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. 2017 Sep;25(4):172-181.
doi: 10.1080/10669817.2016.1230352. Epub 2016 Sep 12.

Spinal manipulation does not affect pressure pain thresholds in the absence of neuromodulators: a randomized controlled trial

Max K Jordon  1 , Paul F Beattie  1 , Sarah D'Urso  1 , Sarah Scriven  1
Affiliations

Spinal manipulation does not affect pressure pain thresholds in the absence of neuromodulators: a randomized controlled trial

Max K Jordon et al. J Man Manip Ther. 2017 Sep.

Abstract

Background: Measurement of pressure pain threshold (PPT) is a way to determine one of the many potential treatment effects of spinal manipulative therapy.

Objective: To determine how multiple spinal manipulations administered in a single-session affected PPTs at local and distal sites in asymptomatic individuals.

Methods: Participants were randomly assigned into one of three groups: Group one (n = 18) received a lumbar manipulation followed by a cervical manipulation. Group two (n = 17) received a cervical manipulation followed by a lumbar manipulation. The control group (n = 19) received two bouts of five minutes of rest. At baseline and after each intervention or rest period, each participant's PPTs were obtained using a handheld algometer. The PPTs were tested bilaterally over the lateral epicondyles of the humerus and over the mid-bellies of the upper trapezius, lumbar paraspinal, and the tibialis anterior muscles. This study was registered with ClinicalTrials.gov, and its Identifier is NCT02828501.

Results: Repeated-measures ANOVAs and Kruskal-Wallis tests showed no significant within- or between-group differences in PPT. Within-group effect sizes in the changes of PPT ranged from -.48 at the left paraspinal muscles to .24 at the left lateral humeral epicondyle. Statistical power to detect significant differences at α of 0.05 was calculated to be 0.94.

Conclusions: This study suggests that in young adults who do not have current or recent symptoms of spinal pain, multiple within-session treatments of cervical and lumbar spinal manipulation fail to influence PPTs. Changes in PPT that are observed in symptomatic individuals are likely to be primarily influenced by pain-related neuromodulators rather than by an isolated, mechanical effect of spinal manipulation.

Keywords: Neuromodulation; pain mechanisms; spinal pain.

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Figures

Figure 1.
Figure 1.
Flow of study.
Figure 2.
Figure 2.
Spinal manipulative treatments. (A) Mid-cervical rotational manipulation. (B) Lower lumbar rotational manipulation.
Figure 3.
Figure 3.
Locations of PPT measurements. (A) Upper trapezius. (B) Tibialis anterior. (C) Lateral epicondyle. (D) Lumbar paraspinals at L4.
See this image and copyright information in PMC

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