Tissue damage markers after a spinal manipulation in healthy subjects: a preliminary report of a randomized controlled trial

A Achalandabaso, G Plaza-Manzano, R Lomas-Vega, A Martínez-Amat, M V Camacho, M Gassó, F Hita-Contreras, F Molina, A Achalandabaso, G Plaza-Manzano, R Lomas-Vega, A Martínez-Amat, M V Camacho, M Gassó, F Hita-Contreras, F Molina

Abstract

Spinal manipulation (SM) is a manual therapy technique frequently applied to treat musculoskeletal disorders because of its analgesic effects. It is defined by a manual procedure involving a directed impulse to move a joint past its physiologic range of movement (ROM). In this sense, to exceed the physiologic ROM of a joint could trigger tissue damage, which might represent an adverse effect associated with spinal manipulation. The present work tries to explore the presence of tissue damage associated with SM through the damage markers analysis. Thirty healthy subjects recruited at the University of Jaén were submitted to a placebo SM (control group; n = 10), a single lower cervical manipulation (cervical group; n = 10), and a thoracic manipulation (n = 10). Before the intervention, blood samples were extracted and centrifuged to obtain plasma and serum. The procedure was repeated right after the intervention and two hours after the intervention. Tissue damage markers creatine phosphokinase (CPK), lactate dehydrogenase (LDH), C-reactive protein (CRP), troponin-I, myoglobin, neuron-specific enolase (NSE), and aldolase were determined in samples. Statistical analysis was performed through a 3 × 3 mixed-model ANOVA. Neither cervical manipulation nor thoracic manipulation did produce significant changes in the CPK, LDH, CRP, troponin-I, myoglobin, NSE, or aldolase blood levels. Our data suggest that the mechanical strain produced by SM seems to be innocuous to the joints and surrounding tissues in healthy subjects.

Figures

Figure 1
Figure 1
Flowchart diagram of the study.

References

    1. Evans D. W., Lucas N. What is “manipulation”? A reappraisal. Manual Therapy. 2010;15(3):286–291. doi: 10.1016/j.math.2009.12.009.
    1. Gatterman M. I., Hansen D. T. Development of chiropractic nomenclature through consensus. Journal of Manipulative and Physiological Therapeutics. 1994;17(5):302–309.
    1. Kuczynski J. J., Schwieterman B., Columber K., Knupp D., Shaub L., Cook C. E. Effectiveness of physical therapist administered spinal manipulation for the treatment of low back pain: a systematic review of the literature. International Journal of Sports Physical Therapy. 2012;7(6):647–662.
    1. Martínez-Segura R., Fernández-de-las-Peñas C., Ruiz-Sáez M., López-Jiménez C., Rodríguez-Blanco C. Immediate effects on neck pain and active range of motion after a single cervical high-velocity low-amplitude manipulation in subjects presenting with mechanical neck pain: a randomized controlled trial. Journal of Manipulative and Physiological Therapeutics. 2006;29(7):511–517. doi: 10.1016/j.jmpt.2006.06.022.
    1. Haldeman S., Kohlbeck F. J., McGregor M. Risk factors and precipitating neck movements causing vertebrobasilar artery dissection after cervical trauma and spinal manipulation. Spine. 1999;24(8):785–794. doi: 10.1097/00007632-199904150-00010.
    1. Stevinson C., Honan W., Cooke B., Ernst E. Neurological complications of cervical spine manipulation. Journal of the Royal Society of Medicine. 2001;94(3):107–110.
    1. Ernst E. Adverse effects of spinal manipulation: a systematic review. Journal of the Royal Society of Medicine. 2007;100(7):330–338. doi: 10.1258/jrsm.100.7.330.
    1. Paciaroni M., Bogousslavsky J. Cerebrovascular complications of neck manipulation. European Neurology. 2009;61(2):112–118. doi: 10.1159/000180314.
    1. Wuest S., Symons B., Leonard T., Herzog W. Preliminary report: biomechanics of vertebral artery segments C1-C6 during cervical spinal manipulation. Journal of Manipulative and Physiological Therapeutics. 2010;33(4):273–278. doi: 10.1016/j.jmpt.2010.03.007.
    1. Cagnie B., Barbaix E., Vinck E., D'Herde K., Cambier D. Atherosclerosis in the vertebral artery: an intrinsic risk factor in the use of spinal manipulation? Surgical and Radiologic Anatomy. 2006;28(2):129–134. doi: 10.1007/s00276-005-0060-1.
    1. Symons B., Herzog W. Cervical artery dissection: a biomechanical perspective. The Journal of the Canadian Chiropractic Association. 2013;57(4):276–278.
    1. Ernst E. Vascular accidents after neck manipulation: cause or coincidence? International Journal of Clinical Practice. 2010;64(6):673–677. doi: 10.1111/j.1742-1241.2009.02237.x.
    1. Haldeman S., Kohlbeck F. J., McGregor M. Unpredictability of cerebrovascular ischemia associated with cervical spine manipulation therapy: a review of sixty-four cases after cervical spine manipulation. Spine. 2002;27(1):49–55. doi: 10.1097/00007632-200201010-00012.
    1. Symons B. P., Leonard T., Herzog W. Internal forces sustained by the vertebral artery during spinal manipulative therapy. Journal of Manipulative and Physiological Therapeutics. 2002;25(8):504–510. doi: 10.1067/mmt.2002.127076.
    1. Fernández-de-las-Peñas C., Alonso-Blanco C., Cleland J. A., Rodríguez-Blanco C., Alburquerque-Sendín F. Changes in pressure pain thresholds over C5-C6 zygapophyseal joint after a cervicothoracic junction manipulation in healthy subjects. Journal of Manipulative and Physiological Therapeutics. 2008;31(5):332–337. doi: 10.1016/j.jmpt.2008.04.006.
    1. Brancaccio P., Lippi G., Maffulli N. Biochemical markers of muscular damage. Clinical Chemistry and Laboratory Medicine. 2010;48(6):757–767. doi: 10.1515/CCLM.2010.179.
    1. Kaundal M., Sharma S. Analysis of isoproterenol-induced changes in gastrocnemius muscle and serum lactate dehydrogenase expression in mice. Singapore Medical Journal. 2011;52(4):274–282.
    1. Nie J., Tong T. K., George K., Fu F. H., Lin H., Shi Q. Resting and post-exercise serum biomarkers of cardiac and skeletal muscle damage in adolescent runners. Scandinavian Journal of Medicine and Science in Sports. 2011;21(5):625–629. doi: 10.1111/j.1600-0838.2010.01096.x.
    1. Van Nieuwenhoven F. A., Kleine A. H., Wodzig K. W. H., Hermens W. T., Kragten H. A., Maessen J. G., Punt C. D., Van Dieijen M. P., Van der Vusse G. J., Glatz J. F. C. Discrimination between myocardial and skeletal muscle injury by assessment of the plasma ratio of myoglobin over fatty acid-binding protein. Circulation. 1995;92(10):2848–2854. doi: 10.1161/01.cir.92.10.2848.
    1. Dos Santos E. S. D., Pereira M. P., Minuzzo L., Moreira D. A. R., Ramos R., Avezum Á., Timerman A., Piegas L. Electrical cardioversion and myocardial injury: evaluation by new cardiac injury markers. Arquivos Brasileiros de Cardiologia. 2006;86(3):191–197.
    1. Zandbergen E. G., de Haan R. J., Hijdra A. Systematic review of prediction of poor outcome in anoxic-ischaemic coma with biochemical markers of brain damage. Intensive Care Medicine. 2001;27(10):1661–1667. doi: 10.1007/s001340101076.
    1. Baird M. F., Graham S. M., Baker J. S., Bickerstaff G. F. Creatine-kinase- and exercise-related muscle damage implications for muscle performance and recovery. Journal of Nutrition and Metabolism. 2012;2012 doi: 10.1155/2012/960363.960363
    1. Sorichter S., Mair J., Koller A., Gebert W., Rama D., Calzolari C., Artner-Dworzak E., Puschendorf B. Skeletal troponin I as a marker of exercise-induced muscle damage. Journal of Applied Physiology. 1997;83(4):1076–1082.
    1. Sorichter S., Mair J., Koller A., Calzolari C., Huonker M., Pau B., Puschendorf B. Release of muscle proteins after downhill running in male and female subjects. Scandinavian Journal of Medicine and Science in Sports. 2001;11(1):28–32. doi: 10.1034/j.1600-0838.2001.011001028.x.
    1. Gradisek P., Osredkar J., Korsic M., Kremzar B. Multiple indicators model of long-term mortality in traumatic brain injury. Brain Injury. 2012;26(12):1472–1481. doi: 10.3109/02699052.2012.694567.
    1. Pepys M. B., Hirschfield G. M. C-reactive protein: a critical update. The Journal of Clinical Investigation. 2003;111(12):1805–1812. doi: 10.1172/jci200318921.
    1. Cohen J. Statistical Power Analysis for the Behavioural Sciences. Hillsdale, NJ, USA: Lawrence Erlbaum Associates; 1988.
    1. Serra-Majem L., Trichopoulou A., De La Cruz J. N., Cervera P., Alvarez A. G., La Vecchia C., Lemtouni A., Trichopoulos D. International Task Force on the Mediterranean Diet. Does the definition of the Mediterranean diet need to be updated? Public Health Nutrition. 2004;7(7):927–929. doi: 10.1079/phn2004564.
    1. Pate R. R., O'Neill J. R., Lobelo F. The evolving definition of “sedentary”. Exercise and Sport Sciences Reviews. 2008;36(4):173–178.
    1. Roy R. A., Boucher J. P., Comtois A. S. Inflammatory response following a short-term course of chiropractic treatment in subjects with and without chronic low back pain. Journal of Chiropractic Medicine. 2010;9(3):107–114. doi: 10.1016/j.jcm.2010.06.002.
    1. Giles L. G. F., Muller R. Chronic spinal pain: a randomized clinical trial comparing medication, acupuncture, and spinal manipulation. Spine. 2003;28(14):1490–1503. doi: 10.1097/00007632-200307150-00003.
    1. Albuquerque F. C., Hu Y. C., Dashti S. R., et al. Craniocervical arterial dissections as sequelae of chiropractic manipulation: patterns of injury and management. Journal of Neurosurgery. 2011;115(6):1197–1205. doi: 10.3171/2011.8.JNS111212.
    1. Hebert J. J., Stomski N. J., French S. D., Rubinstein S. M. Serious adverse events and spinal manipulative therapy of the low back region: a systematic review of cases. Journal of Manipulative and Physiological Therapeutics. 2013 doi: 10.1016/j.jmpt.2013.05.009.
    1. Flann K. L., Lastayo P. C., McClain D. A., Hazel M., Lindstedt S. L. Muscle damage and muscle remodeling: no pain, no gain? Journal of Experimental Biology. 2011;214(4):674–679. doi: 10.1242/jeb.050112.
    1. Herrmann M., Curio N., Jost S., Grubich C., Ebert A. D., Fork M. L., Synowitz H. Release of biochemical markers of damage to neuronal and glial brain tissue is associated with short and long term neuropsychological outcome after traumatic brain injury. Journal of Neurology Neurosurgery and Psychiatry. 2001;70(1):95–100. doi: 10.1136/jnnp.70.1.95.
    1. McKune A. J., Semple S. J., Peters-Futre E. M. Acute exercise-induced muscle injury. Biology of Sport. 2012;29(1):3–10. doi: 10.5604/20831862.978976.
    1. Carnes D., Mars T. S., Mullinger B., Froud R., Underwood M. Adverse events and manual therapy: a systematic review. Manual Therapy. 2010;15(4):355–363. doi: 10.1016/j.math.2009.12.006.
    1. Rubinstein S. M., Leboeuf-Yde C., Knol D. L., de Koekkoek T. E., Pfeifle C. E., van Tulder M. W. The benefits outweigh the risks for patients undergoing chiropractic care for neck pain: a prospective, multicenter, cohort study. Journal of Manipulative and Physiological Therapeutics. 2007;30(6):408–418. doi: 10.1016/j.jmpt.2007.04.013.
    1. Carlesso L. C., Cairney J., Dolovich L., Hoogenes J. Defining adverse events in manual therapy: an exploratory qualitative analysis of the patient perspective. Manual Therapy. 2011;16(5):440–446. doi: 10.1016/j.math.2011.02.001.
    1. Lee S.-Y., Choi Y.-C., Kim J.-H., Kim W.-J. Serum neuron-specific enolase level as a biomarker in differential diagnosis of seizure and syncope. Journal of Neurology. 2010;257(10):1708–1712. doi: 10.1007/s00415-010-5608-2.
    1. Huang G., Luo C., Gu X., Wu Z., Wang Z., Du Z., Hu C., Tang L. Mechanical strain induces expression of C-reactive protein in human blood vessels. Journal of Pharmacology and Experimental Therapeutics. 2009;330(1):206–211. doi: 10.1124/jpet.109.150961.
    1. Alexanderson H., Stenström C. H., Jenner G., Lundberg I. The safety of a resistive home exercise program in patients with recent onset active polymyositis or dermatomyositis. Scandinavian Journal of Rheumatology. 2000;29(5):295–301. doi: 10.1080/030097400447679.
    1. Alexanderson H., Munters L. A., Dastmalchi M., Loell I., Heimbur̈ger M., Opava C. H., Lundberg I. E. Resistive home exercise in patients with recent-onset polymyositis and dermatomyositis—a randomized controlled single-blinded study with a 2-year followup. Journal of Rheumatology. 2014;41(6):1124–1132. doi: 10.3899/jrheum.131145.
    1. Wynd S., Anderson T., Kawchuk G. Effect of cervical spine manipulation on a pre-existing vascular lesion within the canine vertebral artery. Cerebrovascular Diseases. 2008;26(3):304–309. doi: 10.1159/000149578.
    1. Austin N., DiFrancesco L. M., Herzog W. Microstructural damage in arterial tissue exposed to repeated tensile strains. Journal of Manipulative and Physiological Therapeutics. 2010;33(1):14–19. doi: 10.1016/j.jmpt.2009.11.006.
    1. Danneskiold-Samsøe B., Christiansen E., Lund B., Andersen R. B. Regional muscle tension and pain (“fibrositis”). Effect of massage on myoglobin in plasma. Scandinavian Journal of Rehabilitation Medicine. 1983;15(1):17–20.
    1. Danneskiold-Samsøe B., Christiansen E., Bach Andersen R. Myofascial pain and the role of myoglobin. Scandinavian Journal of Rheumatology. 1986;15(2):174–178. doi: 10.3109/03009748609102085.
    1. Arkko P. J., Pakarinen A. J., Kari Koskinen O. Effects of whole body massage on serum protein, electrolyte and hormone concentrations, enzyme activities, and hematological parameters. International Journal of Sports Medicine. 1983;4(4):265–267. doi: 10.1055/s-2008-1026047.

Source: PubMed

Patrocinadores y Colaboradores

Condiciones médicas

Intervenciones de drogas

3
Suscribir