Faculty of Rehabilitation Medicine, University of Alberta, Corbett Hall, 8205 114 Street NW, Edmonton, Alberta, T6G 2G4, Canada.
Department of Mechanical Engineering, University of Alberta, Donadeo Innovation Centre for Engineering, 9211-116 Street, Edmonton, Alberta, T6G 1H9, Canada.
Chiropr Man Therap. 2020 Mar 23;28(1):15. doi: 10.1186/s12998-020-00304-x.
In individuals having low back pain, the application of spinal manipulative therapy (SMT) has been shown to reduce spinal stiffness in those who report improvements in post-SMT disability. The underlying mechanism for this rapid change in stiffness is not understood presently. As clinicians and patients may benefit from a better understanding of this mechanism in terms of optimizing care delivery, the objective of this scoping review of current literature was to identify if potential mechanisms that explain this clinical response have been previously described or could be elucidated from existing data.
Three literature databases were systematically searched (MEDLINE, CINAHL, and PubMed). Our search terms included subject headings and keywords relevant to SMT, spinal stiffness, lumbar spine, and mechanism. Inclusion criteria for candidate studies were publication in English, quantification of lumbar spinal stiffness before and after SMT, and publication between January 2000 and June 2019.
The search identified 1931 articles. Of these studies, 10 were included following the application of the inclusion criteria. From these articles, 7 themes were identified with respect to potential mechanisms described or derived from data: 1) change in muscle activity; 2) increase in mobility; 3) decrease in pain; 4) increase in pressure pain threshold; 5) change in spinal tissue behavior; 6) change in the central nervous system or reflex pathways; and 7) correction of a vertebral dysfunction.
This scoping review identified 7 themes put forward by authors to explain changes in spinal stiffness following SMT. Unfortunately, none of the studies provided data which would support the promotion of one theme over another. As a result, this review suggests a need to develop a theoretical framework to explain rapid biomechanical changes following SMT to guide and prioritize future investigations in this important clinical area.
在患有下腰痛的个体中，脊柱手法治疗（SMT）的应用已被证明可以降低那些在 SMT 后残疾程度改善的患者的脊柱僵硬度。目前尚不清楚这种僵硬度快速变化的潜在机制。由于临床医生和患者可能会从更好地理解这一机制中受益，从而优化治疗方案，因此本次对现有文献的范围综述旨在确定是否已经描述了可以从现有数据中阐明的解释这种临床反应的潜在机制。
系统地检索了三个文献数据库（MEDLINE、CINAHL 和 PubMed）。我们的检索词包括与 SMT、脊柱僵硬度、腰椎和机制相关的主题词和关键词。候选研究的纳入标准为：发表于英文期刊，在 SMT 前后定量测量腰椎僵硬度，且发表于 2000 年 1 月至 2019 年 6 月。
搜索共确定了 1931 篇文章。在应用纳入标准后，其中 10 项研究被纳入。从这些文章中，确定了 7 个与潜在机制相关的主题，这些主题或源自数据，或由数据得出：1）肌肉活动的改变；2）活动度的增加；3）疼痛减轻；4）压力疼痛阈值增加；5）脊柱组织行为的改变；6）中枢神经系统或反射途径的改变；7）椎体功能障碍的纠正。
本次范围综述确定了 7 个主题，作者提出这些主题以解释 SMT 后脊柱僵硬度的变化。不幸的是，没有一项研究提供的数据能够支持其中一个主题优于另一个主题。因此，本次综述表明需要制定一个理论框架来解释 SMT 后快速的生物力学变化，从而指导和优先考虑这一重要临床领域的未来研究。
