The Effects of 4 Weeks of Chiropractic Spinal Adjustments on Motor Function in People with Stroke: A Randomized Controlled Trial

Abstract

Chiropractic spinal adjustments have been shown to result in short-term increases in muscle strength in chronic stroke patients, however, the effect of longer-term chiropractic spinal adjustments on people with chronic stroke is unknown. This exploratory study assessed whether 4 weeks of chiropractic spinal adjustments, combined with physical therapy (chiro + PT), had a greater impact than sham chiropractic with physical therapy (sham + PT) did on motor function (Fugl Meyer Assessment, FMA) in 63 subacute or chronic stroke patients. Secondary outcomes included health-related quality of life and other measures of functional mobility and disability. Outcomes were assessed at baseline, 4 weeks (post-intervention), and 8 weeks (follow-up). Data were analyzed using linear mixed-effects models or generalized linear mixed models. A post-hoc responder analysis was performed to investigate the clinical significance of findings. At 4 weeks, there was a larger effect of chiro + PT, compared with sham + PT, on the FMA (difference = 6.1, p = 0.04). The responder analysis suggested the improvements in motor function seen following chiropractic spinal adjustments may have been clinically significant. There was also a robust improvement in both groups in most measures from baseline to the 4- and 8-week assessments, but between-group differences were no longer significant at the 8-week assessment. Four weeks of chiro + PT resulted in statistically significant improvements in motor function, compared with sham + PT, in people with subacute or chronic stroke. These improvements appear to be clinically important. Further trials, involving larger group sizes and longer follow-up and intervention periods, are required to corroborate these findings and further investigate the impacts of chiropractic spinal adjustments on motor function in post-stroke survivors. ClinicalTrials.gov Identifier NCT03849794.

Chiropractic Spinal Adjustment Increases the Cortical Drive to the Lower Limb Muscle in Chronic Stroke Patients

“…Therefore, investigating whether chiropractic spinal adjustment can increase muscle strength and impact walking function in people with stroke can be important for future research. In line with this importance, recently, Holt et al (40) has found clinically significant improvements in motor function following a combination of chiropractic spinal adjustment and physical therapy. It is also postulated that spinal adjustment might affect neural functionality (12,13) in people with chronic stroke.…”

“…This is a basic science study; therefore, the results from this study should not be extrapolated to clinical implications for the chronic stroke population. For clinical implication, Holt et al (40) has found clinically significant improvements in motor function following a combination of chiropractic spinal adjustment and physical therapy. Further work is required to explore what potential clinical implications chiropractic care may have for different stages of stroke progression, which needs to be further investigated in future studies.…”

Chiropractic Care in a Patient With Hereditary Spastic Paraplegia and Chronic Pain

“…Although the mechanisms are not fully understood, chiropractic manipulative therapy increases the cortical intrinsic inhibitory interactions in patients with chronic pain [16,17], normalizes muscle tone, and inhibits spasms [18]. Other studies have also shown that chiropractic adjustments can increase the dorsiflexor muscle strength and walking gait in stroke patients [19,20]. Pregnant women in their second trimester also experience more relaxation of the pelvic floor muscles after chiropractic treatment [21].…”