Effect of lumbar spinal manipulation on local and remote pressure pain threshold and pinprick sensitivity in asymptomati
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RESEARCH
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Effect of lumbar spinal manipulation on local and remote pressure pain threshold and pinprick sensitivity in asymptomatic individuals: a randomised trial Sasha L. Dorron1*, Barrett E. Losco1, Peter D. Drummond2 and Bruce F. Walker1
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 (ACTRN12614000682640). Keywords: Spinal manipulative therapy, Lumbar spine, Pain sensitivity, Pressure pain threshold, Pinprick sensitivity
Background Spinal manipulative therapy (SMT) is a manual therapy technique used by various health care professions including chiropractors, osteopaths and physiotherapists [1]. Evidence is mixed but some studies suggest that SMT may be effective in managing non-specific spinal pain and some types of headache [2–7]. Since musculoskeletal conditions, particularly low back pain (LBP), represent a significant economic burden and affect a substantial proportion of the population [8, 9], improving our management of these conditions is important. * Correspondence: [email protected] 1 Discipline of Chiropractic, School of Health Professions, Murdoch University, 90 South Street, Murdoch, WA 6155, Australia Full list of author information is available at the end of the article
There is a lack of evidence to explain how SMT may achieve positive clinical outcomes such as pain relief. Improving our understanding of the neurophysiological effects of SMT may improve its clinical use and allow practitioners to make better choices about when and where to apply SMT. Pressure pain threshold (PPT) is a widely used form of experimental pain,
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