lundi 29 avril 2019

Effects of an 8-week physical exercise program on spinal manipulation biomechanical parameters in a group of 1st-year chiropractic students.



To determine the effects of a physical exercise program on spinal manipulation (SM) performance in 1st-year chiropractic students.


One hundred and thirteen students from 2 chiropractic schools were assigned to 1 of 2 groups: exercise group (EG) for campus A students or control group (CG) (no training) for campus B students. All participated in 2 1-hour experimental training sessions that were added to the usual technique curriculum. At the beginning and at the end of each session, SM thrust duration and preload force release were recorded as dependent variables in 5 trials performed on a force-sensing table for a total of 10 recorded trials per session. The session consisted of several drills during which augmented feedback was provided to students to improve their skills. The EG performed physical exercises (push-ups, core stabilization, and speeder board exercises) 3 times per week for an 8-week period between the 2 training sessions.


The mean thrust duration increased between the 2 sessions [+0.8 ms (±15.6)]. No difference between groups was found using a t test for independent samples ( p = .94). The mean preload force release decreased between the 2 sessions (-6.1 N [±17.1]). Differences between groups were found using a t test for independent samples ( p = .03); the results showed a reduction of preload force release in the participants in the EG group compared to those in the CG group (-8.1 N [±16.9] vs -0.3 N [±16.5]).


A physical exercise program seems to be beneficial in the SM learning process; chiropractic students should therefore be encouraged to do home physical exercises to develop their physical capabilities and improve SM delivery.

The immediate effect of osteopathic cervical spine mobilization on median nerve mechanosensitivity

Authors: Gary Whelan, M.Ost (Osteopath), Ross Johnston, M.Sc. B.Sc. (Hons) Ost Med, DO (Senior Lecturer), Charles Millward, ND DO (Lecturer), Darren J. Edwards, B.Sc. M.Sc. Ph.D. (Lecturer)
Published in: J Bodyw Mov Ther. 2018 Apr;22:252-260. doi: 10.1016/j.jbmt.2017.05.009. Epub 2017 May 18.


Neurodynamics is a clinical medium for testing the mechanical sensitivity of peripheral nerves which innervate the tissues of both the upper and lower limb. Currently, there is paucity in the literature of neurodynamic testing in osteopathic research, and where there is research, these are often methodologically flawed, without the appropriate comparators, blinding and reliability testing.
This study aimed to assess the physiological effects (measured through Range of Motion; ROM), of a commonly utilized cervicalmobilization treatment during a neurodynamic test, with the appropriate methodology, i.e., compared against a control and sham. Specifically, this was to test whether cervical mobilization could reduce upper limb neural mechanical sensitivity.
Thirty asymptomatic participants were assessed and randomly allocated to either a control, sham or mobilization group, where they were all given a neurodynamic test and ROM was assessed.
The results showed that the mobilization group had the greatest and most significant increase in ROM with Change-Left p < 0.05 and Change-Right p < 0.05 compared against the control group, and Change-Left p < 0.01 and Change-Right p < 0.05 compared against the sham group.
This study has highlighted that, as expected, cervical mobilization has an effect at reducing upper limb neural mechanical sensitivity. However, there may be other factors interacting with neural mechanosensitivity outside of somatic influences such as psychological expectation bias. Further research could utilize the methodology employed here, but with other treatment areas to help develop neural tissue research. In addition to this, further exploration of psychological factors should be made such as utilizing complex top-down cognitive processing theories such as the neuromatrix or categorization theories to help further understand cognitive biases such as the placebo effect, which is commonly ignored in osteopathic research, as well as other areas of science, and which would further complete a holistic perspective.

Impact of Spinal Manipulation on Migraine Pain and Disability: A Systematic Review & Meta-Analysis

Authors: Pamela M. Rist ScD, Audrey Hernandez MS, Carolyn Bernstein MD, Matthew Kowalski DC, Kamila Osypiuk MS, Robert Vining DC, Cynthia R. Long PhD, Christine Goertz DC, PhD, Rhayun Song RN, PhD, Peter M. Wayne PhD
Published in: Headache. 2019 Apr;59 :532-542. doi: 10.1111/head.13501. Epub 2019 Mar 14.


Several small studies have suggested that spinal manipulation may be an effective treatment for reducing migraine pain and disability. We performed a systematic review and meta-analysis of published randomized clinical trials (RCTs) to evaluate the evidence regarding spinal manipulation as an alternative or integrative therapy in reducing migraine pain and disability.
PubMed and the Cochrane Library databases were searched for clinical trials that evaluated spinal manipulation and migraine-related outcomes through April 2017. Search terms included: migraine, spinal manipulation, manual therapy, chiropractic, and osteopathic. Meta-analytic methods were employed to estimate the effect sizes (Hedges' g) and heterogeneity (I2 ) for migraine days, pain, and disability. The methodological quality of retrieved studies was examined following the Cochrane Risk of Bias Tool.
Our search identified 6 RCTs (pooled n = 677; range of n = 42-218) eligible for meta-analysis. Intervention duration ranged from 2 to 6 months; outcomes included measures of migraine days (primary outcome), migraine pain/intensity, and migraine disability. Methodological quality varied across the studies. For example, some studies received high or unclear bias scores for methodological features such as compliance, blinding, and completeness of outcome data. Due to high levels of heterogeneity when all 6 studies were included in the meta-analysis, the 1 RCT performed only among chronic migraineurs was excluded. Heterogeneity across the remaining studies was low. We observed that spinal manipulation reduced migraine days with an overall small effect size (Hedges' g = -0.35, 95% CI: -0.53, -0.16, P < .001) as well as migraine pain/intensity.
Spinal manipulation may be an effective therapeutic technique to reduce migraine days and pain/intensity. However, given the limitations to studies included in this meta-analysis, we consider these results to be preliminary. Methodologically rigorous, large-scale RCTs are warranted to better inform the evidence base for spinal manipulation as a treatment for migraine.

Impact of Spinal Manipulation on Cortical Drive to Upper and Lower Limb Muscles.

Authors: Haavik H, Niazi IK, Jochumsen M, Sherwin D, Flavel S, Türker KS.
Published in: Brain Sci. 2016 Dec 23;7(1). pii: E2. doi: 10.3390/brainsci7010002.
This study investigates whether spinal manipulation leads to changes in motor control by measuring the recruitment pattern of motor units in both an upper and lower limb muscle and to see whether such changes may at least in part occur at the cortical level by recording movement related cortical potential (MRCP) amplitudes. In experiment one, transcranial magnetic stimulation input-output (TMS I/O) curves for an upper limb muscle (abductor pollicus brevis; APB) were recorded, along with F waves before and after either spinal manipulation or a control intervention for the same subjects on two different days. During two separate days, lower limb TMS I/O curves and MRCPs were recorded from tibialis anterior muscle (TA) pre and post spinal manipulation. Dependent measures were compared with repeated measures analysis of variance, with p set at 0.05. Spinal manipulation resulted in a 54.5% ± 93.1% increase in maximum motor evoked potential (MEPmax) for APB and a 44.6% ± 69.6% increase in MEPmax for TA. For the MRCP data following spinal manipulation there were significant difference for amplitude of early bereitschafts-potential (EBP), late bereitschafts potential (LBP) and also for peak negativity (PN). The results of this study show that spinal manipulation leads to changes in cortical excitability, as measured by significantly larger MEPmax for TMS induced input-output curves for both an upper and lower limb muscle, and with larger amplitudes of MRCP component post manipulation. No changes in spinal measures (i.e., F wave amplitudes or persistence) were observed, and no changes were shown following the control condition.
These results are consistent with previous findings that have suggested increases in strength following spinal manipulation were due to descending cortical drive and could not be explained by changes at the level of the spinal cord. Spinal manipulation may therefore be indicated for the patients who have lost tonus of their muscle and/or are recovering from muscle degrading dysfunctions such as stroke or orthopaedic operations and/or may also be of interest to sports performers. These findings should be followed up in the relevant populations.

Sacroiliac Stretching Improves GH Int R° Deficit of the Opposite Shoulder in Baseball players (RCT)

Authors: Romano V1, Romano J1, Gilbert GE1.
Published in: J Am Acad Orthop Surg Glob Res Rev. 2018 Oct 8;2(10):e060. doi: 10.5435/JAAOSGlobal-D-18-00060. eCollection 2018 Oct.


Glenohumeral internal rotation deficit (GIRD) is a well-documented finding in throwing athletes.
To investigate whether stretching the contralateral sacroiliac (SI) joint can improve GIRD in baseball players.
After internal shoulder rotation was measured in 23 minor league baseball players, the players randomly were assigned to either a control (ie, sleeper stretch of the dominant shoulder) or experimental (ie, SI joint stretch contralateral to the dominant shoulder) group. Afterward, internal rotation (IR) of their dominant shoulders was remeasured.
The mean initial end-range IR was 68.6° (SD = 7.9°) in the sleeper stretch group (n = 8) and 64.5° (SD = 5.1°) in the SI joint stretch group (n = 15). After stretching, the sleeper stretch group's mean end-range IR was 72.1° (SD = 7.2°), a 3.5° improvement (P = 0.1058), whereas the contralateral SI joint stretch group's mean end-range IR was 71.9° (SD = 6.6°), a 7.4° improvement (P = 0.0041).
Stretching the contralateral SI joint improved GIRD more than the sleeper's stretch.

Changes in biochemical markers following spinal manipulation-a systematic review and meta-analysis.

Authors: Kovanur-Sampath K, Mani R, Cotter J, Gisselman AS, Tumilty S.
Published in: Musculoskelet Sci Pract. 2017 Jun;29:120-131. doi: 10.1016/j.msksp.2017.04.004. Epub 2017 Apr 5.


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.

The Immediate Effects of Upper Thoracic SMT on Cervical Pain and ROM : a RCT

Authors: John Krauss, PT, PhD, OCS, FAAOMPT, Doug Creighton, DPT, OCS, FAAOMPT, Jonathan D. Ely, PT, MS, FAAOMPT, and Joanna Podlewska-Ely, PT, MS, FAAOMPT
Published in: J Man Manip Ther. 2008; 16(2): 93–99. doi: 10.1179/106698108790818530



This study examined the effect of translatoric spinal manipulation (TSM) on cervical pain and cervical active motion restriction when applied to upper thoracic (T1-T4) segments. Active cervical rotation range of motion was measured re- and post-intervention with a cervical inclinometer (CROM), and cervical pain status was monitored before and after manipulation with a Faces Pain Scale.


Study participants included a sample of convenience that included 32 patients referred to physical therapy with complaints of pain in the mid-cervical region and restricted active cervical rotation. Twenty-two patients were randomly assigned to the experimental group and ten were assigned to the control group. Pre- and post-intervention cervical range of motion and pain scale measurements were taken by a physical therapist assistant who was blinded to group assignment. The experimental group received TSM to hypomobile upper thoracic segments. The control group received no intervention. Paired t-tests were used to analyze within-group changes in cervical rotation and pain, and a 2-way repeated-measure ANOVA was used to analyze between-group differences in cervical rotation and pain. Significance was accepted at p = 0.05.


Significant changes that exceeded the MDC95 were detected for cervical rotation both within group and between groups with the TSM group demonstrating increased mean (SD) in right rotation of 8.23° (7.41°) and left rotation of 7.09° (5.83°). Pain levels perceived during post-intervention cervical rotation showed significant improvement during right rotation for patients experiencing pain during bilateral rotation only (p=.05).


This study supports the hypothesis that spinal manipulation applied to the upper thoracic spine (T1-T4 motion segments) significantly increases cervical rotation ROM and may reduce cervical pain at end range rotation for patients experiencing pain during bilateral cervical rotation.

Does cervical lordosis change after spinal manipulation for non-specific neck pain?

Authors: Michael Shilton, Jonathan Branney, Bas Penning de Vries, and Alan C. Breen
Published in: Chiropr Man Therap. 2015; 23: 33. Published online 2015 Dec 7. doi: 10.1186/s12998-015-0078-3



The association between cervical lordosis (sagittal alignment) and neck pain is controversial. Further, it is unclear whether spinal manipulative therapy can change cervical lordosis. This study aimed to determine whether cervical lordosis changes after a course of spinal manipulation for non-specific neck pain.


Posterior tangents of C2 and C6 were drawn on the lateral cervical fluoroscopic images of 29 patients with subacute/chronic non-specific neck pain and 30 healthy volunteers matched for age and gender, recruited August 2011 to April 2013. The resultant angle was measured using ‘Image J’ digital geometric software. The intra-observer repeatability (measurement error and reliability) and intra-subject repeatability (minimum detectable change (MDC) over 4 weeks) were determined in healthy volunteers. A comparison of cervical lordosis was made between patients and healthy volunteers at baseline. Change in lordosis between baseline and 4-week follow-up was determined in patients receiving spinal manipulation.


Intra-observer measurement error for cervical lordosis was acceptable (SEM 3.6°) and reliability was substantial ICC 0.98, 95 % CI 0.962–0991). The intra-subject MDC however, was large (13.5°). There was no significant difference between lordotic angles in patients and healthy volunteers (p = 0.16). The mean cervical lordotic increase over 4 weeks in patients was 2.1° (9.2) which was not significant (p = 0.12).


This study found no difference in cervical lordosis (sagittal alignment) between patients with mild non-specific neck pain and matched healthy volunteers. Furthermore, there was no significant change in cervical lordosis in patients after 4 weeks of cervical spinal manipulation.

Motor Neuron Excitability Attenuation as a Sequel to L5-S1 Manipulation

Authors: Dishman JD, Burke JR, Dougherty P.
Published in: J Manipulative Physiol Ther. 2018 Jun;41(5):363-371. doi: 10.1016/j.jmpt.2017.10.015. Epub 2018 Jul 9.
The H-Reflex


The purpose of the study was to compare a time series of tibial nerve H-reflex trials between patients with subacute low back pain (LBP) and asymptomatic adults using pre and post high-velocity, low-amplitude (HVLA) spinal manipulation (SM) and control procedures.
Asymptomatic adults (n = 66) and patients with subacute LBP (n = 45) were randomized into 3 lumbosacral procedures: side-posture positioning, joint preloading with no thrust, and HVLA SM. A time series of 40 Hmax/Mmax ratios at a rate of 0.1 Hz were recorded in blocks of 10 trials at baseline and after the lumbosacral procedures at time points corresponding to immediately after, 5 minutes after, and 10 minutes after the procedure. Descriptive time series analysis techniques included time plots, outlier detection, and autocorrelation functions. A mixed analysis of variance model (group × procedure × time) was used to compare the effects of lumbosacral procedures on Hmax/Mmaxratios between the patients with subacute LBP and asymptomatic participants.
The time series analysis and the significant lumbosacral × time interaction term (P < .05) indicated that inhibition of the Hmax/Mmax ratios at the 10-second postlumbosacral procedure time point was greatest after the HVLA SM procedure. The effects of lumbosacral procedures on Hmax/Mmax ratios were similar between patients with subacute LBP and asymptomatic participants.
Although nonspecific effects of movement or position artifacts on the Hmax/Mmax ratio were present, a reliable and valid attenuation of the Hmax/Mmax ratio occurred as a specific aspect of HVLA SM in both asymptomatic adults and patients with subacute LBP.