The effects of spinal manipulation on performance-related outcomes in healthy asymptomatic adult population: a systematic review of best evidence

The mechanisms of manual therapy: A living review of systematic, narrative, and scoping reviews

INTRODUCTION

Treatment mechanisms are the underlying process or pathway through which a treatment influences the body. This includes molecular, cellular and physiological processes or pathways contributing to treatment effect. Manual therapy (MT) evokes complex mechanistic responses across body systems, interacting with the individual patient and context to promote a treatment response. Challenges arise as mechanistic studies are spread across multiple professions, settings and populations. The purpose of this review is to summarize treatment mechanisms that have been reported to occur with MT application.

METHODS

Four electronic databases were searched (Medline, CINAHL, Cochrane Library, and PEDro) for reviews investigating mechanistic responses which occur during/post application of MT. This review was registered a priori with PROSPERO (CRD42023444839). Methodological quality (AMSTAR-2) and risk of bias (ROBIS) were assessed for systematic and scoping reviews. Data were synthesized by mechanistic domain.

RESULTS

Sixty-two reviews were included. Systematic reviews (n = 35), narrative reviews (n = 24), and scoping reviews (n = 4) of asymptomatic (n = 37), symptomatic (n = 43), non-specified human subjects (n = 7) and animals (n = 7) were included. Reviews of moderate quality supported neurovascular, neurological, and neurotransmitter/neuropeptide changes. Reviews of low quality supported neuroimmunce, neuromuscular, and neuroendocrine changes. Reviews of critically low quality support biomechanical changes.

CONCLUSIONS

Findings support critically low to moderate quality evidence of complex multisystem mechanistic responses occurring with the application of MT. Results support peripheral, segmental spinal, and supraspinal mechanisms occurring with the application of MT, which can be measured directly or indirectly. The clinical value of these findings has not been well established. While MT has proven to be an effective intervention to treat conditions such as pain, the current body of literature leaves uncertainty as to 'why' MT interventions work, and future research should look to better define which mechanisms (or combinations of mechanisms) are mediators of clinical response.

Investigating the research capacity and productivity of Canadian sports chiropractors

Objectives

To investigate the research capacity and productivity of Canadian sports chiropractors.

Methods

A cross-sectional survey (phase one) and scoping review (phase two) investigated the research capacity and productivity (from 2015-2020) of the Canadian sports chiropractic field.

Results

Most respondents (72%) reported obtaining research training from fellowship and master's programs, with only 2 (1%) PhD qualifications identified. Approximately, 30% reported active involvement in research, with 28% being part-time clinician researchers. Access to human and technological research resources were limited. We identified 67 publications and 16 conference presentations within a five-year period, with clinical, population health, and basic science research as the areas most studied.

Conclusion

The research effort of Canadian sports chiropractors is primarily conducted by clinicians involved in research on a part-time basis. Its research outputs predominantly reflect the research requirements of the RCCSS(C) Sports Sciences Residency Program, highlighting its contribution in developing capacity and producing research for the Canadian sports chiropractic field.

I expected to be pain free: a qualitative study exploring athletes' expectations and experiences of care received by sports chiropractors

Background

Knowledge about patient satisfaction and experience with care they receive can guide practitioners in establishing doctor-patient relationships and improve health outcomes. Although evidence suggests high patient satisfaction with chiropractic care in general, there is limited understanding of the expectations and experiences of athletes receiving sports chiropractic care.

Objective

To explore the athletes’ expectations and experiences with care received from sports chiropractors, and their perceptions of relevant areas of future research.

Methods

A qualitative study was conducted through an interpretivist lens exploring the perspectives of elite and competitive athletes receiving care from sports chiropractors in Canada. Participants were purposively recruited and interviewed until saturation was reached. Two research team members independently analyzed the interview transcripts using a conventional approach to content analysis. Content was inductively coded and discussed by the research team to generate categories.

Results

We interviewed 18 participants between December 2018 and March 2020, 14 were national level athletes participating in sports ranging from paddling to combat sports. Reported reasons for seeking care included acute care, injury prevention, enhancing performance and maintenance care. Generated categories were organized under topics of experience with care, expectations of care, and research agenda. Participants experienced a variety of interventions, reassurance, varying treatment times, and reported positive impact on their athletic performance. They expected musculoskeletal assessment and treatment including at and beyond the injury site, symptom improvement, good communication and expertise from the chiropractor. Some participants suggested interpersonal and interprofessional communication can be improved, in particular the level of collaboration with other members of their health care team. Overall, participants reported a high level of trust and satisfaction with care received from sports chiropractors. From our participants’ perspective, suggested areas of research should focus on injury mechanics and prevention, impact of care on performance, and interprofessional collaboration.

Conclusions

In general, participants were very satisfied with care. Overall, participants’ expectations and experiences aligned but changed over time. Addressing the findings of this study can be used to enhance the quality of care provided to athletes from sports chiropractors, as well as inform future research agendas. Further work assessing if athletes in other competitive levels have similar experiences and expectations is needed.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12998-022-00426-4.

A clinical crossover trial of the effect of manipulative therapy on pain and passive and active range of motion of the painful hip

OBJECTIVES

This study aims to determine whether manipulative therapy of the hip joint can increase range of motion (ROM) and/or decrease pain in individuals experiencing symptomatic hip pain.

METHODS

Non-disabled young adults were recruited on campus of a chiropractic college for this randomized crossover study. Subjects' hip active and passive ROM and pain perception were measured. Subjects then received a drop-piece hip manipulation (DPHM) or an alternative treatment, followed by measurement of active and passive ROM and pain.

RESULTS

Eight males and 12 females (n=20) between the ages of 21-32 years completed the study. Statistically significant improvements in numeric pain scale (NRS) and passive abduction were observed for the manipulation group when compared to the alternative treatment. No significant change was observed for all other hip ranges.

CONCLUSIONS

DPHM of the symptomatic hip joint in a small sample of young adults resulted in statistically significant improvements in pain and passive abduction when compared to sham manipulation. Due to low sample size, further research is recommended.

Effect of osteopathic manipulation on gait asymmetry

CONTEXT

Movement and loading asymmetry are associated with an increased risk of musculoskeletal injury, disease progression, and suboptimal recovery. Osteopathic structural screening can be utilized to determine areas of somatic dysfunction that could contribute to movement and loading asymmetry. Osteopathic manipulation treatments (OMTs) targeting identified somatic dysfunctions can correct structural asymmetries and malalignment, restoring the ability for proper compensation of stresses throughout the body. Little is currently known about the ability for OMTs to reduce gait asymmetries, thereby reducing the risk of injury, accelerated disease progression, and suboptimal recovery.

OBJECTIVES

To demonstrate whether osteopathic screening and treatment could alter movement and loading asymmetry during treadmill walking.

METHODS

Forty-two healthy adults (20 males, 22 females) between the ages of 18 and 35 were recruited for this prospective intervention. Standardized osteopathic screening exams were completed by a single physician for each participant, and osteopathic manipulation was performed targeting somatic dysfunctions identified in the screening exam. Three-dimensional (3-D) biomechanical assessments, including the collection of motion capture and force plate data, were performed prior to and following osteopathic manipulation to quantify gait mechanics. Motion capture and loading data were processed utilizing Qualisys Track Manager and Visual 3D software, respectively. Asymmetry in the following temporal, kinetic, and kinematic measures was quantified utilizing a limb symmetry index (LSI): peak vertical ground reaction force, the impulse of the vertical ground reaction force, peak knee flexion angle, step length, stride length, and stance time. A 2-way repeated-measures analysis of variance model was utilized to evaluate the effects of time (pre/post manipulation) and sex (male/female) on each measure of gait asymmetry.

RESULTS

Gait asymmetry in the peak vertical ground reaction force (-0.6%, p=0.025) and the impulse of the vertical ground reaction force (-0.3%, p=0.026) was reduced in males following osteopathic manipulation. There was no difference in gait asymmetry between time points in females. Osteopathic manipulation did not impact asymmetry in peak knee flexion angle, step length, stride length, or stance time. Among the participants, 59.5% (25) followed the common compensatory pattern, whereas 40.5% (17) followed the uncommon compensatory pattern. One third (33.3%, 14) of the participants showed decompensation at the occipitoatlantal (OA) junction, whereas 26.2% (11), one third (33.3%, 14), and 26.2% (11) showed decompensation at the cervicothoracic (CT), thoracolumbar (TL), and lumbosacral (LS) junctions, respectively. Somatic dysfunction at the sacrum, L5, right innominate, and left innominate occurred in 88.1% (37), 69.0% (29), 97.6% (41), and 97.6% (41) of the participants, respectively.

CONCLUSIONS

Correcting somatic dysfunction can influence gait asymmetry in males; the sex-specificity of the observed effects of osteopathic manipulation on gait asymmetry is worthy of further investigation. Osteopathic structural examinations and treatment of somatic dysfunctions may improve gait symmetry even in asymptomatic individuals. These findings encourage larger-scale investigations on the use of OMT to optimize gait, prevent injury and the progression of disease, and aid in recovery after surgery.

The Immediate Effect of Spinal Manipulation on Ball Velocity and Neuromuscular Function During an Instep Kick in Former Varsity Soccer Players: A Feasibility Study

Corso, M, Liang, L, Tran, S, Howitt, S, Srbely, J, and Mior, SA. The immediate effect of spinal manipulation on ball velocity and neuromuscular function during an instep kick in former Varsity soccer players: a feasibility study. J Strength Cond Res XX(X): 000-000, 2020-Spinal manipulation (SM) has been shown to increase ball velocity (BV) in soccer players. Evidence suggests that SM modulates responses at spinal or cortical levels to enhance force production in asymptomatic populations. No studies have explored the underlying neuromuscular mechanisms contributing to changes in BV post-SM in soccer players. We assessed the feasibility of measuring change in BV and neuromuscular function after SM in former Varsity level soccer players with a pre-post study design. Three to 5 maximal instep kicks were performed before and after SM at the L3-5 level. Ball velocity was measured using high-speed camera. Activation of lower limb and trunk musculature was recorded with electromyography. Outcomes included ease of recruitment, scheduling and data capture, as well as expectation and perception of SM effect and adverse events (AE). Fifteen potential subjects were recruited over 1.5 months. Eleven were scheduled (24-31 years; 8 females, 3 males). Two subjects reported mild AE after maximal voluntary isometric contraction testing. A significant increase in BV (mean change: 1.75 m·s [95% confidence interval: 0.5-3.0]) and a trend to increased peak-activation of knee extensors (90.7%) were observed post-SM. Findings suggest that our recruitment strategy and methodology are feasible in a larger trial with some modifications. Our preliminary findings support previous research by suggesting that increased BV may be mediated through increased activation of knee extensors during the kick. Our findings may offer additional insight into the underlying neuromuscular mechanisms contributing to immediate change in BV post-SM.

The usage of multidisciplinary physical therapies at the Rio de Janeiro 2016 Olympic Summer Games: an observational study

BACKGROUND

This observational research study analyses the uptake of physical therapies treatments in the Polyclinic during the Rio 2016 Olympic Games.

OBJECTIVE

To describe the usage of physical therapies services - physical therapy, osteopath, chiropractic, and sports massage - by athletes and non-athletes and across different sports.

METHODS

The multidisciplinary team of physical therapies recorded treatment modalities, information on provider discipline and reason for attendance, in an Electronic Medical Record system throughout the 32 days of operation of the Olympic Polyclinic. Cold-therapy total immersion ice baths (TIIB) were provided as part of the services, but were reported and analysed separately.

RESULTS

There were 4993 encounters (4038 athletes, 955 non-athlete encounters). 1395 athletes (12.4% of all athletes) and 393 non-athletes sought treatment. For all four provider disciplines, in addition to TIIB, the primary reason for athlete attendance was for recovery (52% of all encounters), followed by injury treatment (30%), and maintenance (16%). Athletes reported "injury" as the main reason for physical therapy (92% of all encounters, 2.8 encounters per athlete), chiropractic (94%, 1.9) and osteopathy (91%, 1.8) visits. Almost all TIIB visits were used for recovery (98% of all TIIB encounters; 2.1 encounters per athlete). Athletes from handball (37% of all handball athletes), followed by judo (22%), and athletics (21%), presented the largest user groups.

CONCLUSION

This Olympic Polyclinic study evaluates the physical therapies' activity, and athlete's reason for use of the multidisciplinary physical therapies team, including total immersion ice bath provision. These results emphasise the importance of a multidisciplinary approach.