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Systematic reviews

The role of spinal manipulation in addressing disordered sensorimotor integration and altered motor control


 * the central neural plastic effects of manual spinal manipulation
 * ‘manipulable lesion’’ will be referred to as an area of spinal dysfunction or joint dysfunction.
 * Hypothesis areas of spinal dysfunction, represent a state of altered afferent input which may be responsible for ongoing central plastic changes at the CNS.
 * SMT results in plastic changes in sensorimotor function within the CNS in humans
 * Unsure if changes are due to correction of spinal dysfunction thereby normalizing aberrant afferent input to CNS or result of afferent barrage with manipulative thrust

Changes in pain sensitivity following spinal manipulation: a systematic review and meta-analysis.


 * SMT demonstrated a favorable effect over other interventions on increasing PPT. Subgroup analysis showed a significant effect of SMT on increasing PPT at the remote sites of stimulus application supporting a potential central nervous system mechanism.

Basis for SMT: PT perspective


 * Physical therapists internationally provide SMT to patients with musculoskeletal pain complaints.
 * Clinical decision making is upon identifying a dysfunctional vertebral segment with the application of SMT to restore mobility and/or alleviate pain.




 * HVLAM has a profound influence on nociceptive stimulus via the possible activation of the DIPM.
 * "It seems that the application of this technique activates the periaqueductal gray region area of the midbrain, stimulates the noradrenergic descending system and at the level of the spinal cord, the nociceptive afferent barrage is reduced and mechanical hypoalgesia is induced."




 * " short-term changes in lateral abdominal muscle thickness post spinal manipulation. Although case series have significant limitations, including the fact that no cause-and-effect claims can be made, the decrease in muscle thickness at rest and the greater increase in muscle thickness during the ADIM postmanipulation observed in some of the patients could suggest an improvement in muscular function"




 * "the literature infrequently reports useful data toward understanding the association between cSMT, CADs and stroke. Improving the quality, completeness, and consistency of reporting adverse events may improve our understanding of this important relation."




 * " manipulation treatment on vertebral artery type of cervical spondylosis is safe, both cure rate and the effective rate are much better than other therapies; but the incorporation of a limited number of documents and the quality is not very high, the conclusion is still uncertain, high-quality evidence should be needed to be further validated."




 * Regression relationships demonstrated that species, HVLA-SM site, and interactions thereof were significantly and moderately well correlated for HVLA-SM that generated tensile strain in the FJC.




 * Biomechanical changes caused by spinal manipulation are thought to have physiological consequences by means of their effects on the inflow of sensory information to the central nervous system
 * spinal manipulation impacts primary afferent neurons from paraspinal tissues, the motor control system and pain processing.
 * Substantial evidence demonstrates that spinal manipulation evokes paraspinal muscle reflexes and alters motoneuron excitability.




 * descending pathways might play a key role in manual therapy induced hypoalgesia. Our review supports the existence of an alternative neurophysiological model, in which passive joint mobilisation stimulates areas within the central nervous system.




 * Cervical muscle tone and salivary amylase were decreased after CSM. Conclusion The results of this study suggest that CSM affects regional cerebral glucose metabolism related to sympathetic relaxation and pain reduction.




 * back and neck pain affect more people and have greater impact on work capacity and health-care costs than any other musculoskeletal condition

[

Strain Patterns

http://www.ncbi.nlm.nih.gov/pubmed/22483611


 * major issues of the use of SMT is its safety, especially with the risk of stroke. The vast majority of these accidents involve the vertebro-basilar system, specifically the vertebral artery (VA) between C2/C1
 * VA strains obtained during SMT are significantly smaller than those obtained during diagnostic and range of motion testing, and are much smaller than failure strains
 * cervical SMT performed by trained clinicians does not appear to place undue strain on VA, and thus does not seem to be a factor in vertebro-basilar injuries.




 * When performed in cadavers, cSMT tends to be more "aggressive" in terms of all biomechanical indices used to describe cSMT.
 * reload and peak forces were significantly higher for cadaveric cSMT; the average peak force was 190.3±85.5N (mean±SD) in living subjects, versus 283.9±53.6N in cadavers.




 * SMT produced reflex responses distant from the treatment site, caused movements of vertebral bodies in the "para-physiological" zone, and were associated with cavitation of facet joints.
 * Stresses and strains on the vertebral artery during chiropractic spinal manipulation of the neck were always much smaller than those produced during passive range of motion testing and diagnostic procedures.




 * Decreases in terminal spinal stiffness were observed after SMT delivered at some application sites but not the others. The results suggest that SMT contact site modulates SMT's effect on spinal stiffness in a feline model.
 * Specific sites were the spinous process and lamina
 * Changes in spinal terminal instantaneous spinal stiffness were similar in magnitude and direction to those observed in symptomatic human subjects who report benefits after SMT.




 * The smaller compared with the larger preload magnitude and the longer compared with the shorter preload duration significantly increased muscle spindle responses during the HVLA-SM thrust
 * Interactions between preload magnitude, duration, and downward incisural point often produced statistically significant but arguably physiologically modest changes in the passive signaling properties of the muscle spindle after the manipulation.



Tertiary sources


 * | MSK MM
 * | Science and Practice of Manual Therapy
 * | Chiropractic technique and principles
 * | An Osteopathic Approach to Dx and Tx
 * | Manipulative Therapy: Musculoskeletal Medicine

Spinal manipulation is a therapeutic intervention used for the treatment spinal dysfunction in the hopes of reducing pain and disability of the neuromusculoskeletal system. The medicinal use of spinal manipulation can be traced back over 3000 years to ancient Chinese writings. Hippocrates, the "father of medicine" used manipulative techniques, as did the ancient Egyptians and many other cultures. A modern re-emphasis on manipulative therapy occurred in the late 19th century in North America with the emergence of the osteopathic medicine and chiropractic medicine. SMT gained mainstream recognition during the 1980s. Spinal manipulation/adjustment describes techniques where the hands are used to manipulate, massage, mobilize, adjust, stimulate, apply traction to, or otherwise influence the spine and related tissues. It is the most common and primary intervention used in chiropractic care. In North America, chiropractors perform over 90% of all manipulative treatments with the balance provided by osteopathic medicine, physical therapy and naturopathic medicine. Manipulation under anesthesia or MUA is a specialized manipulative procedure that typically occurs in hospitals administered under general anesthesia. Typically, it is performed on patients who have failed to respond to other forms of treatment.

Research
In 1975, legitimate scientific investigation from the  chiropractic, osteopathic and allopathic communities were invited to attended the first research symposium on spinal manipulation at the National Institute of Health (NIH.)  Basic science studies presented were in anatomy, biochemistry, biomechanics, and neuroscience. Clinical investigators with chiropractic, osteopathic and medical backgrounds presented papers on research findings from pathology, radiology and clinical evaluations; the latter being primarily observational studies. In the 1980s, spinal manipulation had gained mainstream acceptance, which has led to increased collaboration with medical practitioners on models for the delivery manual and manipulative therapies for spinal and musculoskeletal conditions.

Terminology
High-velocity low amplitude {HVLA) manipulative therapy is also known as adjustment and Grade V mobilisation. Chiropractors and some osteopaths prefer to use the term "adjustment," a term which reflects "their belief in the therapeutic and health-enhancing effect of correcting spinal joint abnormalities."

Categories
Manual and mechanically assisted manipulative procedures can include:


 * HVLA thrust manipulation
 * HVLA thrust manipulation with recoil
 * LVLA manipulation (mobilization)
 * Drop tables and terminal point manipulative thrust
 * Flexion-distraction and traction-type tables
 * Pelvic blocks
 * Instrument assisted manipulative devices

Manual non-articular manipulative procedures can include:
 * Manual reflex and muscle relaxation procedures
 * Muscle energy techniques
 * Reflex techniques
 * Myofascial ischemic compression procedures
 * Myofascial, and soft tissue manipulative techniques

Musculoskeletal disorders
The use of manual and manipulative therapies is a commonly used intervention used by manual medicine practitioners in the treatment of neuromusculoskeletal disorders. Spinal manipulation, in particular is widely seen as a reasonable treatment option for biomechanical disorders of the spine, such as neck pain and low back pain Manual therapies, including spinal manipulation, commonly used by manipulative medicine practitioners may be effective for the treatment of spinal pain, including low back pain, neck pain, some forms of headache and a number of extremity joint conditions such as shoulder and hip pain. Specifically, spinal manipulation/mobilization may be effective in adults for: acute, subacute, and chronic low back pain; migraine and cervicogenic headache; cervicogenic dizziness; manipulation/mobilization is effective for several extremity joint conditions; and thoracic manipulation/mobilization is effective for acute/subacute neck pain and might also be effective for the treatment of lumbar disc herniation with radiculopathy, neck pain, some forms of headache,  and some extremity joint conditions.

Non-musculoskeletal
The evidence is inconclusive for cervical manipulation/mobilization alone for neck pain of any duration, and for manipulation/mobilization for mid back pain, sciatica, tension-type headache, coccydynia, temporomandibular joint disorders, fibromyalgia, premenstrual syndrome, and pneumonia in older adults. Spinal manipulation is not effective for asthma and dysmenorrhea when compared to sham manipulation, or for Stage 1 hypertension when added to an antihypertensive diet. In children, the evidence is inconclusive regarding the effectiveness for otitis media and enuresis, and it is not effective for infantile colic and asthma when compared to sham manipulation.Massage is effective in adults for chronic low back pain and chronic neck pain. The evidence is inconclusive for knee osteoarthritis, fibromyalgia, myofascial pain syndrome, migraine headache, and premenstrual syndrome. In children, the evidence is inconclusive for asthma and infantile colic. and no scientific data for idiopathic adolescent scoliosis.

Safety
The safe application of spinal manipulation requires a thorough medical history, assessment, diagnosis and plan of management. Manipulative therapists, including chiropractors, must rule out contraindications to HVLA spinal manipulative techniques. Absolute contraindications refers to diagnoses and conditions that put the patient at risk to developing adverse events. For example, a diagnosis of rheumatoid arthritis and other conditions that structurally destabilizes joints, is an absolute contraindication of SMT to the upper cervical spine. Relative contraindications, such as osteoporosis are conditions where increased risk is acceptable in some situations and where mobilization and soft-tissue techniques would be treatments of choice. Most contraindication apply only to the manipulation of the affected region.

Adverse events in SM studies are believed to be under-reported and appear to be more common following HVLA manipulation than mobilization. Mild, frequent and temporary adverse events occur in SMT which include temporary increase in pain, tenderness and stiffness. These events typically dissipates within 24-48 hours Serious injuries and fatal consequences, especially to SM in the upper cervical region, can occur. but are regarded as rare when spinal manipulation is employed skillfully and appropriately.

There is considerable debate regarding the relationship of spinal manipulation to the upper cervical spine and stroke. Stoke is statistically associated with both general practitioner and chiropractic services in persons under 45 years of age suggesting that these associations are likely explained by preexisting conditions. Weak to moderately strong evidence supports causation (as opposed to statistical association) between cervical manipulative therapy and vertebrobasilar artery stroke. A 2012 systematic review determined that there is insufficient evidence to support a strong association or no association between cervical manipulation and stroke.


 * Apology issued re: personal attack complaint, transparent request for a RfC, DR mechanism regarding MM for MSK.
 * Block this year was for 2 reverts in 3 days, not generally associated with edit warring as per unblock
 * 1 acupuncture edit of the last 500, warned about making false allegations against me , did not follow protocol with the blocking and continues to mis-represent that I am a pseudoscience advocate. Here he is warned about his stridency in editing , and religious attitude in editing .  False accessions which ruin my reputation.
 * Debate whether or not MM is pseudoscience at the OMM page
 * Brangifer misrepresenting my intentions to delete, rather trim the duplication and puffery quotes
 * Attack by Brangifer for incorrectly assuming my intent and continuing to mis-represent me or any 'agenda'
 * Misrepresentation that I am trying to white-wash. I am not as I stated here and have decided to disengage  as there are more pressing issues elsewhere.
 * Misrepresentation of the facts, assuming I understood a spam tag , asking him to not write on my page , and he did again , more character assination [https://en.wikipedia.org/w/index.php?title=User_talk:Moxy&diff=prev&oldid=612938078
 * Brangifer making misleading statements based on opinions without verifiable facts., .]
 * Total of 14 edits over the 500 at chiropractic, with 6 coming from adding the NPOV tag due to the unbalanced views at the article


 * Manipulative therapies are practiced by a wide variety of professions, including osteopathic, chiropractic, physical therapy, medicine and naturopathic medicine. The issue of MM for MSK is germane to all these professions.  However, because chiropractors are the largest purveyor of manipulative services, and it is their primary intervention, it would naturally be a topic that is arguably the most relevant
 * Regardless of which profession is providing MM, the evidence basis is consistent across all. Scientific research into MM is not owned by any profession and there is scientific research detailing the mechanisms of action of spinal manipulation.  Hence, this because the mechanisms of action are known, and MM has comparative effectiveness so other standard treatments for MSK disorders, there is an argument that it is mainstream, especially when existing sources and sociological analysis suggests MM is mainstream.
 * Discussing fringe vs. mainstream for MM for MSK and the perceptions about fringe and mainstream as a policy on WP
 * Began process for Wikiproject manual medicine, intention is to increase awareness of sciences of manual medicine and their role in health care
 * Collective efforts to tag team per

. MT and TTH