Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Chiropractic & Manual Therapies
Published in: Chiropractic & Manual Therapies 1/2016

Open Access 01-12-2016 | Research

Effect of lumbar spinal manipulation on local and remote pressure pain threshold and pinprick sensitivity in asymptomatic individuals: a randomised trial

Authors: Sasha L. Dorron, Barrett E. Losco, Peter D. Drummond, Bruce F. Walker

Published in: Chiropractic & Manual Therapies | Issue 1/2016

Login to get access

Abstract

Background

The mechanisms of clinical pain relief associated with spinal manipulative therapy (SMT) are poorly understood. Our objective was to determine whether lumbar high-velocity low-amplitude SMT altered pressure pain threshold (PPT) and pinprick sensitivity (PPS) locally and remotely, how long any change lasted (up to 30 min), and whether changes related to the side of SMT.

Methods

Thirty-four asymptomatic participants (mean age 22.6 years ±4.0) received a right- or left-sided lumbar SMT. PPT and PPS were measured bilaterally at the calf, lumbar spine, scapula, and forehead before and immediately, 10, 20, and 30 min after intervention. Data were collected between October 2014 and June 2015.

Results

Bilateral calf and lumbar spine PPT increased significantly after 10 – 20 min and was maintained at 30 min (7.2–11.8 % increase). PPS decreased significantly in all locations at various times (9.8 – 22.5 % decrease). At the calf and lumbar spine, PPT increased slightly more ipsilateral to the SMT than contralateral.

Conclusions

Lumbar SMT reduced deep pressure sensitivity locally and in the lower limbs for at least 30 min, whereas sensitivity to pinprick was reduced systemically. These findings suggest that SMT specifically inhibits deep pressure sensitivity distally. These findings are novel compared to other lumbar SMT studies, and may reflect a local spinal or complex supraspinal analgesic mechanism.

Trial registration

Registered with the Australian New Zealand Clinical Trials Registry (ACTRN12614000682​640).
Appendix
Available only for authorised users
Literature
1.
Hurwitz EL. Epidemiology: spinal manipulation utilization. J Electromyogr Kinesiol. 2012;22(5):648–54.CrossRefPubMed
2.
Bronfort G, Evans R, Anderson AV, Svendsen KH, Bracha Y, Grimm RH. Spinal manipulation, medication, or home exercise with advice for acute and subacute neck pain: a randomized trial. Ann Intern Med. 2012;156(1 Pt 1):1–10.CrossRefPubMed
3.
Bryans R, Descarreaux M, Duranleau M, Marcoux H, Potter B, Ruegg R, et al. Evidence-based guidelines for the chiropractic treatment of adults with headache. J Manipulative Physiol Ther. 2011;34(5):274–89.CrossRefPubMed
4.
Goertz CM, Pohlman KA, Vining RD, Brantingham JW, Long CR. Patient-centered outcomes of high-velocity, low-amplitude spinal manipulation for low back pain: a systematic review. J Electromyogr Kinesiol. 2012;22(5):670–91.CrossRefPubMed
5.
Gross A, Miller J, D’Sylva J, Burnie SJ, Goldsmith CH, Graham N, Haines T, Brønfort G, Hoving JL. Manipulation or mobilisation for neck pain. Cochrane Database Syst Rev. 2010;(1):CD004249 DOI: 10.​1002/​14651858.​CD004249.​pub3.
6.
Schneider M, Haas M, Glick R, Stevans J, Landsittel D. A comparison of spinal manipulation methods and usual medical care for acute and Sub-acute low back pain: a randomized clinical trial. Spine (Phila Pa 1976). 2015;40(4):209–17.CrossRef
7.
Rubinstein SM, van Middelkoop M, Assendelft WJ, de Boer MR, van Tulder MW. Spinal manipulative therapy for chronic low-back pain: an update of a Cochrane review. Spine (Phila Pa 1976). 2011;36(13):E825–46.CrossRef
8.
Walker BF, Muller R, Grant WD. Low back pain in Australian adults: the economic burden. Asia Pac J Public Health. 2003;15(2):79–87.CrossRefPubMed
9.
Hoy D, Bain C, Williams G, March L, Brooks P, Blyth F, et al. A systematic review of the global prevalence of low back pain. Arthritis Rheum. 2012;64(6):2028–37.CrossRefPubMed
10.
Curatolo M, Petersen-Felix S, Arendt-Nielsen L. Sensory assessment of regional analgesia in humans: a review of methods and applications. Anesthesiology. 2000;93(6):1517–30.CrossRefPubMed
11.
12.
Takahashi K, Taguchi T, Itoh K, Okada K, Kawakita K, Mizumura K. Influence of surface anesthesia on the pressure pain threshold measured with different-sized probes. Somatosens Mot Res. 2005;22(4):299–305.CrossRefPubMed
13.
Millan M, Leboeuf-Yde C, Budgell B, Amorim M. The effect of spinal manipulative therapy on experimentally induced pain: a systematic literature review. Chiropr Man Ther. 2012;20(1):26.CrossRef
14.
Coronado RA, Gay CW, Bialosky JE, Carnaby GD, Bishop MD, George SZ. Changes in pain sensitivity following spinal manipulation: a systematic review and meta-analysis. J Electromyogr Kinesiol. 2012;22(5):752–67.CrossRefPubMedPubMedCentral
15.
Srbely JZ, Vernon H, Lee D, Polgar M. Immediate effects of spinal manipulative therapy on regional antinociceptive effects in myofascial tissues in healthy young adults. J Manipulative Physiol Ther. 2013;36(6):333–41.CrossRefPubMed
16.
Molina-Ortega F, Lomas-Vega R, Hita-Contreras F, Plaza Manzano G, Achalandabaso A, Ramos-Morcillo AJ, et al. Immediate effects of spinal manipulation on nitric oxide, substance P and pain perception. Manual Ther. 2014;19(5):411–7.CrossRef
17.
18.
Coronado RA, Bialosky JE, Bishop MD, Riley R, Joseph L, Robinson ME, Michener LA, et al. The comparative effects of spinal and peripheral thrust manipulation and exercise on pain sensitivity and the relation to clinical outcome: a mechanistic trial using a shoulder pain model. J Orthop Sports Phys Ther. 2015;45(4):252–64.CrossRefPubMedPubMedCentral
19.
Martínez-Segura R, de-la-Llave-Rincón AI, Ortega-Santiago R, Cleland JA, Fernández-de-las-Peñas C. Immediate changes in widespread pressure pain sensitivity, neck pain, and cervical range of motion after cervical or thoracic thrust manipulation in patients with bilateral chronic mechanical neck pain: a randomized clinical trial. J Orthop Sports Phys Ther. 2012;42(9):806–14.CrossRefPubMed
20.
Salom-Moreno J, Ortega-Santiago R, Cleland JA, Palacios-Ceña M, Truyols-Domínguez S, Fernández-de-las-Peñas C. Immediate changes in neck pain intensity and widespread pressure pain sensitivity in patients with bilateral chronic mechanical neck pain: a randomized controlled trial of thoracic thrust manipulation vs non–thrust mobilization. J Manipulative Physiol Ther. 2014;37(5):312–9.CrossRefPubMed
21.
Bialosky JE, George SZ, Horn ME, Price DD, Staud R, Robinson ME. Spinal manipulative therapy-specific changes in pain sensitivity in individuals with low back pain (NCT01168999). J Pain. 2014;15(2):136–48.CrossRefPubMed
22.
Orakifar N, Kamali F, Pirouzi S, Jamshidi F. Sacroiliac joint manipulation attenuates alpha-motoneuron activity in healthy women: a quasi-experimental study. Arch Phys Med Rehabil. 2012;93(1):56–61.CrossRefPubMed
23.
Gay CW, Robinson ME, George SZ, Perlstein WM, Bishop MD. Immediate changes after manual therapy in resting-state functional connectivity as measured by functional magnetic resonance imaging in participants with induced low back pain. J Manipulative Physiol Ther. 2014;37(9):614–27.CrossRefPubMedPubMedCentral
24.
de Oliveira RF, Liebano RE, Costa LCM, Rissato LL, Costa LOP. Immediate effects of region-specific and Non–region-specific spinal manipulative therapy in patients with chronic low back pain: a randomized controlled trial. Phys Ther. 2013;93(6):748–56.CrossRefPubMed
25.
Thomson O, Haig L, Mansfield H. The effects of high-velocity low-amplitude thrust manipulation and mobilisation techniques on pressure pain threshold in the lumbar spine. Int J Osteopath Med. 2009;12(2):56–62.CrossRef
26.
Côté P, Mior SA, Vernon H. The short-term effect of a spinal manipulation on pain/pressure threshold in patients with chronic mechanical low back pain. J Manipulative Physiol Ther. 1994;17(6):364–8.PubMed
27.
Hamilton L, Boswell C, Fryer G. The effects of high-velocity, low-amplitude manipulation and muscle energy technique on suboccipital tenderness. Int J Osteopath Med. 2007;10(2):42–9.CrossRef
28.
Casanova-Méndez A, Oliva-Pascual-Vaca Á, Rodriguez-Blanco C, Heredia-Rizo AM, Gogorza-Arroitaonandia K, Almazán-Campos G. Comparative short-term effects of two thoracic spinal manipulation techniques in subjects with chronic mechanical neck pain: a randomized controlled trial. Manual Ther. 2014;19(4):331–7.CrossRef
29.
Fernández-Carnero J, Cleland JA, Arbizu RLT. Examination of motor and hypoalgesic effects of cervical vs thoracic spine manipulation in patients with lateral epicondylalgia: a clinical trial. J Manipulative Physiol Ther. 2011;34(7):432–40.CrossRefPubMed
30.
Fernández-Carnero J, Fernández-de-las-Peñas C, Cleland JA. Immediate hypoalgesic and motor effects after a single cervical spine manipulation in subjects with lateral epicondylalgia. J Manipulative Physiol Ther. 2008;31(9):675–81.CrossRefPubMed
31.
Fernández-de-las-Peñas C, Alonso-Blanco C, Cleland JA, Rodriǵuez-Blanco C, Alburquerque-Sendiń F. Changes in pressure pain thresholds over C5-C6 zygapophyseal joint after a cervicothoracic junction manipulation in healthy subjects. J Manipulative Physiol Ther. 2008;31(5):332–7.CrossRefPubMed
32.
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. J Orthop Sports Phys Ther. 2007;37(6):325–9.CrossRefPubMed
33.
Maduro de Camargo V, Alburquerque-Sendín F, Bérzin F, Stefanelli VC, de Souza DPR, Fernández-de-las-Peñas C. Immediate effects on electromyographic activity and pressure pain thresholds after a cervical manipulation in mechanical neck pain: a randomised controlled trial. J Manipulative Physiol Ther. 2011;34(4):211–20.CrossRef
34.
Fischer AA. Pressure algometry over normal muscles. Standard values, validity and reproducibility of pressure threshold. Pain. 1987;30(1):115–26.CrossRefPubMed
35.
Bisset LM, Evans K, Tuttle N. Reliability of 2 protocols for assessing pressure pain threshold in healthy young adults. J Manipulative Physiol Ther. 2015;38(4):282–7.CrossRefPubMed
36.
Lacourt TE, Houtveen JH, van Doornen LJP. Experimental pressure-pain assessments: test–retest reliability, convergence and dimensionality. Scand J Pain. 2012;3(1):31–7.CrossRef
37.
Vo L, Drummond PD. High frequency electrical stimulation concurrently induces central sensitization and ipsilateral inhibitory pain modulation. Eur J Pain. 2013;17(3):357–68.CrossRefPubMed
38.
Bergmann TF, Peterson DH. Chiropractic technique: principles and practice. 3rd ed. Missouri: Elsevier Mosby; 2011.
39.
Bialosky JE, Bishop MD, Robinson ME, George SZ. The relationship of the audible Pop to hypoalgesia associated with high-velocity, Low-amplitude thrust manipulation: a secondary analysis of an experimental study in pain-free participants. J Manipulative Physiol Ther. 2010;33(2):117–24.CrossRefPubMedPubMedCentral
40.
Cleland JA, Flynn TW, Childs JD, Eberhart S. The audible pop from thoracic spine thrust manipulation and its relation to short-term outcomes in patients with neck pain. J Man Manip Ther. 2007;15(3):143–54.CrossRefPubMedPubMedCentral
41.
Flynn TW, Childs JD, Fritz JM. The audible pop from high-velocity thrust manipulation and outcome in individuals with Low back pain. J Manipulative Physiol Ther. 2006;29(1):40–5.CrossRefPubMed
42.
43.
Richardson JTE. Eta squared and partial eta squared as measures of effect size in educational research. Educ Res Rev. 2011;6(2):135–47.CrossRef
44.
Potter L, McCarthy C, Oldham J. Algometer reliability in measuring pain pressure threshold over normal spinal muscles to allow quantification of anti-nociceptive treatment effects. Int J Osteopath Med. 2006;9(4):113–9.CrossRef
45.
Walton D, MacDermid J, Nielson W, Teasell R, Chiasson M, Brown L. Reliability, standard error, and minimum detectable change of clinical pressure pain threshold testing in people with and without acute neck pain. J Orthop Sports Phys Ther. 2011;41(9):644–50.CrossRefPubMed
46.
Vernon HT, Aker P, Burns S, Viljakaanen S, Short L. Pressure pain threshold evaluation of the effect of spinal manipulation in the treatment of chronic neck pain: a pilot study. J Manipulative Physiol Ther. 1990;13(1):13–6.PubMed
47.
48.
Park G, Kim CW, Park SB, Kim MJ, Jang SH. Reliability and usefulness of the pressure pain threshold measurement in patients with myofascial pain. Ann Phys Rehabil Med. 2011;35(3):412–7.CrossRef
49.
Lopez-Lopez A, Alonso Perez JL, Gonzalez Gutierez JL, La Touche R, Lerma Lara S, Izquierdo H, et al. Mobilization versus manipulations versus sustain apophyseal natural glide techniques and interaction with psychological factors for patients with chronic neck pain: randomized controlled trial. Eur J Phys Rehabil Med. 2015;51(2):121–32.PubMed
50.
Krouwel O, Hebron C, Willett E. An investigation into the potential hypoalgesic effects of different amplitudes of PA mobilisations on the lumbar spine as measured by pressure pain thresholds (PPT). Manual Ther. 2010;15(1):7–12.CrossRef
51.
Willett E, Hebron C, Krouwel O. The initial effects of different rates of lumbar mobilisations on pressure pain thresholds in asymptomatic subjects. Manual Ther. 2010;15(2):173–8.CrossRef
52.
Ruiz-Saez M, Fernandez-de-las-Penas C, Blanco CR, Martinez-Segura R, Garcia-Leon R. Changes in pressure pain sensitivity in latent myofascial trigger points in the upper trapezius muscle after a cervical spine manipulation in pain-free subjects. J Manipulative Physiol Ther. 2007;30(8):578–83.CrossRefPubMed
53.
Hübscher M, Moloney N, Leaver A, Rebbeck T, McAuley JH, Refshauge KM. Relationship between quantitative sensory testing and pain or disability in people with spinal pain—A systematic review and meta-analysis. Pain. 2013;154(9):1497–504.CrossRefPubMed
54.
Potter L, McCarthy C, Oldham J. Physiological effects of spinal manipulation: a review of proposed theories. Phys Ther Rev. 2005;10(3):163–70.CrossRef
55.
Benarroch EE. Periaqueductal gray: an interface for behavioral control. Neurology. 2012;78(3):210–7.CrossRefPubMed
56.
57.
Skyba DA, Radhakrishnan R, Rohlwing JJ, Wright A, Sluka KA. Joint manipulation reduces hyperalgesia by activation of monoamine receptors but not opioid or GABA receptors in the spinal cord. Pain. 2003;106(1–2):159–68.CrossRefPubMedPubMedCentral
58.
Kotzé A, Simpson KH. Stimulation-produced analgesia: acupuncture, TENS and related techniques. Anaesth Intens Care Med. 2008;9(1):29–32.CrossRef
59.
Bialosky JE, Bishop MD, Price DD, Robinson ME, George SZ. The mechanisms of manual therapy in the treatment of musculoskeletal pain: a comprehensive model. Manual Ther. 2009;14(5):531–8.CrossRef
60.
Rhudy JL, Meagher MW. Fear and anxiety: divergent effects on human pain thresholds. Pain. 2000;84(1):65–75.CrossRefPubMed
61.
Kawchuk GN, Haugen R, Fritz J. A true blind for subjects who receive spinal manipulation therapy. Arch Phys Med Rehabil. 2009;90(2):366–8.CrossRefPubMed
Metadata
Title
Effect of lumbar spinal manipulation on local and remote pressure pain threshold and pinprick sensitivity in asymptomatic individuals: a randomised trial
Authors
Sasha L. Dorron
Barrett E. Losco
Peter D. Drummond
Bruce F. Walker
Publication date
01-12-2016
Publisher
BioMed Central
Published in
Chiropractic & Manual Therapies / Issue 1/2016
Electronic ISSN: 2045-709X
DOI
https://doi.org/10.1186/s12998-016-0128-5

Other articles of this Issue 1/2016

Chiropractic & Manual Therapies 1/2016 Go to the issue

Review

Effectiveness of manual therapy for cervical radiculopathy, a review

Research

Perceptions of the quality of the therapeutic alliance in chiropractic care in The Netherlands: a cross-sectional survey

Research

Awareness of radiographic guidelines for low back pain: a survey of Australian chiropractors

Research

Absence of low back pain to demarcate an episode: a prospective multicentre study in primary care

Research

Match injuries in amateur Rugby Union: a prospective cohort study - FICS Biennial Symposium Second Prize Research Award

Study protocol

Conservative care with or without manipulative therapy in the management of back and neck pain in Danish children aged 9–15. Study protocol for a randomized controlled trial