Manipulation's Mechanisms on EIM

[Jason Silvernail]

Here's an interesting post from Dr Rob Wainner, a very talented and well educated PT, over on EIM. He's a great guy, as well. Notice his remarks re: biomechanics vs neurophysiology...

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Manipulation and Underlying Mechanisms
In one of the daily EIM feeds I receive I noticed this link: Immediate effects of spinal manipulation on thermal pain sensitivity: an experimental study. It points to a study published by Steve George and his colleagues in BMC Online.

Although much of the recent and past work has rightfully focused on the question of “Is manipulation effective”, this study attempts to ask the question of “Why”.

Most manual therapists have opinions about this topic, but if this study is any indication of what is to come, then folks who dogmatically hold to a biomechanical rational better start reviewing their neurophysiology.

To all my EIM Bloggin' Homies........have a GREAT WEEKEND!!!!!


Rob

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Link here: http://blog.evidenceinmotion.com/evidence/2006/08/manipulation_an.html

Comments, anyone? On EIM or here??

J

[bernard]

BMC Musculoskelet Disord. (javascript:AL_get(this, 'jour', 'BMC Musculoskelet Disord.');) 2006 Aug 15;7(1):68 [Epub ahead of print] Related Articles, (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Display&dopt=pubmed_pubmed&from_uid=16911795&tool=ExternalSearch) Links (javascript:PopUpMenu2_Set(Menu16911795);) http://www.ncbi.nlm.nih.gov/entrez/query/egifs/http:--www.biomedcentral.com-graphics-pubmed-bmc.gif (http://www.ncbi.nlm.nih.gov/entrez/utils/lofref.fcgi?itool=Abstract-def&PrId=3196&uid=16911795&db=PubMed&url=http://www.biomedcentral.com/1471-2474/7/68)
Immediate effects of spinal manipulation on thermal pain sensitivity: an experimental study.

George SZ (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Search&itool=pubmed_Abstract&term=%22George+SZ%22%5BAuthor%5D), Bishop MD (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Search&itool=pubmed_Abstract&term=%22Bishop+MD%22%5BAuthor%5D), Bialosky JE (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Search&itool=pubmed_Abstract&term=%22Bialosky+JE%22%5BAuthor%5D), Zeppieri G Jr (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Search&itool=pubmed_Abstract&term=%22Zeppieri+G+Jr%22%5BAuthor%5D), Robinson ME (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Search&itool=pubmed_Abstract&term=%22Robinson+ME%22%5BAuthor%5D).

ABSTRACT: BACKGROUND: The underlying causes of spinal manipulation hypoalgesia are largely unknown. The beneficial clinical effects were originally theorized to be due to biomechanical changes, but recent research has suggested spinal manipulation may have a direct neurophysiological effect on pain perception through dorsal horn inhibition. This study added to this literature by investigating whether spinal manipulation hypoalgesia was: a) local to anatomical areas innervated by the lumbar spine; b) correlated with psychological variables; c) greater than hypoalgesia from physical activity; and d) different for A-delta and C-fiber mediated pain perception. METHODS: Asymptomatic subjects (n = 60) completed baseline psychological questionnaires and underwent thermal quantitative sensory testing for A-delta and C-fiber mediated pain perception. Subjects were then randomized to ride a stationary bicycle, perform lumbar extension exercise, or receive spinal manipulation. Quantitative sensory testing was repeated 5 minutes after the intervention period. Data were analyzed with repeated measures ANOVA and post-hoc testing was performed with Bonferroni correction, as appropriate. RESULTS: Subjects in the three intervention groups did not differ on baseline characteristics. Hypoalgesia from spinal manipulation was observed in lumbar innervated areas, but not control (cervical innervated) areas. Hypoalgesic response was not strongly correlated with psychological variables. Spinal manipulation hypoalgesia for A-delta fiber mediated pain perception did not differ from stationary bicycle and lumbar extension (p > 0.05). Spinal manipulation hypoalgesia for C-fiber mediated pain perception was greater than stationary bicycle riding (p = 0.040), but not for lumbar extension (p = 0.105). CONCLUSION: Local dorsal horn mediated inhibition of C-fiber input is a potential hypoalgesic mechanism of spinal manipulation for asymptomatic subjects, but further study is required to replicate this finding in subjects with low back pain.

PMID: 16911795 [PubMed - as supplied by publisher]

[Jon Newman]

Hi Jason,

Thanks. I look forward to reading the article and I'm encouraged by the effort.