The evidence showing how spinal dysfunction, spinal manipulation and spinal adjustments alter central multimodal integration and motor control centres will be covered in a second invited review. Results Many studies have shown spinal adjustments increase voluntary force and prevent fatigue, which mainly occurs due to altered supraspinal excitability and multimodal integration. The literature suggests physical injury, pain, inflammation, and acute or chronic physiological or psychological stress can alter the vertebral column’s central neural motor control, leading to a CSMC problem. The many gaps in the literature have been identified, along with suggestions for future studies. Conclusion Spinal adjustments of CSMC problems impact motor control in a variety of ways. These include increasing muscle force and preventing fatigue. These changes in neuromuscular function most likely occur due to changes in supraspinal excitability. The current contemporary model of the CSMC problem, and our understanding of the mechanisms of spinal adjustments, provide a biologically plausible explanation for how the vertebral column’s central neural motor control can dysfunction, can lead to a self-perpetuating central segmental motor control problem, and how HVLA spinal adjustments can improve neuromuscular function.
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Haavik H, Niazi IK, Kumari N, Amjad I, Duehr J, Holt K. The Potential Mechanisms of High-Velocity, Low-Amplitude, Controlled Vertebral Thrusts on Neuroimmune Function: A Narrative Review. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:536. [PMID: 34071880 PMCID: PMC8226758 DOI: 10.3390/medicina57060536] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 05/25/2021] [Indexed: 12/12/2022]
Abstract
The current COVID-19 pandemic has necessitated the need to find healthcare solutions that boost or support immunity. There is some evidence that high-velocity, low-amplitude (HVLA) controlled vertebral thrusts have the potential to modulate immune mediators. However, the mechanisms of the link between HVLA controlled vertebral thrusts and neuroimmune function and the associated potential clinical implications are less clear. This review aims to elucidate the underlying mechanisms that can explain the HVLA controlled vertebral thrust--neuroimmune link and discuss what this link implies for clinical practice and future research needs. A search for relevant articles published up until April 2021 was undertaken. Twenty-three published papers were found that explored the impact of HVLA controlled vertebral thrusts on neuroimmune markers, of which eighteen found a significant effect. These basic science studies show that HVLA controlled vertebral thrust influence the levels of immune mediators in the body, including neuropeptides, inflammatory markers, and endocrine markers. This narravtive review discusses the most likely mechanisms for how HVLA controlled vertebral thrusts could impact these immune markers. The mechanisms are most likely due to the known changes in proprioceptive processing that occur within the central nervous system (CNS), in particular within the prefrontal cortex, following HVLA spinal thrusts. The prefrontal cortex is involved in the regulation of the autonomic nervous system, the hypothalamic-pituitary-adrenal axis and the immune system. Bi-directional neuro-immune interactions are affected by emotional or pain-related stress. Stress-induced sympathetic nervous system activity also alters vertebral motor control. Therefore, there are biologically plausible direct and indirect mechanisms that link HVLA controlled vertebral thrusts to the immune system, suggesting HVLA controlled vertebral thrusts have the potential to modulate immune function. However, it is not yet known whether HVLA controlled vertebral thrusts have a clinically relevant impact on immunity. Further research is needed to explore the clinical impact of HVLA controlled vertebral thrusts on immune function.
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Affiliation(s)
- Heidi Haavik
- Centre for Chiropractic Research, New Zealand College of Chiropractic, Auckland 1060, New Zealand; (H.H.); (N.K.); (I.A.); (J.D.)
| | - Imran Khan Niazi
- Centre for Chiropractic Research, New Zealand College of Chiropractic, Auckland 1060, New Zealand; (H.H.); (N.K.); (I.A.); (J.D.)
- Faculty of Health & Environmental Sciences, Health & Rehabilitation Research Institute, AUT University, Auckland 0627, New Zealand
- Department of Health Science and Technology, Aalborg University, 9220 Aalborg, Denmark
| | - Nitika Kumari
- Centre for Chiropractic Research, New Zealand College of Chiropractic, Auckland 1060, New Zealand; (H.H.); (N.K.); (I.A.); (J.D.)
- Faculty of Health & Environmental Sciences, Health & Rehabilitation Research Institute, AUT University, Auckland 0627, New Zealand
| | - Imran Amjad
- Centre for Chiropractic Research, New Zealand College of Chiropractic, Auckland 1060, New Zealand; (H.H.); (N.K.); (I.A.); (J.D.)
- Faculty of Rehabilitation and Allied Health Sciences, Riphah International University, Islamabad 46000, Pakistan
| | - Jenna Duehr
- Centre for Chiropractic Research, New Zealand College of Chiropractic, Auckland 1060, New Zealand; (H.H.); (N.K.); (I.A.); (J.D.)
| | - Kelly Holt
- Centre for Chiropractic Research, New Zealand College of Chiropractic, Auckland 1060, New Zealand; (H.H.); (N.K.); (I.A.); (J.D.)
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Luceño-Mardones A, Luceño-Rodríguez I, Rodríguez-López ES, Oliva-Pascual-Vaca J, Rosety I, Oliva-Pascual-Vaca Á. Effects of Osteopathic T9-T10 Vertebral Manipulation in Tonsillitis: A Randomized Clinical Trial. Healthcare (Basel) 2021; 9:394. [PMID: 33916061 PMCID: PMC8065872 DOI: 10.3390/healthcare9040394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/03/2021] [Accepted: 03/25/2021] [Indexed: 11/16/2022] Open
Abstract
This study aimed to determine whether osteopathic manipulation of the T9-T10 vertebrae improves the evolution of tonsillitis. A randomized, stratified, controlled clinical trial with blinded patients, evaluator and data analyst was performed. The patients in the control group (CG) underwent a "sham" manipulation. A high-speed, low-amplitude technique was applied to the T9-T10 vertebrae in the osteopathic manipulative group (OMG) patients. The number of days needed to resolve the tonsillitis was significantly lower (p = 0.025) in the OMG (2.03 ± 0.95 days) than the CG (2.39 ± 0.82 days). Additionally, the number of episodes of tonsillitis after the treatment decreased significantly more in the OMG (0.8 ± 1.88 episodes/year in total) than the CG (2 ± 2.12) (p = 0.005). In the OMG, 60.8% had no recurrences of tonsillitis, compared to 22.5% of the CG, in the following year (χ2 (1) = 15.57, p < 0.001). No patients reported adverse effects. It has been concluded that during an episode of tonsillitis, the number of days to resolution was significantly lower after the application of an osteopathic manipulation of the T9-T10 vertebrae, compared to a sham manipulation. The number of subsequent year tonsillitis episodes was greatly reduced in both groups, significantly more in the OMG than in the CG patients.
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Affiliation(s)
- Agustín Luceño-Mardones
- Escuela de Osteopatía de Madrid, 28002 Madrid, Spain; (A.L.-M.); (J.O.-P.-V.); (Á.O.-P.-V.)
- Centro Sanitario de Fisioterapia y Osteopatía Agustín Luceño, 10005 Cáceres, Spain
| | | | - Elena Sonsoles Rodríguez-López
- Escuela de Osteopatía de Madrid, 28002 Madrid, Spain; (A.L.-M.); (J.O.-P.-V.); (Á.O.-P.-V.)
- Department of Physiotherapy, Universidad Camilo José Cela, 28692 Madrid, Spain
| | - Jesús Oliva-Pascual-Vaca
- Escuela de Osteopatía de Madrid, 28002 Madrid, Spain; (A.L.-M.); (J.O.-P.-V.); (Á.O.-P.-V.)
- Departamento de Fisioterapia, Universidad de Sevilla, 41004 Sevilla, Spain
- Escuela Universitaria Fco. Maldonado, Osuna, 41640 Sevilla, Spain
| | - Ignacio Rosety
- School of Medicine, University of Cadiz, 11003 Cádiz, Spain;
| | - Ángel Oliva-Pascual-Vaca
- Escuela de Osteopatía de Madrid, 28002 Madrid, Spain; (A.L.-M.); (J.O.-P.-V.); (Á.O.-P.-V.)
- Departamento de Fisioterapia, Universidad de Sevilla, 41004 Sevilla, Spain
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Gevers-Montoro C, Provencher B, Descarreaux M, Ortega de Mues A, Piché M. Neurophysiological mechanisms of chiropractic spinal manipulation for spine pain. Eur J Pain 2021; 25:1429-1448. [PMID: 33786932 DOI: 10.1002/ejp.1773] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 03/05/2021] [Accepted: 03/27/2021] [Indexed: 12/19/2022]
Abstract
Together, neck pain and back pain are the first cause of disability worldwide, accounting for more than 10% of the total years lived with disability. In this context, chiropractic care provides a safe and effective option for the management of a large proportion of these patients. Chiropractic is a healthcare profession mainly focused on the spine and the treatment of spinal disorders, including spine pain. Basic studies have examined the influence of chiropractic spinal manipulation (SM) on a variety of peripheral, spinal and supraspinal mechanisms involved in spine pain. While spinal cord mechanisms of pain inhibition contribute at least partly to the pain-relieving effects of chiropractic treatments, the evidence is weaker regarding peripheral and supraspinal mechanisms, which are important components of acute and chronic pain. This narrative review highlights the most relevant mechanisms of pain relief by SM and provides a perspective for future research on SM and spine pain, including the validation of placebo interventions that control for placebo effects and other non-specific effects that may be induced by SM. SIGNIFICANCE: Spinal manipulation inhibits back and neck pain partly through spinal segmental mechanisms and potentially through peripheral mechanisms regulating inflammatory responses. Other mechanisms remain to be clarified. Controls and placebo interventions need to be improved in order to clarify the contribution of specific and non-specific effects to pain relief by spinal manipulative therapy.
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Affiliation(s)
- Carlos Gevers-Montoro
- Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada.,CogNAC Research Group, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada.,Madrid College of Chiropractic - RCU María Cristina, Madrid, Spain
| | - Benjamin Provencher
- Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada.,CogNAC Research Group, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Martin Descarreaux
- Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada.,GRAN Research Group, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | | | - Mathieu Piché
- Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada.,CogNAC Research Group, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
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Chow N, Hogg-Johnson S, Mior S, Cancelliere C, Injeyan S, Teodorczyk-Injeyan J, Cassidy JD, Taylor-Vaisey A, Côté P. Assessment of Studies Evaluating Spinal Manipulative Therapy and Infectious Disease and Immune System Outcomes: A Systematic Review. JAMA Netw Open 2021; 4:e215493. [PMID: 33847753 PMCID: PMC8044731 DOI: 10.1001/jamanetworkopen.2021.5493] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
IMPORTANCE Claims that spinal manipulative therapy (SMT) can improve immune function have increased substantially during the COVID-19 pandemic and may have contributed to the rapid spread of both accurate and inaccurate information (referred to as an infodemic by the World Health Organization). OBJECTIVE To identify, appraise, and synthesize the scientific literature on the efficacy and effectiveness of SMT in preventing the development of infectious disease or improving disease-specific outcomes in patients with infectious disease and to examine the association between SMT and selected immunological, endocrine, and other physiological biomarkers. EVIDENCE REVIEW A literature search of MEDLINE, the Cumulative Index to Nursing and Allied Health Literature, the Index to Chiropractic Literature, the Cochrane Central Register of Controlled Trials, and Embase was conducted from inception to April 15, 2020. Randomized clinical trials and cohort studies were included. Eligible studies were critically appraised, and evidence with high and acceptable quality was synthesized using the Synthesis Without Meta-Analysis guideline. FINDINGS A total of 2593 records were retrieved; after exclusions, 50 full-text articles were screened, and 16 articles reporting the findings of 13 studies comprising 795 participants were critically appraised. The literature search found no clinical studies that investigated the efficacy or effectiveness of SMT in preventing the development of infectious disease or improving disease-specific outcomes among patients with infectious disease. Eight articles reporting the results of 6 high- and acceptable-quality RCTs comprising 529 participants investigated the effect of SMT on biomarkers. Spinal manipulative therapy was not associated with changes in lymphocyte levels or physiological markers among patients with low back pain or participants who were asymptomatic compared with sham manipulation, a lecture series, and venipuncture control groups. Spinal manipulative therapy was associated with short-term changes in selected immunological biomarkers among asymptomatic participants compared with sham manipulation, a lecture series, and venipuncture control groups. CONCLUSIONS AND RELEVANCE In this systematic review of 13 studies, no clinical evidence was found to support or refute claims that SMT was efficacious or effective in changing immune system outcomes. Although there were limited preliminary data from basic scientific studies suggesting that SMT may be associated with short-term changes in immunological and endocrine biomarkers, the clinical relevance of these findings is unknown. Given the lack of evidence that SMT is associated with the prevention of infectious diseases or improvements in immune function, further studies should be completed before claims of efficacy or effectiveness are made.
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Affiliation(s)
- Ngai Chow
- Centre for Disability Prevention and Rehabilitation, Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
- Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
| | - Sheilah Hogg-Johnson
- Centre for Disability Prevention and Rehabilitation, Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
- Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Silvano Mior
- Centre for Disability Prevention and Rehabilitation, Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
- Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Carol Cancelliere
- Centre for Disability Prevention and Rehabilitation, Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
| | - Stephen Injeyan
- Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
| | | | - J. David Cassidy
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Anne Taylor-Vaisey
- Centre for Disability Prevention and Rehabilitation, Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
- Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
| | - Pierre Côté
- Centre for Disability Prevention and Rehabilitation, Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Butts R, Legaspi O, Nocera-Mekel A, Dunning J. Physical therapy treatment of a pediatric patient with symptoms consistent with a spinal cord injury without radiographic abnormality: A retrospective case report. J Bodyw Mov Ther 2021; 27:455-463. [PMID: 34391271 DOI: 10.1016/j.jbmt.2021.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 12/22/2020] [Accepted: 01/13/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND A spinal cord injury without radiographic abnormality (SCIWORA) is a relatively uncommon event that occurs in children following cervical trauma primarily due to sports-related injuries or physical abuse. CASE DESCRIPTION This case report describes an 11-year-old wrestler that developed signs and symptoms consistent with a SCIWORA following neck trauma during competition. Despite all diagnostic tests being inconclusive, the patient demonstrated increased cervical, thoracic, and lumbar paraspinal tone along with pain, loss of sensation, loss of mobility, and weakness of the lower extremities. As a result, the patient was confined to a wheelchair and required maximum assistance to transfer and ambulate with a walker. The patient was referred to physical therapy nine days after the traumatic event, where he received interferential current with moist heat, myofascial release of paraspinal muscles, functional exercise, gait training, and spinal manipulative therapy targeting the cervical, thoracic, and lumbar vertebrae. OUTCOME After 13 physical therapy treatments over 5-weeks, the patient was able to ambulate independently and perform all activities of daily living without pain or functional limitation. The following case report outlines this patient's successful journey toward recovery. CONCLUSION This case report suggests that spinal manipulative therapy may be a safe and effective intervention when used within a multi-modal treatment strategy for patients with signs and symptoms consistent with SCIWORA. Moreover, spinal manipulative therapy may be considered a beneficial treatment in some pediatric patients. However, this report describes a single patient, and further research is required on the use of spinal manipulation in this patient population.
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Affiliation(s)
- Raymond Butts
- Research Physical Therapy Specialists, Columbia, SC, USA; American Academy of Manipulative Therapy, Montgomery, AL, USA.
| | | | | | - James Dunning
- American Academy of Manipulative Therapy, Montgomery, AL, USA; Montgomery Osteopractic Physiotherapy and Acupuncture Clinic, Montgomery, AL, USA
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17
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Navarro-Santana MJ, Gómez-Chiguano GF, Somkereki MD, Fernández-de-Las-Peñas C, Cleland JA, Plaza-Manzano G. Effects of joint mobilisation on clinical manifestations of sympathetic nervous system activity: a systematic review and meta-analysis. Physiotherapy 2020; 107:118-132. [PMID: 32026812 DOI: 10.1016/j.physio.2019.07.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 06/08/2019] [Accepted: 07/03/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND A potential mechanism of action of manual therapy is the activation of a sympathetic-excitatory response. OBJECTIVE To evaluate the effects of joint mobilisation on changes in clinical manifestations of sympathetic nervous system activity. DATA SOURCES MEDLINE, EMBASE, AMED, CINAHL, EBSCO, PubMed, PEDro, Cochrane Collaboration Trials Register, Cochrane Database of Systematic Reviews and SCOPUS databases. STUDY SELECTION Randomised controlled trials that compared a mobilisation technique applied to the spine or the extremities with a control or placebo. DATA EXTRACTION AND DATA SYNTHESIS Human studies collecting data on skin conductance or skin temperature were used. Data were extracted by two reviewers. Risk of bias was assessed using the Cochrane guidelines, and quality of evidence was assessed using the GRADE approach. Standardised mean differences (SMD) and random effects were calculated. RESULTS Eighteen studies were included in the review and 17 were included in the meta-analysis. The meta-analysis found a significant increase in skin conductance [SMD 1.21, 95% confidence interval (CI) 0.88 to 1.53, n=269] and a decrease in temperature (SMD 0.92, 95% CI -1.47 to -0.37, n=128) after mobilisation compared with the control group. An increase in skin conductance (SMD 0.73, 95% CI 0.51 to 0.96, n=293) and a decrease in temperature (SMD -0.50, 95% CI -0.82 to -0.18, n=134) were seen after mobilisation compared with placebo. The risk of bias was generally low, but the heterogenicity of the results downgraded the level of evidence. LIMITATIONS Most trials (14/18) were conducted on asymptomatic healthy subjects. CONCLUSION There is moderate evidence suggesting a sympatho-excitatory effect of joint mobilisation. Systematic Review Registration Number PROSPERO CRD42018089991.
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Affiliation(s)
| | - Guido F Gómez-Chiguano
- Podiatry Clinic, Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, Madrid, Spain
| | - Mihai D Somkereki
- Clínica de Investigación Fisioterapia y Dolor, Fundación General de la Universidad de Alcalá, Alcalá de Henares, Spain
| | - César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain.
| | - Joshua A Cleland
- Department of Physical Therapy, Franklin Pierce University, Manchester, NH, USA; Rehabilitation Services, Concord Hospital, Concord, NH, USA; Manual Therapy Fellowship Program, Regis University, Denver, CO, USA
| | - Gustavo Plaza-Manzano
- Department of Radiology, Rehabilitation and Physiotherapy, Universidad Complutense de Madrid, Madrid, Spain; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain
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Gorrell LM, Conway PJ, Herzog W. Reflex Responses of Neck, Back, and Limb Muscles to High-Velocity, Low-Amplitude Manual Cervical and Upper Thoracic Spinal Manipulation of Asymptomatic Individuals-A Descriptive Study. J Manipulative Physiol Ther 2019; 42:572-581. [PMID: 31864518 DOI: 10.1016/j.jmpt.2018.11.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 11/28/2018] [Accepted: 11/28/2018] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The purpose of this research was to determine the extent of reflex responses after spinal manipulative therapy (SMT) of the cervical and upper thoracic spine. METHODS Eleven asymptomatic participants received 6 commonly used SMTs to the cervical and upper thoracic spine. Bipolar surface electromyography electrodes were used to measure reflex responses of 16 neck, back, and proximal limb muscles bilaterally. The percentage of occurrence and the extent of reflex responses of these muscles were determined. RESULTS Reflex responses after cervical SMT were typically present in all neck and most back muscles, whereas responses in the outlets to the arm and leg were less frequent. This trend was similar, although decreased in magnitude, after thoracic SMT. CONCLUSION Reflex responses were greatest after upper cervical SMT and lowest with thoracic SMT.
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Affiliation(s)
- Lindsay M Gorrell
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada.
| | | | - Walter Herzog
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
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20
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Gyer G, Michael J, Inklebarger J, Tedla JS. Spinal manipulation therapy: Is it all about the brain? A current review of the neurophysiological effects of manipulation. JOURNAL OF INTEGRATIVE MEDICINE-JIM 2019; 17:328-337. [DOI: 10.1016/j.joim.2019.05.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 04/22/2019] [Indexed: 12/19/2022]
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Colombi A, Testa M. The Effects Induced by Spinal Manipulative Therapy on the Immune and Endocrine Systems. ACTA ACUST UNITED AC 2019; 55:medicina55080448. [PMID: 31394861 PMCID: PMC6722922 DOI: 10.3390/medicina55080448] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 07/27/2019] [Accepted: 08/02/2019] [Indexed: 12/18/2022]
Abstract
Background and Objectives: Spinal manipulations are interventions widely used by different healthcare professionals for the management of musculoskeletal (MSK) disorders. While previous theoretical principles focused predominantly on biomechanical accounts, recent models propose that the observed pain modulatory effects of this form of manual therapy may be the result of more complex mechanisms. It has been suggested that other phenomena like neurophysiological responses and the activation of the immune-endocrine system may explain variability in pain inhibition after the administration of spinal manipulative therapy (SMT). The aim of this paper is to provide an overview of the available evidence supporting the biological plausibility of high-velocity, low-amplitude thrust (HVLAT) on the immune-endocrine system. Materials and Methods: Narrative critical review. An electronic search on MEDLINE, ProQUEST, and Google Scholar followed by a hand and "snowballing" search were conducted to find relevant articles. Studies were included if they evaluated the effects of HVLAT on participants' biomarkers Results: The electronic search retrieved 13 relevant articles and two themes of discussion were developed. Nine studies investigated the effects of SMT on cortisol levels and five of them were conducted on symptomatic populations. Four studies examined the effects of SMT on the immune system and all of them were conducted on healthy individuals. Conclusions: Although spinal manipulations seem to trigger the activation of the neuroimmunoendocrine system, the evidence supporting a biological account for the application of HVLAT in clinical practice is mixed and conflicting. Further research on subjects with spinal MSK conditions with larger sample sizes are needed to obtain more insights about the biological effects of spinal manipulative therapy.
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Affiliation(s)
- Andrea Colombi
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona, Via Magliotto, 2 17100 Savona, Italy
| | - Marco Testa
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona, Via Magliotto, 2 17100 Savona, Italy.
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Valera-Calero A, Lluch Girbés E, Gallego-Izquierdo T, Malfliet A, Pecos-Martín D. Endocrine response after cervical manipulation and mobilization in people with chronic mechanical neck pain: a randomized controlled trial. Eur J Phys Rehabil Med 2019; 55:792-805. [PMID: 30621368 DOI: 10.23736/s1973-9087.19.05475-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Most of the research on the effects of spinal manipulation on endocrine function has been done on healthy subjects and has yielded contradictory results. The potential role of cervical manual therapy intervention in order to induce changes in the endocrine system has not yet been investigated. AIM The aim of this trial is to compare the effects on salivary cortisol levels and clinical outcomes of cervical manipulation versus cervical mobilization or sham manipulation in patients with chronic mechanical neck pain. DESIGN Randomized controlled trial. SETTING University of Alcala de Henares: outpatient (referrals from office workers). POPULATION A total of 83 patients with chronic mechanical neck pain. METHODS Participants were randomized to receive one session of cervical manipulation, cervical mobilization, or sham manipulation. The measured variables were salivary cortisol levels, neck pain and disability, pressure pain thresholds (PPT), and cervical range of motion (ROM). They were obtained at baseline, immediately after treatment (except neck disability), and at one-week follow-up (except cortisol). RESULTS A significant and comparable increase in cortisol levels was observed immediately after cervical manipulation and mobilization (both P<0.001). Neck disability improved to a similar degree in the cervical manipulation and mobilization groups at the one-week follow-up (both P<0.001). Neck pain was reduced immediately after cervical manipulation (P<0.001), cervical mobilization (P=0.001), and sham manipulation (P<0.001). There were no significant changes in most ROM directions after either treatment. No significant interaction effect was observed for PPT. CONCLUSIONS Cervical manipulation and mobilization resulted in a similar increase in cortisol concentrations immediately post-treatment in people with chronic mechanical neck pain. Supraspinal mechanisms may thus play a role in the hypoalgesic effects that follow the application of both interventions. CLINICAL REHABILITATION IMPACT The increase in cortisol levels was similar with cervical manipulation and mobilization so induced stress levels can be similar in both interventions.
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Affiliation(s)
| | - Enrique Lluch Girbés
- Department of Physical Therapy, University of Valencia, Valencia, Spain - .,Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education and Physiotherapy, Free University of Brussels, Brussels, Belgium
| | | | - Anneleen Malfliet
- Department of Physical Therapy, University of Valencia, Valencia, Spain.,Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Campus Heymans, Ghent, Belgium
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Lohman EB, Pacheco GR, Gharibvand L, Daher N, Devore K, Bains G, AlAmeri M, Berk LS. The immediate effects of cervical spine manipulation on pain and biochemical markers in females with acute non-specific mechanical neck pain: a randomized clinical trial. J Man Manip Ther 2018; 27:186-196. [PMID: 30935335 PMCID: PMC7025692 DOI: 10.1080/10669817.2018.1553696] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Study Design: Randomized clinical trial with pre-test, post-test control group design. Objectives: To examine the immediate effects of cervical spinal manipulation (CSM) on serum concentration of biochemical markers (oxytocin, neurotensin, orexin A, and cortisol). Background: Several studies have found an association between spinal manipulation (SM) and pain perception. However, the mechanism by which SM modulates pain remains undefined. Methods: Twenty-eight female subjects with non-specific mechanical neck pain were randomly assigned to one of two interventions (CSM versus sham CSM). Blood samples were drawn before and immediately after the respective interventions. Oxytocin, neurotensin, orexin A, and cortisol were measured from the blood and serum using the Milliplex Map Magnetic Bead Panel Immunoassay on the Luminex 200 Platform. Results: In the CSM group, there were significant increases in pre- versus post-manipulation mean oxytocin (154.5 ± 60.1 vs. 185.1 ± 75.6, p = .012); neurotensin (116.0 ± 26.5 vs.136.4 ± 34.1, p < . 001); orexin A (52.2 ± 31.1 vs. 73.8 ± 38.8, p < .01) serum concentration; but no significant differences in mean cortisol (p = .052) serum concentration. In the sham group, there were no significant differences in any of the biomarkers (p > .05). Conclusion: The results of the current study suggest that the mechanical stimuli provided through a CSM may modify neuropeptide expression by immediately increasing the serum concentration of nociception-related biomarkers (oxytocin, neurotensin, orexin A, but not cortisol) in the blood of female subjects with non-specific mechanical neck pain.
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Affiliation(s)
- E B Lohman
- a School of Allied Health Professions, Physical Therapy Department, Loma Linda University , Loma Linda , CA , USA
| | - G R Pacheco
- a School of Allied Health Professions, Physical Therapy Department, Loma Linda University , Loma Linda , CA , USA
| | - L Gharibvand
- b School of Allied Health Professions, Allied Health Studies Department, Loma Linda University , Loma Linda , CA , USA
| | - N Daher
- b School of Allied Health Professions, Allied Health Studies Department, Loma Linda University , Loma Linda , CA , USA
| | - K Devore
- b School of Allied Health Professions, Allied Health Studies Department, Loma Linda University , Loma Linda , CA , USA
| | - G Bains
- b School of Allied Health Professions, Allied Health Studies Department, Loma Linda University , Loma Linda , CA , USA
| | - M AlAmeri
- a School of Allied Health Professions, Physical Therapy Department, Loma Linda University , Loma Linda , CA , USA
| | - L S Berk
- b School of Allied Health Professions, Allied Health Studies Department, Loma Linda University , Loma Linda , CA , USA.,c School of Medicine, Department of Pathology and Human Anatomy, Loma Linda University , Loma Linda , CA , USA
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El-Fatatry BM, Ibrahim OM, Hussien FZ, Mostafa TM. Role of metformin in oxaliplatin-induced peripheral neuropathy in patients with stage III colorectal cancer: randomized, controlled study. Int J Colorectal Dis 2018; 33:1675-1683. [PMID: 29931409 DOI: 10.1007/s00384-018-3104-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/13/2018] [Indexed: 02/04/2023]
Abstract
PURPOSE Peripheral sensory neuropathy is the most prominently reported adverse effect of oxaliplatin. The purpose of this study was to evaluate metformin role in oxaliplatin-induced neuropathy. PATIENTS AND METHODS From November 2014 to May 2016, 40 patients with stage III colorectal cancer completed 12 cycles of FOLFOX-4 regimen. Twenty patients in the control arm received FOLFOX-4 regimen only, and 20 patients in the metformin arm, received the same regimen along with metformin 500 mg three times daily. The metformin efficacy was evaluated using National Cancer Institute Common Terminology Criteria for Adverse Events (NCI-CTCAE version 4.0), a12-item neurotoxicity questionnaire (Ntx-12) from the validated Functional Assessment of Cancer Therapy/Gynecologic Oncology Group and, the brief pain inventory short form "worst pain" item. In addition to neurotensin, malondialdehyde and interleukin-6 serum levels assessment. RESULTS At the end of the 12th cycle, there were less patients with grade 2 and 3 neuropathy in metformin arm as compared to control arm. (60 versus 95%, P = 0.009) In addition, metformin arm showed significantly higher total scores of Ntx-12 questionnaire than control arm (24.0 versus 19.2, P < 0.001). Furthermore, the mean pain score in metformin arm was significantly lower than those of control arm, (6.7 versus 7.3, P = 0.005). Mean serum levels of malondialdehyde and neurotensin were significantly lower in metformin arm after the 6th and the 12th cycles. CONCLUSION Metformin may be a promising drug in protecting colorectal cancer patients against oxaliplatin-induced chronic peripheral sensory neuropathy.
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Affiliation(s)
| | - Osama Mohamed Ibrahim
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tanta University, Tanta, Egypt
| | - Fatma Zakaria Hussien
- Department of Clinical Oncology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Tarek Mohamed Mostafa
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tanta University, Tanta, Egypt
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Sparks CL, Liu WC, Cleland JA, Kelly JP, Dyer SJ, Szetela KM, Elliott JM. Functional Magnetic Resonance Imaging of Cerebral Hemodynamic Responses to Pain Following Thoracic Thrust Manipulation in Individuals With Neck Pain: A Randomized Trial. J Manipulative Physiol Ther 2018; 40:625-634. [PMID: 29229052 DOI: 10.1016/j.jmpt.2017.07.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 06/22/2017] [Accepted: 07/20/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The purpose of this study was to examine whether cerebral activation in response to noxious mechanical stimuli varies with thrust manipulation (TM) when compared with sham manipulation (SM) as measured by blood oxygenation level-dependent functional magnetic resonance imaging. METHODS Twenty-four volunteers (67% female) with complaints of acute or subacute mechanical (nontraumatic) neck pain satisfied eligibility requirements and agreed to participate. Participants were randomized to receive TM to the thoracic spine or SM, and then underwent functional magnetic resonance scanning while receiving noxious stimuli before and after TM or SM. An 11-point numeric pain rating scale was administered pre- and postmanipulation for neck pain and to determine perceptions of pain intensity with respect to neck pain and mechanical stimuli. Blood oxygenation level-dependent functional magnetic resonance imaging recorded the cerebral hemodynamic response to the mechanical stimuli. RESULTS Imaging revealed significant group differences, with those individuals in the manipulation group exhibiting increased areas of activation (postmanipulation) in the insular and somatosensory cortices and individuals in the sham group exhibiting greater areas of activation in the precentral gyrus, supplementary motor area, and cingulate cortices (P < .05). However, between-group differences on the numeric pain rating scale for mechanical stimuli and for self-reported neck pain were not statistically significant. CONCLUSIONS This study provides preliminary level 2b evidence suggesting cortical responses in patients with nontraumatic neck pain may vary between thoracic TM and a sham comparator.
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Affiliation(s)
- Cheryl L Sparks
- Rehabilitation Center of Expertise, OSF Healthcare, Peoria, Illinois.
| | - Wen C Liu
- Department of Radiology, Saint Francis Medical Center, OSF Healthcare, Peoria, Illinois
| | - Joshua A Cleland
- Department of Physical Therapy, Franklin Pierce University, Concord, New Hampshire
| | - Joseph P Kelly
- Department of Physical Therapy, Bradley University, Peoria, Illinois
| | - Sarah J Dyer
- OSF Rehabilitation at Saint Francis Medical Center, OSF Healthcare, Peoria, Illinois
| | - Kathryn M Szetela
- OSF Rehabilitation at Saint Francis Medical Center, OSF Healthcare, Peoria, Illinois
| | - James M Elliott
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Walston Z, Hernandez L, Yake D. Utilization of manual therapy to the lumbar spine in conjunction with traditional conservative care for individuals with bilateral lower extremity complex regional pain syndrome: A case series. Physiother Theory Pract 2018; 36:241-248. [PMID: 29873592 DOI: 10.1080/09593985.2018.1482392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Background and purpose: Conservative therapies for complex regional pain syndrome (CRPS) have traditionally focused on exercise and desensitization techniques targeted at the involved extremity. The primary purpose of this case series is to report on the potential benefit of utilizing manual therapy to the lumbar spine in conjunction with traditional conservative care when treating patients with lower extremity CRPS.Case description: Two patients with the diagnosis of lower extremity CRPS were treated with manual therapy to the lumbar spine in conjunction with education, exercise, desensitization, and soft tissue techniques for the extremity.Outcomes: Patient 1 received 13 sessions over 6 weeks resulting in a 34-point improvement in oswestry disability index (ODI) and 35-point improvement in lower extremity functional scale (LEFS). Patient 2 received 21 sessions over 12 weeks resulting in a 28-point improvement in ODI and a 41-point improvement in LEFS.Discussion: Both patients exhibited reductions in pain and clinically meaningful improvements in function. Manual therapies when applied to the lumbar spine in these patients as part of a comprehensive treatment plan resulted in improved spinal mobility, decreased pain, and reduction is distal referred symptoms. Although one cannot infer a cause and effect relationship from a case series, this report identifies meaningful clinical outcomes potentially associated with manual physical therapy to the lumbar spine for two patients with complex regional pain syndrome type 1.
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Affiliation(s)
| | | | - Dale Yake
- PT Solutions Physical Therapy, Atlanta, GA, USA
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Snider KT, Redman CL, Edwards CR, Bhatia S, Kondrashova T. Ultrasonographic Evaluation of the Effect of Osteopathic Manipulative Treatment on Sacral Base Asymmetry. J Osteopath Med 2018; 118:159-169. [DOI: 10.7556/jaoa.2018.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Abstract
Context
Patients with low back pain (LBP) may receive osteopathic manipulative treatment (OMT) to resolve or manage their pain. The indication for OMT for patients with LBP is the presence of somatic dysfunction, diagnosed using palpatory examination. Because palpatory findings commonly have poor interexaminer reliability, the current study used ultrasonography (US) to establish pre-OMT and post-OMT musculoskeletal measurements of relative asymmetry between pelvic and sacral bony landmarks.
Objective
To document objective musculoskeletal changes that occur in response to OMT using US and to compare palpatory assessment of landmark asymmetry with US assessment.
Methods
Sixty men and women aged 20 to 55 years with at least 1 episode of LBP in the past 2 weeks were assigned to a seated control, walking control, or OMT group (20 participants per group). Participants received an initial, bilateral US measurement of the skin to posterior superior iliac spine (SPSIS), skin to sacral base position (SBP), and sacral sulcus depth (SSD). Participants in seated control and OMT groups received a palpatory assessment of SBP and SSD prior to initial US assessment. After assessment, the seated control group sat in a waiting room for 30 minutes, the walking control group walked for 5 minutes, and the OMT group received OMT to address sacral base asymmetry using predominantly direct techniques for a maximum of 20 minutes. Participants then received a second US assessment of the same structures.
Results
Body mass index (BMI) was correlated with SPSIS (r=0.5, P=.001) and SBP (r=0.6, P<.001). More participants in seated control (75%) and OMT (65%) groups had an increase in asymmetry from first to second US assessment for SPSIS compared with participants in the walking control group (35%, P=.05). No significant differences were found between groups for absolute asymmetry or total change in asymmetry (all P>.10). The κ was −0.1 (95% CI, −0.2 to 0.03) for SBP and −0.01 (95% CI, −0.1 to 0.1) for SSD.
Conclusion
Musculoskeletal changes in SPSIS and SBP measurements related to OMT could not be readily identified using US. The SPSIS and SBP measurements were dependent on BMI, which may have affected the accuracy of US to detect small changes in asymmetry. Qualitative palpatory assessments did not correlate with US measurements. Further study is needed to identify US measurements that demonstrate change with OMT. (ClinicalTrials.gov number NCT02820701)
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Galindez-Ibarbengoetxea X, Setuain I, González-Izal M, Jauregi A, Ramírez-Velez R, Andersen LL, Izquierdo M. Randomised controlled pilot trial of high-velocity, low-amplitude manipulation on cervical and upper thoracic spine levels in asymptomatic subjects. INT J OSTEOPATH MED 2017. [DOI: 10.1016/j.ijosm.2016.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
Study Design Controlled laboratory study. Background Spinal manipulation (SM) can trigger a cascade of responses involving multiple systems, including the sympathetic nervous system and the endocrine system, specifically, the hypothalamic-pituitary axis. However, no manual therapy study has investigated the neuroendocrine response to SM (ie, sympathetic nervous system-hypothalamic-pituitary axis) in the same trial. Objective To determine short-term changes in sympathetic nervous system activity, heart rate variability, and endocrine activity (cortisol, testosterone, and testosterone-cortisol [T/C] ratio) following a thoracic SM. Methods Twenty-four healthy men aged between 18 and 45 years were randomized into 2 groups: thoracic SM (n = 12) and sham (n = 12). Outcome measures were salivary cortisol (micrograms per deciliter), salivary testosterone (picograms per milliliter), T/C ratio, heart rate variability, and changes in oxyhemoglobin concentration of the right calf muscle (micromoles per liter). Measurements were done before and at 5 minutes, 30 minutes, and approximately 6 hours after intervention. Results A statistically significant group-by-time interaction was noted for T/C ratio (P<.05) and salivary cortisol (P<.01) concentrations. Significant between-group differences were noted for salivary cortisol concentration at 5 minutes (mean difference, 0.35; 95% confidence interval: 0.12, 0.6; interaction: P<.01) and for T/C ratio at 6 hours postintervention (mean difference, -0.09; 95% confidence interval: -0.16, -0.04; P = .02). However, SM did not differentially alter oxyhemoglobin, testosterone, or heart rate variability relative to responses in the sham group. Conclusion Thoracic SM resulted in an immediate decrease in salivary cortisol concentration and reduced T/C ratio 6 hours after intervention. A pattern of immediate sympathetic excitation was also observed in the SM group. J Orthop Sports Phys Ther 2017;47(9):617-627. Epub 13 Jul 2017. doi:10.2519/jospt.2017.7348.
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Kovanur-Sampath K, Mani R, Cotter J, Gisselman AS, Tumilty S. Changes in biochemical markers following spinal manipulation-a systematic review and meta-analysis. Musculoskelet Sci Pract 2017; 29:120-131. [PMID: 28399479 DOI: 10.1016/j.msksp.2017.04.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Revised: 03/21/2017] [Accepted: 04/04/2017] [Indexed: 12/30/2022]
Abstract
The aim of this meta-analysis was to determine the effectiveness of spinal manipulation in influencing various biochemical markers in healthy and or symptomatic population. Electronic databases (n = 10) were searched (from inception till September 2016) and eight trials (325 participants) that met the inclusion criteria were included in the meta-analysis. Two authors independently extracted and assessed the risk of bias in included studies. Standardised mean differences for outcome measures were used to calculate effect sizes. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) tool was used for assessing the quality of the body of evidence for each outcome of interest. There was moderate quality evidence that spinal manipulation influenced biochemical markers. There was moderate quality evidence of significant difference that spinal manipulation is better (SMD -0.46, 95% CI - 0.93 to 0) than control in eliciting changes in cortisol levels immediately after intervention. There was also a low quality evidence that spinal manipulation is better than control at post-intervention in increasing substance-P (SMD -0.48,95%CI-0.87 to -0.1), neurotensin (SMD -1.8,95%CI-2.56 to -1.04) and oxytocin levels (SMD -2.61,95%CI-3.5to-1.72). However, low quality evidence indicated that spinal manipulation did not influence epinephrine (SMD 0.1,95%CI- 0.56to0.75) or nor-epinephrine levels (SMD -0.06,95%CI-0.71to0.6). The current review found that spinal manipulation can increase substance-p, neurotensin, oxytocin and interleukin levels and may influence cortisol levels post-intervention. However, future trials targeting symptomatic populations are required to understand the clinical importance of such changes.
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Affiliation(s)
- Kesava Kovanur-Sampath
- Centre for Health, Activity, and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand.
| | - Ramakrishnan Mani
- Centre for Health, Activity, and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Jim Cotter
- School of Physical Education, Sport and Exercise Sciences, University of Otago, Dunedin, New Zealand
| | - Angela Spontelli Gisselman
- Centre for Health, Activity, and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Steve Tumilty
- Centre for Health, Activity, and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
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The analgesic effects of oxytocin in the peripheral and central nervous system. Neurochem Int 2017; 103:57-64. [DOI: 10.1016/j.neuint.2016.12.021] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 12/01/2016] [Accepted: 12/28/2016] [Indexed: 02/07/2023]
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Lumbar Thrust Manipulation and Exercise for the Treatment of Mechanical Low Back Pain in Adolescents: A Case Series. J Orthop Sports Phys Ther 2016; 46:391-8. [PMID: 27049600 DOI: 10.2519/jospt.2016.6366] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Study Design Case series. Background Low back pain (LBP) is an increasing problem in health care. The evidence for the use of spinal manipulative therapy to treat pediatric patients with LBP is minimal. The treatment of pediatrics with manual therapy, particularly spinal manipulation, is controversial within the medical community, primarily with respect to adverse events. The purpose of this case series was to illustrate the feasibility and safety of lumbar manipulation plus exercise in the adolescent population with mechanical LBP. Case Description Three patients-a 13-year-old adolescent girl, 15-year-old adolescent girl, and 13-year-old adolescent boy-were treated in an outpatient physical therapy setting for mechanical LBP. All 3 patients were assessed using a lumbar manipulation clinical prediction rule and treated with sidelying lumbar manipulation and exercise. Outcomes Patients were treated for a total of 10 to 14 visits over a course of 8 to 9 weeks. Pain (measured by a numeric pain-rating scale) and disability (measured by the modified Oswestry Disability Index) improved to 0/10 and 0%, respectively, in each patient. No adverse reactions to manipulation were reported. Discussion The results of this case series describe the use of lumbar thrust manipulation and exercise for the treatment of mechanical LBP in adolescents. The positive results indicate that lumbar manipulation may be a safe adjunct therapy. Further studies, including randomized controlled trials, are needed to determine effectiveness. Level of Evidence Therapy, level 4. J Orthop Sports Phys Ther 2016;46(5):391-398. Epub 6 Apr 2016. doi:10.2519/jospt.2016.6366.
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The Role of Descending Modulation in Manual Therapy and Its Analgesic Implications: A Narrative Review. PAIN RESEARCH AND TREATMENT 2015; 2015:292805. [PMID: 26788367 PMCID: PMC4695672 DOI: 10.1155/2015/292805] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 11/15/2015] [Accepted: 11/29/2015] [Indexed: 12/23/2022]
Abstract
Manual therapy has long been a component of physical rehabilitation programs, especially to treat those in pain. The mechanisms of manual therapy, however, are not fully understood, and it has been suggested that its pain modulatory effects are of neurophysiological origin and may be mediated by the descending modulatory circuit. Therefore, the purpose of this review is to examine the neurophysiological response to different types of manual therapy, in order to better understand the neurophysiological mechanisms behind each therapy's analgesic effects. It is concluded that different forms of manual therapy elicit analgesic effects via different mechanisms, and nearly all therapies appear to be at least partially mediated by descending modulation. Additionally, future avenues of mechanistic research pertaining to manual therapy are discussed.
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Kovanur Sampath K, Mani R, Cotter JD, Tumilty S. Measureable changes in the neuro-endocrinal mechanism following spinal manipulation. Med Hypotheses 2015; 85:819-24. [DOI: 10.1016/j.mehy.2015.10.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 09/14/2015] [Accepted: 10/03/2015] [Indexed: 10/22/2022]
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McDevitt A, Young J, Mintken P, Cleland J. Regional interdependence and manual therapy directed at the thoracic spine. J Man Manip Ther 2015; 23:139-46. [PMID: 26309384 DOI: 10.1179/2042618615y.0000000005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Thoracic spine manipulation is commonly used by physical therapists for the management of patients with upper quarter pain syndromes. The theoretical construct for using thoracic manipulation for upper quarter conditions is a mainstay of a regional interdependence (RI) approach. The RI concept is likely much more complex and is perhaps driven by a neurophysiological response including those related to peripheral, spinal cord and supraspinal mechanisms. Recent evidence suggests that thoracic spine manipulation results in neurophysiological changes, which may lead to improved pain and outcomes in individuals with musculoskeletal disorders. The intent of this narrative review is to describe the research supporting the RI concept and its application to the treatment of individuals with neck and/or shoulder pain. Treatment utilizing both thrust and non-thrust thoracic manipulation has been shown to result in improvements in pain, range of motion and disability in patients with upper quarter conditions. Research has yet to determine optimal dosage, techniques or patient populations to which the RI approach should be applied; however, emerging evidence supporting a neurophysiological effect for thoracic spine manipulation may negate the need to fully answer this question. Certainly, there is a need for further research examining both the clinical efficacy and effectiveness of manual therapy interventions utilized in the RI model as well as the neurophysiological effects resulting from this intervention.
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Affiliation(s)
- Amy McDevitt
- University of Colorado, School of Medicine, Physical Therapy Program, Anschutz Medical Campus, Aurora, CO, USA
| | - Jodi Young
- Franklin Pierce University, Physical Therapy Program, Concord, NH, USA
| | - Paul Mintken
- University of Colorado, School of Medicine, Physical Therapy Program, Anschutz Medical Campus, Aurora, CO, USA
| | - Josh Cleland
- Franklin Pierce University, Physical Therapy Program, Concord, NH, USA
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Wormley ME, Grimes JK, Romney W, Yen SC, Chui KK. Neurophysiological Effects of Manual Therapy in Aging and Older Adults. TOPICS IN GERIATRIC REHABILITATION 2015. [DOI: 10.1097/tgr.0000000000000071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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