What do we know about spinal manual therapy for people with osteoporosis? A narrative review

Abstract

Background

Provision of spinal manual therapy for people with osteoporosis is controversial: the effect and safety have not been studied in-depth and are unclear.

Objectives

To provide an overview about spinal manual therapy and its safety and applicability for people with osteoporosis. We conducted two separate search strategies of biomechanical and clinical literature in PubMed, EMBASE, and Sportdiscus (1955–2020) to answer the following research questions: (1) How much force results from spinal mobilizations and is required to fracture vertebral components with spinal mobilizations? (2) What spinal manual therapy techniques have been described and what are their effects for people with osteoporosis? (3) What adverse events have been reported?

Major findings

16 articles described forces produced by PA mobilization varying widely by grade of mobilization [(9 to 205.8 N (Grade I), 2.2 to 119.23 N (Grade II), 75.5 to 206 N (Grade III), and 89.2 to 499.8 N (Grade IV)]. One article identified vertebral components fail under PA loads of 200 to 727 N. One case study and three randomized controlled trials were included. Mobilization techniques used were Grade II to IV with no serious adverse events reported.

Conclusions

Our narrative review revealed limited literature about the risk and clinical benefits of spinal manual therapy for people with osteoporosis. Further, the forces applied during spinal manual therapy techniques vary widely between therapists depending on the area being treated and patient characteristics. Further work about spinal manual therapy for people with osteoporosis is necessary to draw conclusions about safety and effectiveness.

Keywords:

• Osteoporosis
• manual therapy
• posterior-anterior mobilization
• vertebra(e)

Disclosure statement

The authors declare no funding or conflicts of interest related to this work.

Additional information

Notes on contributors

Caitlin McArthur

Caitlin McArthur is an assistant professor in the School of Physiotherapy at Dalhousie University. Her research focuses on improving the effectiveness of and access to rehabilitation for people living with chronic health conditions across the continuum of care, particularly home and long-term care. She is interested in fall and fracture prevention and improving functional mobility.

Christina Ziebart

Christina Ziebart is a registered kinesiologist and certified exercise physiologist, studying to become a physical therapist. She graduated her undergraduate and master's from the University of Waterloo in Kinesiology. She is currently working on her PhD in Rehabilitation Sciences at Western University. Christina has published several studies on exercise and posture in people with osteoporosis. Her PhD aims to gain a better understanding of patient's expectations related to exercise through a randomized controlled trial on the effects of exercise, nutrition and falls prevention for fracture prevention.

Judi Laprade

Judi Laprade is an associate professor in the Division of Anatomy at University of Toronto. She obtained her Physical Therapy degree from Queen's University and went on to complete her Master's and PhD in Anatomy also at Queen's. Always involved in teaching, she has held academic and teaching positions at Queen's University, the Hong Kong Polytechnic University and the University of Toronto, teaching musculoskeletal content to physical therapy students.