Changes in biochemical markers following a spinal manipulation – a systematic review update

ABSTRACT

Objective

The aim of this systematic review was to update the current level of evidence for spinal manipulation in influencing various biochemical markers in healthy and/or symptomatic population.

Methods

This is a systematic review update. Various databases were searched (inception till May 2023) and fifteen trials (737 participants) that met the inclusion criteria were included in the review. Two authors independently screened, extracted and assessed the risk of bias in included studies. Outcome measure data were synthesized using standard mean differences and meta-analysis for the primary outcome (biochemical markers). The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) was used for assessing the quality of the body of evidence for each outcome of interest.

Results

There was low-quality evidence that spinal manipulation influenced various biochemical markers (not pooled). There was low-quality evidence of significant difference that spinal manipulation is better (SMD −0.42, 95% CI − 0.74 to −0.1) than control in eliciting changes in cortisol levels immediately after intervention. Low-quality evidence further indicated (not pooled) that spinal manipulation can influence inflammatory markers such as interleukins levels post-intervention. There was also very low-quality evidence that spinal manipulation does not influence substance-P, neurotensin, oxytocin, orexin-A, testosterone and epinephrine/nor-epinephrine.

Conclusion

Spinal manipulation may influence inflammatory and cortisol post-intervention. However, the wider prediction intervals in most outcome measures point to the need for future research to clarify and establish the clinical relevance of these changes.

KEYWORDS:

• Spinal Manipulation
• Biochemical Markers
• Pain Markers
• Inflammatory Markers
• Cortisol

Disclosure statement

No potential conflict of interest was reported by the author(s).

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/10669817.2023.2252187.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.

Notes on contributors

Kesava Kovanur Sampath

Kesava Kovanur Sampath is a Principal Academic Staff Member in the Centre for Health and Social Practice at Waikato Institute of Technology in New Zealand. He is the chair of the osteopathic research steering committee in New Zealand. He is part of the leadership team at the Duke Centre of Excellence in Manual and Manipulative Therapy. He is also a visiting research fellow at the University of Technology, Sydney. Kesava’s research specialties include neurophysiological outcomes, spinal manipulation, manual therapy practice and education.

Loïc Treffel

Dr Loïc Treffel is a Principal Investigator of ALGOS project: Osteopathy in Oncology (NCT05726929 Study Record | Beta ClinicalTrials.gov). He is a Ph.D. Researcher in Space Physiology on vertebral deconditioning. Scientist Principal Investigator supported by CNES (French Space Agency). PhD. Thesis defended in 2017 Life Sciences and Health, Vertebral Dysfunctions and Postural changes after microgravity simulation studies. University of Strasbourg, IPHC-CNRS (UMR7178, ED 414).

Oliver P.Thomson

Dr Oliver P.Thomson is an Associate Professor at the University College of Osteopathy where he leads the Doctoral Programme, and he works clinically as an osteopath in London. Oliver has a particular interest in qualitative research methodologies to explore the clinical and theoretical aspects of osteopathy and musculoskeletal practice such as the areas of clinical decision-making and the role of evidence-base practice. He has over 50 peer-reviewed publication in these areas. Oliver examines and supervises PhD students in the UK and Australia and collaborates with national and international colleagues on numerous research projects.

Jerry Draper Rodi

Dr Jerry Draper-Rodi is the Director of the National Council for Osteopathic Research (NCOR) in the UK, a Senior Research Fellow at the University College of Osteopathy (UCO), a visiting fellow on the international osteopathic research leadership programme (UTS School of Public Health, Australia) and a clinician. Jerry’s research streams include: knowledge mobilisation; Research methods in complex interventions; and Equity, Diversity and Inclusion (EDI).

Michael Fleischmann

Dr Michael Fleischmann has over 25 peer-reviewed publications. His research focus can be conceptualised as 3 main areas: 1. evaluation of education intervention; 2. Epidemiology, particularly in osteopathy and manual therapies; 3. clinical reasoning of manual therapists. Michael’s wide range of experience in educational and clinical settings displays an exceptional ability to work with a high degree of productivity with students as a core focus. He embraces diversity and welcomes opportunities to work with a broad range of disciplines and specialties. His teaching practice focusses on constantly engaging with students and other staff to provide rich learning experiences.

Steve Tumilty

SteveTumilty is one of the few clinician scientists in Physiotherapy Worldwide and one of the few Registered Physiotherapy Specialists in New Zealand. The majority of his clinical experience has been in the outpatient musculoskeletal practice setting in UK, Germany and New Zealand. He also has experience in professional sports and Occupational Health Physiotherapy. In 2002 he came to work at the School of Physiotherapy, Otago University and he has developed and coordinated the specialist Masters degree for Sports and Orthopaedic Manipulative Therapy for which he provides teaching and clinical expertise. He is the author or co-author on 125 research outputs in the field of Physiotherapy and Orthopaedic Manipulative Therapy for musculoskeletal conditions and has been invited to present at international conferences. He has taught manual therapy seminars in New Zealand and Japan. Associate Professor Tumilty’s research interests are in Tendinopathy, modulation of the Hypothalamus-Pituitary Axis using manual interventions, and the influence of the autonomic nervous system on musculoskeletal pain and healing.