Medical Research Unit, Spine Centre of Southern Denmark, University Hospital of Southern Denmark, Odense, Denmark.
Department of Physical Therapy, University of Alberta, Edmonton, Canada.
Sci Rep. 2020 Sep 3;10(1):14615. doi: 10.1038/s41598-020-71557-y.
The mechanisms underlying pain relief following spinal manipulative therapy (SMT) are not understood fully although biomechanical and neurophysiological processes have been proposed. As such, we designed this randomized trial to elucidate the contributions of biomechanical and neurophysiological processes. A total of 132 participants with low back pain were randomly assigned to receive SMT at either the lumbar segment measured as the stiffest or the segment measured as having the lowest pain threshold. The primary outcome was patient reported low back pain intensity following treatment. Secondary outcomes were biomechanical stiffness and neurophysiological pressure pain threshold. All outcomes were measured at baseline, after the fourth and final session and at 2-weeks follow-up. Data were analyzed using linear mixed models, and demonstrated that the SMT application site did not influence patient reported low back pain intensity or stiffness. However, a large and significant difference in pressure pain threshold was observed between groups. This study provides support that SMT impacts neurophysiological parameters through a segment-dependent neurological reflex pathway, although this do not seem to be a proxy for improvement. This study was limited by the assumption that the applied treatment was sufficient to impact the primary outcome.
脊柱手法治疗（SMT）缓解疼痛的机制尚不完全清楚，尽管已经提出了生物力学和神经生理学过程。因此，我们设计了这项随机试验来阐明生物力学和神经生理学过程的贡献。共有 132 名腰痛患者被随机分配接受 SMT，治疗部位要么是测量最僵硬的腰椎节段，要么是测量疼痛阈值最低的节段。主要结果是治疗后患者报告的腰痛强度。次要结果是生物力学刚度和神经生理压力疼痛阈值。所有结果均在基线、第四次和最后一次治疗后以及 2 周随访时进行测量。使用线性混合模型进行数据分析，结果表明 SMT 应用部位不影响患者报告的腰痛强度或刚度。然而，两组之间的压力疼痛阈值存在显著差异。这项研究支持 SMT 通过与节段相关的神经反射途径影响神经生理学参数，尽管这似乎不是改善的替代指标。本研究的局限性在于假设应用的治疗足以影响主要结果。
