Effects of spinal manipulative therapy biomechanical parameters on clinical and biomechanical outcomes of participants with chronic thoracic pain: a randomized controlled experimental trial

Isabelle Pagé, Martin Descarreaux, Isabelle Pagé, Martin Descarreaux

Abstract

Background: Spinal manipulative therapy (SMT) includes biomechanical parameters that vary between clinicians, but for which the influence on the therapy clinical effects is unknown. This parallel-randomized controlled trial aimed to investigate the effect of SMT biomechanical parameters on the outcomes of participants with chronic thoracic pain (CTP) following three treatment sessions (follow-up at one week).

Methods: Adults reporting CTP (pain within the evaluated region [T6 to T8] for ≥3 months) were asked to participate in a four-session trial. At the first session, participants were randomly assigned to one of three experimental groups (different SMT doses) or the control group (no SMT). During the first three sessions, one SMT was executed at T7 for the experimental groups, while a 5-min rest was provided to the control group. SMT were delivered through an apparatus using a servo-controlled linear actuator motor and doses consisted of peak forces, impulse durations, and rates of force application set at 135 N, 125 ms and 920 N/s (group 1), at 250 N, 125 ms and 1840 N/s (group 2), and at 250 N, 250 ms, 920 N/s (group 3). Disability and pain intensity were evaluated at each session (primary outcomes). Spinal stiffness was assessed before-and-after each SMT/rest and at follow-up. Tenderness and muscle activity were evaluated during each spinal stiffness trial. Improvement was evaluated at follow-up. Differences in outcomes between groups and sessions were evaluated as well as factors associated with clinical improvement.

Results: Eighty-one participants were recruited and 17, 20, 20 participants of the three experimental groups and 18 of the control group completed the protocol. In exception of higher pain intensity at baseline in the control group, no between-group differences were found for any of the outcomes. A decrease in pain intensity, disability, spinal stiffness, and tenderness during spinal stiffness were observed (p-values< 0.05). At follow-up, 24% of participants were classified as 'improved'. Predictors of improvement were a greater decrease in pain intensity and in tenderness (p-values< 0.05).

Conclusions: In an experimental setting, the delivery of a SMT does not lead to significantly different outcomes in participants with CTP than a control condition (spinal stiffness assessment). Studies are still required to explore the mechanisms underlying SMT effects.

Trial registration: ClinicalTrials.gov NCT03063177 , registered 24 February 2017).

Keywords: Back pain; Biomechanics; Chronic pain; Dose; Electromyography; Manual therapy; Musculoskeletal manipulation; Spinal manipulation; Spinal stiffness; Spine; Thoracic spine.

Conflict of interest statement

Ethics approval and consent to participate

This study was carried out at the Université du Québec à Trois-Rivières (Trois-Rivières, Québec, Canada) in accordance with the Human Research Ethics Committee of the Université du Québec à Trois-Rivières (CER-17-232-07.03). All subjects provided written informed consent in accordance with the Declaration of Helsinki.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Experimental setup. sEMG electrodes, contact areas during the spinal manipulative therapy (T7 transverse processes; circles) and contact areas during spinal stiffness assessment (T6, T7 and T8 spinous processes; triangles) are visualized
Fig. 2
Fig. 2
The mechanical device used to deliver the spinal manipulative therapy and to assess spinal stiffness. A twin tip was used during spinal manipulative therapy delivery, while a single tip was used during the assessment of spinal stiffness
Fig. 3
Fig. 3
Flow chart of the study. SMT: spinal manipulative therapy
Fig. 4
Fig. 4
a Spinal manipulative therapy parameters, b Muscle activity (pale bars, median ± IQR) and indenter displacement (dark bars, mean ± SD)

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