The effect of spinal manipulative therapy on spinal range of motion: a systematic literature review

Abstract

BackgroundSpinal manipulative therapy (SMT) has been shown to have an effect on spine-related pain, both clinically and in experimentally induced pain. However, it is unclear if it has an immediate noticeable biomechanical effect on spinal motion that can be measured in terms of an increased range of motion (ROM).ObjectiveTo assess the quality of the literature and to determine whether or not SMT is associated with an immediate increase in ROM.DesignA systematic critical literature review.MethodSystematic searches were performed in Pubmed, the Cochrane Library and EMBASE using terms relating to manipulation, movement and the spine. Selection of articles was made according to specific criteria by two independent reviewers. Two checklists were created based on the needs of the present review. Articles were independently reviewed by two reviewers. Articles were given quality scores and the data synthesized for each region treated in the literature. Findings were summarized in tables and reported in a narrative fashion.ResultsFifteen articles were retained reporting on experiments on the neck, lumbar spine, hip and jaw. The mean quality score was 71/100 (ranges 33/100 - 92/100). A positive effect of SMT was reported in both studies where mouth opening was assessed after cervical manipulation. In five of the nine studies on cervical ROM a positive effect was reported, whereas the remaining four studies did not show improvement. None of the three studies of the lumbar spine showed an effect of SMT on lumbar ROMs and one study of sacroiliac manipulation reported no effect on the ROM of the hip joint.In relation to the quality score, the seven highest ranked studies, showed significant positive effects of SMT on ROM. Continuing down the list, the other studies reported no significant differences in the outcomes between groups.ConclusionSMT seems sometimes to have a small effect on ROM, at least in the cervical spine. Further research should concentrate on areas of the spine that have the potential of actually improving to such a degree that a change can be easily uncovered.

Short term modulation of trunk neuromuscular responses following spinal manipulation: a control group study

“…Interestingly, these changes were not associated with changes in lumbo-pelvic kinematics. In a recent review, Millan et al [23] reported that none of the selected studies of the lumbar spine showed an immediate effect of SMT on lumbar range of motions. Future studies should include assessment for an extended period of time (hours and days) in order to better document the association between neuromuscular response to SMT and changes in lumbo-pelvic kinematics.…”

Integrating osteopathic approaches based on biopsychosocial therapeutic mechanisms. Part 2: Clinical approach

“…Of the biological mechanisms, experimental and clinical evidence suggest that manual therapy produces short-term modulation of pain, probably mediated by activation of the descending inhibitory pathways of the CNS [8][9][10][11]. While there is limited clinical evidence supporting immediate increases in spinal range of motion [12][13][14][15][16][17] and influence on posture [16,[18][19][20], additional research is required to determine whether these changes are clinically relevant. It is important to realise that, while basic or primary experimental research may support the plausibility of a variety of mechanisms that produce changes to the tissues or nervous system, there remains a lack of clinical evidence that establishes these changes as relevant and meaningful to clinical outcomes in patients.…”

“…For example, very gentle extensibility and stretching forces are advisable for a strained muscle in the first few days of injury, which can be progressively increased as the sensitivity of the tissue decreases and healing occurs. Passive manual techniques may promote movement [12][13][14][15][16][17] and reduce pain [8][9][10][11] and, combined with reassurance and pain education, encourage the person to perform normal movement patterns and activity ( Figure 1). Active and passive movements create pressure fluctuations within synovial joints [66], which promote trans-synovial flow of fluids across the synovial membrane and stimulate blood flow around the joint [67][68][69].…”

“…Manual therapy may have a small role in decreasing pain by activating descending pain mechanisms [8][9][10][11], aiding sensorimotor and proprioceptive processing [37][38][39][40][41][42][43], and promoting mobility and flexibility [12][13][14][15][16][17]. When a person has persistent pain, they may be fearful of movement, employ bracing and guarding strategies, and have poorer proprioceptive and fine-position motor control [76][77][78][79][80][81].…”

Atlanto-axial facet displacement during rotational high-velocity low-amplitude thrust: An in vitro 3D kinematic analysis

“…HVLA techniques produce different effects on the body system: mechanical effects (Triano and Schultz, 1997;Triano, 2001;Millan et al, 2012;Snodgrass et al, 2012) and neurophysiological effects (Pickar, 2002) on the axial muscles (Bicalho et al, 2010;Clark et al, 2011;Koppenhaver et al, 2011;Puentedura et al, 2011) as well as on the peripheral muscles (Herzog et al, 1999;Suter et al, 2000;Hillermann et al, 2006), and on sensitivity (Bialosky et al, 2009;Bishop et al, 2011;Sparks et al, 2013).…”