Effect of spinal manipulative therapy on mechanical pain sensitivity in patients with chronic nonspecific low back pain: a pilot randomized, controlled trial

ABSTRACT

Objectives: The long-term goal of our study is to improve the understanding of the biological mechanisms associated with spinal manipulative therapy (SMT) in low back pain.

Methods: This project involved a pilot randomized, blinded clinical trial (ClinicalTrials.gov registration number NCT03078114) of 3-week SMT in chronic nonspecific low back pain (CNSLBP) patients. We recruited 29 participants and randomly assigned them into either a SMT (n = 14) or sham SMT (n = 15) group. Pre- and postintervention, we quantified the effect of SMT on clinical outcomes (Numeric Pain Rating Scale and Oswestry Disability Index) and pressure pain threshold (PPT) at local (lumbar spine), regional (lower extremity), and remote (upper extremity) anatomical sites.

Results: We observed a significant main effect for time signifying reduced hypersensitivity (increased PPT) at local (p = .015) and regional (p = .014) locations at 3 weeks. Furthermore, we found significant main effects of time indicating improvements in pain (p < .001) and disability (p = .02) from baseline among all participants regardless of intervention. However, no between-group differences were observed in PPT, clinical pain, or disability between the SMT and sham SMT groups over 3 weeks.

Conclusions: After 3 weeks of SMT or sham SMT in CNSLBP patients, we found hypoalgesia at local and remote sites along with improved pain and low back-related disability.

Level of Evidence: 1b

Trial registration: ClinicalTrials.gov identifier: NCT03078114.

KEYWORDS:

• Spinal manipulation
• lumbar spine
• manual therapy
• low back pain
• pressure pain threshold
• chronic
• treatment outcome

Acknowledgments

BB was supported by National Chiropractic Mutual Insurance Company Foundation.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by the National Chiropractic Mutual Insurance Company Foundation.

Notes on contributors

Bryan M. Bond

Bryan M. Bond holds the position of professor in the physical therapy program at the University of Saint Mary. His research interest includes exploring the biology of manual therapies.

Chris D. Kinslow

Chris D. Kinslow, PT, DC, OCS has been an assistant professor at the University of Saint Mary in the physical therapy program since 2014. His clinical expertise include manual therapies and dry needling with over 19 years of experience

Adam W. Yoder

Adam W. Yoder is an assistant professor in the physical therapy program at the University of Saint Mary. He is board certified in orthopedics and a fellow of the American Academy of Orthopedic Manual Physical Therapists.

Wen Liu

Wen Liu, PhD, is an associate professor in the department of physical therapy at the University of Kansas Medical Center. Liu is responsible for teaching in the DPT and PhD programs. He is currently conducting research in the area of motor learning, postural control, and gait disorders in individuals with age-related diseases such as stroke, and Parkinson’s disease.