Background
Pain
Modulating pain
Treating back pain with spinal manipulative therapy
The possible mechanisms of spinal manipulative therapy in back pain
Local pain reducing effect
Regional pain reducing effect
Central pain reducing effect
Conflicting literature
Aims and objectives
Methods
Reference | Year | Authors | Title | Location | Setting | n° of subjects | n° males | n° females | Ages | Treatment groups | How was pain produced | How was pain measured | When was pain measured | Description of study subjects | Approval ethics committee |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
[37] | 2011 | Josue Fernández-Carnero, Joshua A. Cleland and Roy La Touche Arbizu | Examination of motor and hypoalgesic effects of cervical vs thoracic spine manipulation in patients with lateral epicondyalgia: a clinical trial. | Spain | University | 18? | 8 | 9 | 44.8 SD, 9.2 (30–60) | - Cervical manipulation | Pressure | Electronic digital algometer | Before and after | Faculty of the Health Science | Yes |
- Thoracic manipulation | |||||||||||||||
[42] | 2011 | V. Maduro de Camargo, F. Alburquerque-Sendín, F. Bérzin, Vinicius Cobos Stefanelli, D. P. Rodrigues de Souza and C. Fernández-de-las-Peñas, | Immediate effects on electromyographic activity and pressure pain thresholds after a cervical manipulation in mechanical neck pain: a randomized controlled trial. | Brazil | University | 37 | 21 | 16 | 18 – 42 | - SMT C5-C6 | Pressure | Analogue algometer | Before and after | University workers | Yes |
- Control | |||||||||||||||
[23] | 2011 | Mark D. Bishop, Jason M. Beneciuk, Steven Z. George; | Immediate reduction in temporal sensory summation after thoracic spinal manipulation. | USA | University | 90 | 24 | 66 | 22.9 + −2.7 | - SMT | T° and pressure | Algometer | Before and Immediately after | Students | No |
- Cervical exercises | |||||||||||||||
- Control | |||||||||||||||
[28] | 2010 | Benjamin Soon, Annina B. Schmid, Elias J. Fridriksson, Elizabeth Gresslos, Philip Cheong and Anthony Wright; | A crossover study on the effect of cervical mobilization on motor function and pressure pain threshold in pain-free individuals. | Australia | University | 24 | 13 | 11 | 34 +/−12 | - Mobilization | Pressure | Digital algometer | Before and after | Students | Yes |
- Manual contact control | |||||||||||||||
- Control | |||||||||||||||
[29] | 2010 | Oliveira-Campelo NM, Rubens-Rebelatto J, Martín-Vallejo FJ, Alburquerque-Sendí N F, Fernández-de-Las-Peñas C. | The immediate effects of atlanto-occipital joint manipulation and suboccipital muscle inhibition technique on active mouth opening and pressure pain sensitivity over latent myofascial trigger points in the masticatory muscles. | Spain | Osteopathic school and university | 122 | 31 | 91 | 18-30 | - Manipulation | Pressure | Mechanical algometer | Before and 2 min post treatment | Students | Yes |
Brazil | - Soft tissue | ||||||||||||||
- Control | |||||||||||||||
[44] | 2010 | Elaine Willett, Clair Hebron and Oliver Krouwel | The initial effects of different rates of lumbar mobilizations on pressure pain thresholds in asymptomatic subjects. | UK | University | 30 | 8 | 22 | 33.05 (18–57) | - 2 Hz | Pressure | Electronic algometer | Base | 11 naive physiotherapists 19 non naive | Yes |
- 1 Hz | + 48 h | ||||||||||||||
- Quasi stable | + 48 h | ||||||||||||||
[38] | 2009 | P. Mansilla-Ferragut, C. Fernández-de-las Peñas, F Alburquerque-Sendin, J. A. Cleland and JJ Boscá-Gandia | Immediate effects of atlanto-occipital joint | Spain | Osteopathic school | 37 | 0 | 37 | 35 +/−8 | - SMT | Pressure | Mechanical algometer | Before and after | Volunteers, general population | Yes |
Manipulation on active mouth opening and pressure pain sensitivity in women with mechanical neck pain. | |||||||||||||||
- Control | |||||||||||||||
[30] | 2009 | Oliver Thomson, Lesley Haig, Hazel Mansfield | The effects of high-velocity low-amplitude thrust manipulation and mobilization techniques on pressure pain threshold in the lumbar spine. | Sweden | Stockholm College Osteopathic | 50 | 29 | 21 | 27 | - unilateral HVLAT | Pressure | Pressure algometer | Before and after | Students | Yes |
UK | School British College | - Spinal lumbar mobilization | |||||||||||||
- Sham laser procedure | |||||||||||||||
[43] | 2009 | Oliver Krouwel , Clair Hebron, Elaine Willett | An investigation into the potential hypoalgesic effects of different amplitudes of PA mobilizations on the lumbar spine as measured by pressure pain thresholds. | UK | University | 30 | 9 | 21 | 26,43 (SD 4,92) | - Large oscillation (force applied) | Pressure | Digital algometer | Baseline before and + 24, + 24 | 13/30 physiotherapy naives | Yes |
- Small oscillation quasi static | |||||||||||||||
[18] | 2009 | Joel E. Bialosky, Mark D. Bishop, Michael E. Robinson, Giorgio Zeppieri Jr, Steven Z. George | Spinal manipulative therapy has an immediate effect on thermal pain sensitivity in people with low back pain: a randomized controlled trial. | USA | University | 36 | 10 | 26 | 32.38 (12.63) | - SMT | T° | Numerical scale | Before and Immediately after | Students with low back pain | No |
- Biking | |||||||||||||||
- Back extension exercise | |||||||||||||||
[19] | 2008 | J. Fernández-Carnero, Cesar Fernández-de-las-Peñas, and Joshua A. Cleland | Immediate hypoalgesic and motor effects after a single cervical manipulation in subjects with lateral epicondyalgia. | Spain | Universities and Osteopathic school Madrid | 10 | 5 | 5 | 42 (SD6) | - Manipulative session | T° and pressure | Electronic algometer | Before and after | Patients | Yes |
USA | - Manual contact intervention | ||||||||||||||
[39] | 2008 | C. Fernández-de-las-Peñas, C. Alonso-Blanco, J. A. Cleland, C. Rodriguez-Blanco and F.Alburquerque-Sendin | Changes in pressure pain thresholds over C5-C6 zygapophyseal joint after a cervicothoracic junction manipulation in healthy subjects. | Spain | Universities and Osteopathic school Madrid | 30 | 13 | 17 | 26 (SD 5) | - Manipulative thrust right side C7-T1 | Pressure | Algometer | Before and after | General population | Yes |
- Manipulative thrust left side C7-T1 | |||||||||||||||
USA | - Sham-manual procedure | ||||||||||||||
[20] | 2007 | M. Ruiz-Sáez, C. Fernández-de-las-Peñas, C. Rodriguez Blanco, R. Martinez-Segura and R. Garcia-León | Changes in pressure pain sensitivity in latent myofascial trigger points in the upper trapezius muscle after a cervical spine manipulation in pain-free subjects. | Spain | Osteopathic school | 72 | 27 | 46 | 31 (SD10) | - Manipulative | Pressure | Mechanical algometer | Baseline before 1, 5 and 10 min after | Volunteers, general population | Yes |
- Sham-manual | |||||||||||||||
[31] | 2007 | Fernández-de-las-Peñas C, Pérez-de-Heredia M, Brea-Rivero M, Miangolarra-Page JC. | Immediate effects on pressure pain threshold following a single cervical spine manipulation in healthy subjects. | Spain | Universities | 15 | 7 | 8 | 21 + −2 | - Manipulation | Pressure | Mechanical algometer | Before 5 min after intervention | Students | Yes |
- Placebo | 3 sessions separated by 48 h | ||||||||||||||
- Control | |||||||||||||||
[34] | 2007 | Hamilton L, Boswell C, Fryer G | The effects of high-velocity, low-amplitude manipulation and muscle energy technique on suboccipital tenderness. | Australia | University | 90 | 29 | 61 | 23 +/−5 | - SMT (C0- C1) | Pressure | Electronic algometer | Before and after | Students | Yes |
- Muscle energy technique | |||||||||||||||
- Control | |||||||||||||||
[36] | 2006 | George SZ, Bishop MD, Bialosky JE, Zeppieri G Jr, Robinson ME. | Immediate effects of spinal manipulation on thermal pain sensitivity: an experimental study. | USA | University | 60 | 20 | 40 | 24.03(SD 3.2° | - SMT | T° | Medoc neurosensory analyzer | Before and 5 min after | Students | Yes |
- Lumbar ext exercise | |||||||||||||||
- Bicycle riding | |||||||||||||||
[40] | 2004 | P.Mohammadi, A. Gonsalves, Chris Tsai, T. Hummel and Thomas Carpenter | Areas of capsaicin-induced secondary hyperalgesia and allodynia are reduced by a single chiropractic adjustment: preliminary study. | USA | Universities | 20 | 14 | 6 | 27 (21–37) | - SMT | Cutaneous capsaicin | Visual Analogue Scale | Before and 20 min after after | Healthy volunteers, mostly naive to SMT | Yes |
Germany | - Non-SMT | ||||||||||||||
[35] | 2004 | Fryer G, Carub J, McIver S. | The effect of manipulation and mobilization on pressure pain thresholds in the thoracic spine. | Australia | University | 96 | 39 | 57 | 19-34 | - SMT T2-T4 | Pressure | Electronic algometer | Before and after | Students | Yes |
- Mobilisation | |||||||||||||||
- Control | |||||||||||||||
[21] | 2001 | M. Sterling, G. Jull, A. Wright | Cervical mobilization: concurrent effects on pain, sympathetic nervous system activity and motor activity. | Canada | University | 30 | 14 | 16 | 35.7 (SD 14.92) | - SMT | Pressure / T° | Visual Analogue Scale, electronic algometer | Before and after | Patients pain +3 months C5/6 | Yes |
- Placebo | |||||||||||||||
- Control | |||||||||||||||
[32] | 1998 | Bill Vicenzino, David Collins and Anthony Wright | An investigation of the Interrelationship between manipulative therapy-Induced hypoalgesia and sympathoexcitation. | Australia | University | 24 | 11 | 13 | 49.0 (27–70) | - Mobilization C5-C6 | Pressure / T° | Visual Analogue Scale, digital algometer | Before and after | Patients epicond 6.2 +/− 5.1 months | Yes |
- Manual contact placebo | |||||||||||||||
- Nothing | |||||||||||||||
[33] | 1996 | Bill Vicenzino, David Collins and Anthony Wright | The initial effects of a cervical spine manipulative physiotherapy treatment on the pain and dysfunction of lateral epicondyalgia. | Australia | University | 15 | 7 | 8 | 44 +/−2 | - Treatment | Pressure | Visual Analogue Scale digital algometer | Before and after | Patients epicond 8 +/− 2 months | Yes |
- Placebo | |||||||||||||||
- Control | |||||||||||||||
[41] | 1984 | Terrett AC, Vernon H. | Manipulation and pain tolerance. A controlled study of the effect of spinal manipulation on paraspinal cutaneous pain tolerance levels. | Canada | Chiropractic college | 50 | ? | ? | 28.6 | - Thoracic manipulation | Electrical induction | Thresholds | Before and after | Chiropractic students | No |
- Control group |
Classifying articles by their quality
Data synthesis
Results
Description of studies
Data synthesis: Quality of studies
Article | Is the assessment blinded? | Is there a control on psychological characteristics of subjects? | The validity of the outcome variable: | When was it measured? | Is the random procedure mentioned? | Number of experiments (pain + SMT) | Study subjects: | SMT performed by: | Is the SMT well described? | Are losses and exclusions reported? | Experimental conditions | Estimates given | Are differences tested for statistical significance? | Total of points | |||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Yes = 2 pts No = 0 point | Points | Yes = 1 point No = 0 point | Points | Pilot study = 1 pts or ,Ref are given = 1 pt or, it's reproducible = 1 pt Nothing = 0 pt | Points (max 1 pt) | before and after = 1 point only after = 0 point | Points | Yes = 2 pts No = 0 point | Points | > 1 = 1 point 1 = 0 point | Points | Naive to tx and blind (sham manip) = 2 pts Naive or blind = 1 point Not naive and not blind = 0 pt | Points | Same person = 1 point Experienced person (> 5 years) = 1 point | Points (max 2 pts) | Yes = 1 point No = 0 point | Points | Yes = 2 pts No = 0 point | Points | same day or T° controlled or same time = 1 point different day and T° or time not controlled = 0 point | Points | Yes = 1 point No = 0 point | Points | Yes = 1 point No = 0 point | Points | Min = 0 Max = 18 | |
[39] | Yes | 2 | No | 0 | Ref given | 1 | Before and after | 1 | Yes | 2 | 3 | 1 | Blind | 1 | Same and experienced | 2 | Yes | 1 | Yes | 2 | Same day | 1 | Yes | 1 | Yes | 1 | 16 |
[21] | Yes | 2 | No | 0 | Reproducible | 1 | Before and after | 1 | Yes | 2 | 3 | 1 | Naive and blind | 2 | Same and experienced | 2 | Yes | 1 | No | 0 | Same day | 1 | Yes | 1 | Yes | 1 | 15 |
[31] | Yes | 2 | No | 0 | Ref given | 1 | Before and after | 1 | Yes | 2 | 3 | 1 | Blind | 1 | Experienced | 1 | Yes | 1 | Yes | 2 | T controlled | 1 | Yes | 1 | Yes | 1 | 15 |
[42] | Yes | 2 | No | 0 | Ref given | 1 | Before and after | 1 | Yes | 2 | 3 | 1 | Blind | 1 | Same and experienced | 2 | Yes | 1 | No | 0 | Same day | 1 | Yes | 1 | Yes | 1 | 14 |
[29] | Yes | 2 | No | 0 | Ref given | 1 | Before and after | 1 | Yes | 2 | 3 | 1 | Naive | 1 | Same and experienced | 2 | Yes | 1 | No | 0 | Same day | 1 | Yes | 1 | Yes | 1 | 14 |
[44] | No | 0 | No | 0 | Ref given | 1 | Before and after | 1 | Yes | 2 | 3 | 1 | Naive and blind | 2 | Same and experienced | 2 | Yes | 1 | Yes | 2 | More 48 H, no control T° | 0 | Yes | 1 | Yes | 1 | 14 |
[38] | Yes | 2 | No | 0 | Ref given | 1 | Before and after | 1 | Yes | 2 | 3 | 1 | Blind | 1 | Same and experienced | 2 | Yes | 1 | No | 0 | Same day | 1 | Yes | 1 | Yes | 1 | 14 |
[34] | Yes | 2 | No | 0 | Ref given | 1 | Before and after | 1 | Yes | 2 | 3 | 1 | Naive | 1 | Same and experienced | 2 | Yes | 1 | No | 0 | Same day? | 1 | Yes | 1 | Yes | 1 | 14 |
[35] | Yes | 2 | No | 0 | Ref given | 1 | Before and after | 1 | Yes | 2 | 3 | 1 | Naive | 1 | Same and experienced | 2 | Yes | 1 | No | 0 | Same day? | 1 | Yes | 1 | Yes | 1 | 14 |
[37] | Yes | 2 | No | 0 | Ref given | 1 | Before and after | 1 | Yes | 2 | 3 | 1 | Nothing | 0 | Same and experienced | 2 | Yes | 1 | No | 0 | Same day | 1 | Yes | 1 | Yes | 1 | 13 |
[28] | Yes | 2 | No | 0 | Ref given | 1 | Before and after | 1 | Yes | 2 | 3 | 1 | Naive and blind | 2 | Experienced | 1 | Yes | 1 | No | 0 | More 48 H, no control T° | 0 | Yes | 1 | Yes | 1 | 13 |
[43] | No | 0 | No | 0 | Ref given | 1 | Before and after | 1 | Yes | 2 | 3 | 1 | Naive and blind | 2 | Same | 1 | Yes | 1 | Yes | 2 | More 3 days, no control T° | 0 | Yes | 1 | Yes | 1 | 13 |
[20] | Yes | 2 | No | 0 | Ref given | 1 | Before and after | 1 | Yes | 2 | 3 | 1 | Blind | 1 | Experienced | 1 | Yes | 1 | No | 0 | Same day | 1 | Yes | 1 | Yes | 1 | 13 |
[40] | Yes | 2 | No | 0 | Reproducible | 1 | Before and after | 1 | Yes | 2 | 2 | 1 | Naive and blind | 2 | Experienced | 1 | Yes | 1 | No | 0 | More 7 days, no control T° | 0 | Yes | 1 | Yes | 1 | 13 |
[18] | No | 0 | Yes | 1 | Ref given | 1 | Before and after | 1 | Yes | 2 | 2 | 1 | Nothing | 0 | Nothing | 0 | Yes | 1 | Yes | 2 | Same day | 1 | Yes | 1 | Yes | 1 | 12 |
[19] | Yes | 2 | No | 0 | Ref given | 1 | Before and after | 1 | No | 0 | 3 | 1 | Blind | 1 | Same and experienced | 2 | Yes | 1 | No | 0 | More 48 H, no control T° | 0 | Yes | 1 | Yes | 1 | 11 |
[32] | Yes | 2 | No | 0 | Ref given | 1 | Before and after | 1 | No | 0 | 3 | 1 | Naive and blind | 2 | Nothing | 0 | Yes | 1 | No | 0 | More 3 days, control T° | 1 | Yes | 1 | Yes | 1 | 11 |
[30] | Yes | 2 | No | 0 | Ref given | 1 | Before and after | 1 | No | 0 | 3 | 1 | Blind to sham laser | 1 | Nothing | 0 | Yes | 1 | No | 0 | Same day | 1 | Yes | 1 | Yes | 1 | 10 |
[36] | No | 0 | Yes | 1 | Ref given | 1 | Before and after | 1 | Yes | 2 | 10 | 1 | Nothing | 0 | Nothing | 0 | Yes | 1 | No | 0 | Same day | 1 | Yes | 1 | Yes | 1 | 10 |
[41] | Yes | 2 | No | 0 | Ref given | 1 | Before and after | 1 | Yes | 2 | 1 | 0 | Nothing | 0 | Nothing | 0 | Yes | 1 | No | 0 | Same day | 1 | Yes | 1 | Yes | 1 | 10 |
[33] | Yes | 2 | No | 0 | Ref given | 1 | Before and after | 1 | No | 0 | 3 | 1 | Naive and blind | 2 | Nothing | 0 | No | 0 | No | 0 | More 3 days, no control T° | 0 | Yes | 1 | Yes | 1 | 9 |
[23] | No | 0 | Yes | 1 | Ref given | 1 | Before and after | 1 | No | 0 | 2 | 1 | Nothing | 0 | Nothing | 0 | yes | 1 | No | 0 | Highly controlled | 1 | Yes | 1 | Yes | 1 | 8 |
Article | Score Max = 8 | Score Max = 18 |
---|---|---|
[39] | 6 | 16 |
[31] | 7 | 15 |
[21] | 6 | 15 |
[42] | 5 | 14 |
[29] | 5 | 14 |
[44] | 6 | 14 |
[38] | 5 | 14 |
[35] | 5 | 14 |
[34] | 5 | 14 |
[28] | 6 | 13 |
[43] | 6 | 13 |
[20] | 5 | 13 |
[40] | 6 | 13 |
[37] | 4 | 13 |
[18] | 4 | 12 |
[19] | 3 | 11 |
[32] | 4 | 11 |
[30] | 3 | 10 |
[36] | 2 | 10 |
[41] | 4 | 10 |
[33] | 4 | 9 |
[23] | 0 | 8 |
Article | Is the assessment blinded? | Is the randomization procedure mentioned? | Study subjects: | Were losses and exclusions reported? | Total points | ||||
---|---|---|---|---|---|---|---|---|---|
Yes = 2 pts | Points | Yes = 2 pts | Points | Naive to tx and blind | Points | Yes = 2 pts | Points | Max = 8 Min = 0 | |
[31] | Yes | 2 | Yes | 2 | Blind | 1 | Yes | 2 | 7 |
[28] | Yes | 2 | Yes | 2 | Naive and blind | 2 | No | 0 | 6 |
[44] | No | 0 | Yes | 2 | Naive and blind | 2 | Yes | 2 | 6 |
[43] | No | 0 | Yes | 2 | Naive and blind | 2 | Yes | 2 | 6 |
[40] | Yes | 2 | Yes | 2 | Naive and blind | 2 | No | 0 | 6 |
[21] | Yes | 2 | Yes | 2 | Naive and blind | 2 | No | 0 | 6 |
[39] | Yes | 2 | Yes | 2 | Blind | 1 | Yes | 2 | 6 |
[42] | Yes | 2 | Yes | 2 | Blind | 1 | No | 0 | 5 |
[29] | Yes | 2 | Yes | 2 | Naive | 1 | No | 0 | 5 |
[38] | Yes | 2 | Yes | 2 | Blind | 1 | No | 0 | 5 |
[20] | Yes | 2 | Yes | 2 | Blind | 1 | No | 0 | 5 |
[34] | Yes | 2 | Yes | 2 | Naive | 1 | No | 0 | 5 |
[35] | Yes | 2 | Yes | 2 | Naive | 1 | No | 0 | 5 |
[37] | Yes | 2 | Yes | 2 | Nothing | 0 | No | 0 | 4 |
[18] | No | 0 | Yes | 2 | Nothing | 0 | Yes | 2 | 4 |
[32] | Yes | 2 | No | 0 | Naive and blind | 2 | No | 0 | 4 |
[33] | Yes | 2 | No | 0 | Naive and blind | 2 | No | 0 | 4 |
[41] | Yes | 2 | Yes | 2 | Nothing | 0 | No | 0 | 4 |
[30] | Yes | 2 | No | 0 | Blind to sham laser | 1 | No | 0 | 3 |
[19] | Yes | 2 | No | 0 | Blind | 1 | No | 0 | 3 |
[36] | No | 0 | Yes | 2 | Nothing | 0 | No | 0 | 2 |
[23] | No | 0 | No | 0 | Nothing | 0 | No | 0 | 0 |
Limitations given by authors | |
---|---|
[37] | Short term effect. Unable to project results on duration. |
Small sample of patients. | |
Did not include control group. | |
[42] | 4 different muscle situations assessed (rest, isotonic contraction and 2 isometric contractions) (Is it enough?) |
Duration (only immediate effect assessed). | |
Pop sound may have a placebo effect. | |
[23] | Healthy subjects. |
Unable to describe duration of effects. | |
[28] | Pain-free patients. |
Style, contacts or force used in the mobilization procedures. | |
[29] | Duration. Unable to project results on duration. |
Widespread to other areas? | |
Subthreshold pain stimulation, what about real pain? | |
Latent trigger points, subjects who may not be typical population. | |
Control group did not receive an intervention; maybe pop sound has a placebo effect. | |
[44] | Lack of control and placebo groups. |
Short term effect. Unable to project results on duration. | |
Did not take into account subject innate stiffness. | |
[38] | Short term effect. Unable to project results on duration. |
Placebo effect of cavitation. | |
Only women. | |
[30] | Algometer was not very precise. |
[43] | - |
[18] | Assessment not blind. |
Chronic low back pain. | |
Temporal summation as an indirect measure of central sensitization has been proven only in animals. | |
[19] | Short term effect. Unable to project results on duration. |
Possible placebo effect of cavitation. | |
Small sample of patients. | |
[39] | Short term effect. Unable to project results on duration. |
Not patients. | |
Possible placebo effect of cavitation. | |
PPT | |
[20] | Short term effect. Unable to project results on duration. |
Placebo effect of cavitation. | |
Healthy people, not patients. | |
[31] | Short term effect. Unable to project results on duration. |
Possible placebo effect of cavitation. | |
Healthy people, not patients. | |
[36] | Short term effect. Unable to project results on duration. |
Possible placebo effect of cavitation. | |
Healthy people, not patients. | |
No control, no sham group. | |
[40] | - |
[21] | - |
[32] | - |
[33] | - |
[41] | - |
[35] | - |
[34] | - |
Data synthesis: Answers to research questions
Systemic effect | Regional effect | Local or same metamere | |
---|---|---|---|
SMT relieved pain | [23]* -Cervical SMT/hand- foot T° | [42] – C5-C6 SMT / deltoid PPT | [37]– C5-C6 SMT/ Elbow PPT |
[44]* -Lumbar Mob/hand PPT | [29] – Atlantooccipital SMT/masseter PPT | [44] – Lumbar mob/ L2 L5 (foot) PPT | |
[43]* - Lumbar SMT/ deltoid PPT | [38] - Atlantooccipital SMT/sphenoid PPT | [19] - C5-C6 SMT/ Elbow PPT | |
[18]* -Lumbar SMT/hand- foot PPT | [30] - Lumbar SMT/ 1st segment below PPT | [20] – C3-C4 SMT/ Trapezius PPT 5’ | |
[18]* -Lumbar SMT/hand- foot T° | [43]* - Lumbar SMT/ L3 PPT | [20] – C3-C4 SMT/ Trapezius PPT 10’ | |
[36]* -Lumbar SMT/hand- foot T° | [39] – C7-T1 SMT/ C5-C6 PPT | [31] - C5-C6 SMT/ Elbow PPT | |
[39] – C7-T1 SMT/ C5-C6 PPT | [21] - C5-C6 SMT/ Elbow PPT | ||
[40] – Areas of stroking allodynia thorax SMT/ forearm | [21] - C5-C6 SMT/ Elbow spontaneous pain | ||
[40] – Mechanical hyperalgesia thorax SMT/ forearm | [32]- C5-C6 SMT/ Elbow PPT | ||
[40] – Spontaneous pain thorax SMT/ forearm | [33] - C5-C6 SMT/ Elbow PPT | ||
[33] –C5-C6 SMT/ Elbow stretch test | |||
[41]- Thoracic SMT/ spinous process electricity | |||
[35]- Thoracic SMT/ Thoracic PPT | |||
SMT did not relieve pain | [23]* - Cervical SMT/hand- foot 1st Pain T° | [37] – T5-T8 SMT (sham SMT)/ Elbow PPT | [42] – C5-C6 SMT / Trapezius PPT |
[23]* - Cervical SMT/hand- foot PPT | [28]** – C5-C6 Mob(AP)/ C5-C6 PPT | ||
[18]* – Lumbar SMT/hand- foot 1st Pain T° | [19] - C5-C6 SMT/ Elbow Cold | ||
[36]* –Lumbar SMT/hand- foot 1st Pain T° | [19] - C5-C6 SMT/ Elbow Hot | ||
[20]*** C3-C4 SMT/ Trapezius PPT0’ | |||
[32] - C5-C6 SMT/ Elbow Temp PPT | |||
[33] –C5-C6 SMT/ Elbow spontaneous pain | |||
[34]- C0-C1SMT/ C2 PPT |
Systemic effect | Regional effect | Local or same metamere | |
---|---|---|---|
SMT relieved pain | [23]* -Cervical SMT/hand- foot T° | [42] – C5-C6 SMT / deltoid PPT | [37] – C5-C6 SMT/ Elbow PPT |
[44]* -Lumbar Mob/hand PPT | [29] – Atlantooccipital SMT/masseter PPT | [44] – Lumbar mob/ L2 L5 (foot) PPT | |
[43]* - Lumbar SMT/ deltoid PPT | [38] - Atlantooccipital SMT/sphenoid PPT | K - C5-C6 SMT/ Elbow PPT | |
[18]* -Lumbar SMT/hand- foot PPT | [30] - Lumbar SMT/ 1st segment below PPT | [20] – C3-C4 SMT/ Trapezius PPT 5’ | |
[18]* -Lumbar SMT/hand- foot T° | [43]* - Lumbar SMT/ L3 PPT | [20] – C3-C4 SMT/ Trapezius PPT 10’ | |
[36]* -Lumbar SMT/hand- foot T° | [39] – C7-T1 SMT/ C5-C6 PPT | [31] - C5-C6 SMT/ Elbow PPT | |
[39] – C7-T1 SMT/ C5-C6 PPT | [21] - C5-C6 SMT/ Elbow PPT | ||
[40]– Areas of stroking allodynia thorax SMT/ forearm | [21]- C5-C6 SMT/ Elbow spontaneous pain | ||
[40] – Mechanical hyperalgesia thorax SMT/ forearm | [32]- C5-C6 SMT/ Elbow PPT | ||
[40] – Spontaneous pain thorax SMT/ forearm | [33] - C5-C6 SMT/ Elbow PPT | ||
[33] –C5-C6 SMT/ Elbow stretch test | |||
[41]- Thoracic SMT/ spinous process electricity | |||
[35]- Thoracic SMT/ Thoracic PPT | |||
SMT did not relieve pain | [23]* - Cervical SMT/hand- foot 1st Pain T° | [37] – T5-T8 SMT (sham SMT)/ Elbow PPT | [42] – C5-C6 SMT / Trapezius PPT |
[23]* - Cervical SMT/hand- foot PPT | [28]** – C5-C6 Mob(AP)/ C5-C6 PPT | ||
[18]* – Lumbar SMT/hand- foot 1st Pain T° | [19]- C5-C6 SMT/ Elbow Cold | ||
[36]* –Lumbar SMT/hand- foot 1st Pain T° | [19] - C5-C6 SMT/ Elbow Hot | ||
[20]*** – C3-C4 SMT/ Trapezius PPT0’ | |||
[32] - C5-C6 SMT/ Elbow Temp PPT | |||
[33] –C5-C6 SMT/ Elbow spontaneous pain | |||
[34]- C0-C1SMT/ C2 PPT |
Art | Effect of SMT on pain | Site of SMT/pain | Values | Local/regional/ systemic effect | Same/opposite side | Above/below | Pain form |
---|---|---|---|---|---|---|---|
[37] | The application of a cervical SMT, but not thoracic SMT, resulted in immediate bilateral hypoalgesic effect in patients with lateral epicondylitis. | SMT C5-C6 and T5-T8 /PPT both epicondyles | Changes PPT in KiloPascals (differences) PPT Cervical Thoracic affected side 88.6 (35.1%) 18.6 (0.8%) unaffected side 95.6 (25.4%) -40.5 (−0.9%) | Effect within the same segment. Used SMT caudal level as placebo with no effect. | No significant differences between L and R side | Effect within the same segment. Used SMT caudal level as placebo with no effect. | Pressure |
[42] | On deltoid, small effect at the same segment. Didn't work on trapezius and C5 | SMT C5-C6 right / PPT upper trapezius, deltoid and C5 spinous process | Changes PPT in Kg/cm² (differences) PPT SMT Control Trapezius ipsilateral 0.2 0.3 Trapezius contralateral 0.4 0.1 Deltoid ipsilateral 0.3 -0.2 Deltoid contralateral 0.2 -0.2 C5 spinous process 0.1 -0.1 | Small effect within the same segment | Comparison of sides baseline in Table2, but no differences p>.523 Bilateral increases of PPT | - | Pressure |
[23] | SMT reduced TSS (temporal sensory summation) but not PPT | Lower cervical and upper thoracic region / T° on hand + popliteal fossa | PPT increased for all groups (not only SMT) from pre to post SMT (F=9.6, partial N²=0.10)= SMT produced a significant reduction in TSS (p=.003) | Averages of lower extremity values were higher than upper extremity values | - | SMT worked at the same level or below | Pressure and Temperature (T°) |
[28] | No effect | Cervical mobilization left C5-C6 / PPT left and right articular pillar of C5-C6 | Differences PPT pre/post treatment Kpa F=0.168 p=0.168 Treatment 15.98 (+/− 4.8%) Manual contact 4.61 (+/− 0.2%) No contact 12.29 (+/− 3.5%) | No effect at same segment | - | - | Pressure |
[29] | Small immediate increase of PPT | SMT atlantooccipital/ PPT on trigger points in the masseter and temporalis muscles | Differences before/after SMT in Kg/cm²: SMT = 0.29 (10%) Soft mobilization = 0.00 control= 0.019 | Regional effect of atlantooccipital SMT and effect on trigeminal area | - | - | Pressure |
[44] | Hypoaglesia significant at test site and without differences between the rates of mobilization | Lumbar mobilization/L2 dermatome(thigh), L5 (foot), hand and L5 paraspinal | Mean of changes: 19,6% paraspinal muscles 14,2% L2 dermatome 13,4% L5 dermatom 12% hand (this suggest that changes are systemic) | lumbar hypoalgesia was greater than distal (P=0.0028) | - | SMT more effective on lumbar dermatomes than more cephalad dermatomes | Pressure |
[38] | Small effect regionally | SMT atlantooccipital/ PPT over both sides of sphenoid bone (V) | PPT effect on group and time F=14.4 (p<0.001) SMT = 3.5 kg/cm² control = − 0.1 kg/cm² | Regional level. | - | - | Pressure |
[30] | Mobilization had a stronger effect on pain than SMT | SMT 1 segment below marked PPT (lumbar) | Mobilization = small increase (0.434 kg/cm² d= 0.78) SMT = decrease ( −0.173 d= 0.36) Control = small decrease (−0.105 d= 0.25) but ANOVA further revealed non signification between groups. | Local and systemic effect but PPT values increase in a caudal direction | - | - | Pressure |
[43] | No differences between amplitudes (p= 0.864) | lumbar mobilization/ 1- right erector spinae (L3) 2- left patella (L3 dermatome) 3- proximal lateral sruface of left 5th metatarsal (S1 dermatome) 4- deltoid | PPT A B C 1 18.73% 14.57% 15.48% 2 17.93% 9.93% 10.67% 3 10.53% 15.57% 8.81% 4 19.06% 18.60% 11.69% | Local and systemic effect | - | - | Pressure |
[18] | Significant changes in temporal summation, only for SMT | Lumbar SMT/ temporal summation on plantar surface (non dominant) and palmar surface (non dominant). Aδ fibers mediated pain sensitivity in non dominant forearm and calf | Lumbar (local response): A- Aδ fibers sensibility: no differences between groups at 47°C(p= .73), or 49°C (p= . 96) No effect of time at 47°C (p= .31) or 49°C (p= . 94) No changes in Aδ fibers B- temporal summation: F= 3,41 (p= . 05), different by group assignment = Changes in temporal summation Cervical (general response): A- No changes in Aδ fibers B- temporal summation: SMT group F= 6,78 (p= . 40), all groups had a decrease in temporal summation = Changes in temporal summation | Systemic effect, except for first pain. | - | - | T°differences Numeric Rating Scale (0–100) Before/after: Bike = −3,7 LE Exercise = 2,5 SMT= 19,9 |
[19] | Effect demonstrated for PPT but not for T° | SMT C5-C6 dominant side (right) / PPT , thermal pain thresholds (HPT - CPT) on lateral epicondyles (both sides) | Differences SMT Control PPT ipsilateral 121.5 (44.2%) 13.3 ( 4.4%) PPT contralateral 74.4 (17.7%) 6.1(1.7%) HPT ipsilateral (°C) 1.2 (2.9%) 0.7 (2.2%) HPT contralateral 1.5 (4.1%) -0.9 (1.9%) CPT ipsilateral −0.25(9.2%) -1.5 (9.6%) CPT contralateral 0.9 ( 18.1%)-1.0 (17.4%) | Same segment | Bilateral increase of PPT. No significant changes for T° | - | Pressure and T° |
[39] | SMT changes PPT in both R and L C5-C6 zygapophyseal joints in healthy subjects | SMT C7-T1 / PPT C5-C6 zygapophyseal joints | Differences on PPT before/after: Right side SMT dominant: 53.1 SMT non-dominant: 80.7 Placebo: -2.7 Left side SMT dominant: 45.9 SMT non-dominant: 48.0 Placebo: -3.9 | Effect at regional level | SMT changes PPT in both R and L C5-C6 zygapophyseal. joints in healthy subjects | SMT is also effective above and below of segment treated | Pressure |
[20] | SMT changes pressure pain sensitivity in triggers points in the upper trapezius | SMT C3-C4 / PPT upper trapezius trigger points (TrPs) | Differences pre/post SMT in Kg/cm² D ifference Placebo SMT Pre post −0.06 d=0.35 0.08 d=0.4 Pre - 5' -0.2 d=1.1 0.1 d=0.5 Pre - 10' -0.22 d=1.1 0.12 d=0.44 | Regional level | - | - | Pressure |
[31] | SMT changes pressure pain sensitivity in epicondyles | SMT C5-C6 both sides / PPT on lateral epicondyles (both sides) | Differences in Kg/cm² SMT ipsilateral 0.8 ( 35.5%) SMT contralateral 0.5 (24.8%) Placebo Ipsilateral 0.003(0.5%) Placebo contralateral 0.006 (0.4%) Control ipsilateral 0.003(0.5%) Control contralateral 0.006 (2.1%) | Same segment | No differences between L and R sides | - | Pressure |
[36] | SMT produces hypoalgesia in lumbar area but not in cervical (control) but no effect on 1st pain | Lumbar SMT/ TSS in plantar surface (non dominant) and palmar surface (non dominant). Aδ fibers mediated pain sensitivity in non dominant forearm and calf | Lumbar Innervated NRS Change 47°C 13.2 (17.2) 12.9 (17.9) 23.5 (17.3) NRS Change 49°C 1.2 (20.2) 6.3 (22.4) 12.1 (19.7) Cervical Innervated NRS Change 47°C −3.0 (13.7) 0.3 (11.6) 0.3 (10.2) NRS Change 49°C 1.9 (9.0) -0.4 (10.1) 1.7 (10.8) NRS= Numeric rating scale | Effect at regional level but not at systemic level | - | Effect at the same level, but not above | T° |
[40] | Allodynia and hyperalgesia decrease with SMT | Non specific thoracic SMT / left and right forearm (capsaicin) | Pre-SMT Post-SMT Pre-sham Post-Sham Hyperalgesia(cm²) 53 31 39 56 Allodynia (cm²) 40 18 28 40 Spontaneous pain (ratings) 4.9 3.3 3.9 4.2 | SMT decreases allodynia at regional level | - | - | Capsaicin |
[21] | Effect on PPT | SMT C5-C6 / PPT over symptomatic segment, T°PT | PPT increases p: < 0.05 +/− 0.? % control +/− 2.?% placebo +/− 22.55 SMT VAS didn't work | Regional level | - | - | Pressure |
[32] | Mobilization has an effect on pressure pain, not on temperature | Mobilization C5-C6 / PPT both elbows | PPT increases p: < 0.05 +/− −4.? % control +/− −7.?% placebo +/− 29 % SMT TPT didn't work | Regional level. | - | - | Pressure and T° |
[33] | Increase of PPT | SMT cervical C5-C6 / PPT both elbows | Changes pre/post treatment SMT +/− 26% Placebo +/− −12% Control +/− 0.2% | Regional level. | - | - | Pressure |
[41] | Elevation of pain tolerance in manipulated group | Thoracic manipulation/ Electric thresholds left and right articular pillar | Intensity of current in mAmp SMT Control Baseline 1.37 1.62 30'' 2.05 1.46 2 min 2.43 1.46 5 min 2.70 1.56 10 min 3.30 1.86 | Local level. | - | - | Electrical induction |
[34] | No significant differences | SMT C0-C1/ PPT C2 | preHVLA-HVLA -5’ -39.37 (76.07) Kpa (SD) preHVLA-HVLA-30’ -15.89 (87.50) preMET-MET-5’ -42.03 (62.37) preMET-MET-30’ -30.00 (69.53) preControl-Control-5’ -15.88 (83.62) preControl-Control-30’ -16.12 (62.49) | Local level. | - | - | Pressure |
[35] | Mobilization and manipulation both produced a statistically significant increase in PPT in the thoracic spines of asymptomatic subjects. Mobilization more than SMT. | Thoracic manipulation T1-T4/ PPT on most tender thoracic vertebra | Differences PPT pre/post treatment Kpa (SD) Manipulation Mobilisation Control Pre-intervention 243.70 (95.22) 204.6 (85.52) 218.71 (82.91) Post-intervention 244.64 (91.59) 216.51 (90.50) 47.13 (96.87) Difference 0.94 (35.07) 11.88 (31.83) 28.42 (39.68) | Local level. | - | - | Pressure |