Association of Spinal Manipulative Therapy With Changes in Cervical Motion Segment Interactions in Patients With Neck Pain: An Observational Study With Matched Asymptomatic Controls

2021 ◽  
Vol 44 (6) ◽  
pp. 475-486
Author(s):  
Alister J. du Rose ◽  
Jonathan Branney ◽  
Alan C. Breen
Keyword(s):  
Observational Study ◽  
Neck Pain ◽  
Spinal Manipulative Therapy ◽  
Manipulative Therapy ◽  
Motion Segment ◽  
Cervical Motion

scholarly journals The effect of two weeks of spinal manipulative therapy and home stretching exercises on pain and disability in patients with persistent or recurrent neck pain; a randomized controlled trial

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Anders Galaasen Bakken ◽  
Andreas Eklund ◽  
Anna Warnqvist ◽  
Søren O’Neill ◽  
Iben Axén
Keyword(s):  
Neck Pain ◽  
Treatment Effect ◽  
Intervention Group ◽  
Spinal Manipulative Therapy ◽  
Control Group ◽  
Manipulative Therapy ◽  
Randomized Controlled ◽  
Neck Disability ◽  
Stretching Exercises

Abstract Background Recurrent or persistent neck pain affects a vast number of people globally, leading to reduced quality of life and high societal costs. Clinically, it is a difficult condition to manage, and treatment effect sizes are often moderate at best. Activity and manual therapy are first-line treatment options in current guidelines. We aimed to investigate the combination of home stretching exercises and spinal manipulative therapy in a multicentre randomized controlled clinical trial, carried out in multidiscipline ary primary care clinics. Methods The treatment modalities utilized were spinal manipulative therapy and home stretching exercises compared to home stretching exercises alone. Both groups received 4 treatments for 2 weeks. The primary outcome was pain, where the subjective pain experience was investigated by assessing pain intensity (NRS − 11) and the quality of pain (McGill Pain Questionnaire). Neck disability and health status were secondary outcomes, measured using the Neck Disability Indexthe EQ-5D, respectively. One hundred thirty-one adult subjects were randomized to one of the two treatment groups. All subjects had experienced persistent or recurrent neck pain the previous 6 months and were blinded to the other group intervention. The clinicians provided treatment for subjects in both group and could not be blinded. The researchers collecting data were blinded to treatment allocation, as was the statistician performing data analyses. An intention-to-treat analysis was used. Results Sixty-six subjects were randomized to the intervention group, and sixty-five to the control group. For NRS − 11, a B-coefficient of − 0,01 was seen, indication a 0,01 improvement for the intervention group in relation to the control group at each time point with a p-value of 0,305. There were no statistically significant differences between groups for any of the outcome measures. Conclusion Based on the current findings, there is no additional treatment effect from adding spinal manipulative therapy to neck stretching exercises over 2 weeks for patients with persistent or recurrent neck pain. Trial registration The trial was registered 03/07/2018 at ClinicalTrials.gov, registration number: NCT03576846.

Spinal manipulative therapy and exercise for seniors with chronic neck pain

2014 ◽  
Vol 14 (9) ◽  
pp. 1879-1889 ◽  
Author(s):  
Michele Maiers ◽  
Gert Bronfort ◽  
Roni Evans ◽  
Jan Hartvigsen ◽  
Kenneth Svendsen ◽  
...  
Keyword(s):  
Neck Pain ◽  
Spinal Manipulative Therapy ◽  
Chronic Neck Pain ◽  
Manipulative Therapy

scholarly journals The effect of spinal manipulative therapy on heart rate variability and pain in patients with chronic neck pain: a randomized controlled trial

Trials ◽  
2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Anders Galaasen Bakken ◽  
Iben Axén ◽  
Andreas Eklund ◽  
Søren O’Neill
Keyword(s):  
Heart Rate ◽  
Heart Rate Variability ◽  
Neck Pain ◽  
Treatment Response ◽  
Spinal Manipulative Therapy ◽  
Pain Modulation ◽  
Manipulative Therapy ◽  
Randomized Controlled ◽  
Second Pain ◽  
Stretching Exercises

Abstract Background Recent experimental research has suggested that spinal manipulative therapy (SMT) may reduce pain through modulation of the ascending pain signals and/or the central pain-regulating mechanisms. People with persistent neck pain (NP) have also been found to have disturbances in autonomic nervous system (ANS) regulation. A common way to study the ANS is to measure heart rate variability (HRV). It is not known whether deviations in HRV are related to changes in pain perception or to the treatment response to SMT. Commonly, an individual in pain will experience pain reduction when exposed to a second pain stimulus, a mechanism known as conditioned pain modulation (CPM). Patients with persistent pain have been found to have a reduced CPM reaction. It is not known whether this is predictive of treatment response to SMT. The aim of the study is to examine the effects of SMT on HRV and pain. Further, a secondary aim is to test whether a CPM test can be used to predict treatment response in a population of patients with recurrent and persistent NP. Method/design A multicentre randomized controlled clinical trial will be carried out in multidisciplinary primary care clinics. This setting is chosen to minimize bias resulting from patient preference for the treatment modality and provider. The subjects are either self-referred or referred from other health care practitioners locally. The treatment modalities are two well-known interventions for NP; SMT and stretching exercises compared to stretching exercises alone. HRV will be measured using a portable heart monitor. The subjective pain experience will be investigated by assessing pain intensity and the affective quality of pain. CPM will be measured with a standardized cold pressor test. Measurements will be performed three times during a 2-week treatment series. Discussion The study will utilize normal clinical procedures, which should aid the transferability and external validity of the results. The study will provide knowledge regarding the underlying mechanisms of the effects of SMT. Furthermore, the study will examine whether a CPM test is predictive of treatment outcome in a population of patients with recurrent and persistent NP. Trial registration ClinicalTrials.gov, NCT03576846. Registered on 3 July 2018.

scholarly journals The Risk of Bias and Sample Size of Trials of Spinal Manipulative Therapy for Low Back and Neck Pain: Analysis and Recommendations

2014 ◽  
Vol 37 (8) ◽  
pp. 523-541 ◽  
Author(s):  
Sidney M. Rubinstein ◽  
Rik van Eekelen ◽  
Teddy Oosterhuis ◽  
Michiel R. de Boer ◽  
Raymond W.J.G. Ostelo ◽  
...  
Keyword(s):  
Neck Pain ◽  
Sample Size ◽  
Spinal Manipulative Therapy ◽  
Risk Of Bias ◽  
Low Back ◽  
Manipulative Therapy ◽  
Pain Analysis

scholarly journals The effect of spinal manipulative therapy and home stretching exercises on heart rate variability in patients with persistent or recurrent neck pain: a randomized controlled trial

2021 ◽  
Vol 29 (1) ◽  
Author(s):  
Anders Galaasen Bakken ◽  
Andreas Eklund ◽  
David M. Hallman ◽  
Iben Axén
Keyword(s):  
Heart Rate ◽  
Heart Rate Variability ◽  
Neck Pain ◽  
Intervention Group ◽  
Spinal Manipulative Therapy ◽  
The Other ◽  
Control Group ◽  
Manipulative Therapy ◽  
Randomized Controlled ◽  
Stretching Exercises

Abstract Background Persistent or recurrent neck pain is, together with other chronic conditions, suggested to be associated with disturbances of the Autonomic Nervous System. Acute effects on the Autonomic Nervous System, commonly measured using Heart Rate Variability, have been observed with manual therapy. This study aimed to investigate the effect on Heart Rate Variability in (1) a combination of home stretching exercises and spinal manipulative therapy versus (2) home stretching exercises alone over 2 weeks in participants with persistent or recurrent neck pain. Methods A randomized controlled clinical trial was carried out in five multidisciplinary primary care clinics in Stockholm from January 2019 to April 2020. The study sample consisted of 131 participants with a history of persistent or recurrent neck. All participants performed home stretching exercises daily for 2 weeks and were scheduled for four treatments during this period, with the intervention group receiving spinal manipulative therapy in addition to the home exercises. Heart Rate Variability at rest was measured at baseline, after 1 week, and after 2 weeks, with RMSSD (Root mean square of successive RR interval differences) as the primary outcome. Both groups were blinded to the other group intervention. Thus, they were aware of the purpose of the trial but not the details of the “other” intervention. The researchers collecting data were blinded to treatment allocation, as was the statistician performing data analyses. The clinicians provided treatment for participants in both groups and could not be blinded. A linear mixed-effects model with continuous variables and person-specific random intercept was used to investigate the group-time interaction using an intention to treat analysis. Results Sixty-six participants were randomized to the intervention group and sixty-five to the control group. For RMSSD, a B coefficient of 0.4 (p value: 0.9) was found, indicating a non-significant difference in the regression slope for each time point with the control group as reference. No statistically significant differences were found between groups for any of the Heart Rate Variability indices. Conclusion Adding four treatments of spinal manipulation therapy to a 2-week program of daily stretching exercises gave no significant change in Heart Rate Variability. Trial Registration: The trial was registered 03/07/2018 at ClinicalTrials.gov, registration number: NCT03576846. (https://pubmed.ncbi.nlm.nih.gov/31606042/)

scholarly journals The effect of Spinal Manipulative Therapy on Heart Rate Variability and pain in patients with chronic neck pain: A Randomized Controlled trial

2019 ◽  
Author(s):  
Anders Galaasen Bakken ◽  
Iben Axén ◽  
Andreas Eklund ◽  
Sören O'neill
Keyword(s):  
Heart Rate ◽  
Heart Rate Variability ◽  
Neck Pain ◽  
Treatment Response ◽  
Spinal Manipulative Therapy ◽  
Pain Modulation ◽  
Manipulative Therapy ◽  
Randomized Controlled ◽  
Second Pain ◽  
Stretching Exercises

Abstract Background Recent experimental research has suggested that Spinal Manipulative Therapy (SMT) may reduce pain through modulation of the ascending pain signals and/or the central pain regulating mechanisms. People with persistent neck pain (NP) have also been found to have disturbances in Autonomic Nervous System (ANS) regulation. A common way to study ANS is to measure heart rate variability (HRV). It is not known if deviations in HRV are related to changes in pain perception or to the treatment response to SMT. Commonly, an individual in pain will experience pain reduction when exposed to a second pain stimulus, a mechanism known as Conditioning Pain Modulation (CPM). Patients with persistent pain have been found to have a reduced CPM reaction. It is not known if this is predictive of treatment response to SMT. The aim of the study is to examine the effects of SMT on HRV and pain and to test if a CPM test can be used to predict treatment response, in a population of patients with recurrent and persistent NP. Method/Design A multicentre randomized controlled clinical trial will be carried out in multidisciplinary primary care clinics. This setting is chosen to minimize bias resulting from patient preference to treatment modality and provider. The subjects are either self-referred or referred from other health care practitioners locally. The treatment modalities are two well-known interventions for NP; SMT and stretching exercises compared to stretching exercises alone. The subjective pain experience will be investigated by assessing pain intensity and the affective quality of pain. HRV will be measured using a portable heart monitor and CPM will be measured with a standardized cold-pressor-test. Measurements will be performed at baseline, prior to the third treatment and after the fourth treatment. Discussion The study will utilize normal clinical procedures, which should aid transferability and external validity of the results. The study will provide knowledge regarding the underlying mechanisms of the effects of SMT. Furthermore, the study will examine if a CPM test is predictive of treatment outcome in a population of patients with recurrent and persistent NP.

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