University of Mary, Bismarck, ND, USA.
Chiropr Man Therap. 2024 May 29;32(1):19. doi: 10.1186/s12998-024-00540-5.
Lumbar spinal manipulative therapy (SMT) is a common intervention used to treat low back pain (LBP); however, the exact neurophysiological mechanisms of SMT reducing pain measured through pain pressure threshold (PPT) have not been fully explored beyond an immediate timeframe (e.g., immediately or five-minutes following) referencing a control group. Therefore, the purpose of this study was to investigate the neurophysiological effects of lumbar SMT compared to deactivated ultrasound using PPT immediately following and 30-minutes following SMT.
A longitudinal, randomized controlled trial design was conducted between September to October 2023. Fifty-five participants were randomized into a control group of deactivated ultrasound (n = 29) or treatment group of right sidelying lumbar SMT (n = 26). PPT, recorded at the right posterior superior iliac spine (PSIS), was documented for each participant in each group prior to intervention, immediately, and 30-minutes after. A repeated measures ANOVA, with a post-hoc Bonferroni adjustment, was used to assess within-group and between-group differences in PPT. The significance level was set at a < 0.05 a priori.
Statistically significant differences were found between the deactivated ultrasound and lumbar SMT groups immediately (p = .05) and 30-minutes (p = .02) following intervention. A significant difference in the lumbar SMT group was identified from baseline to immediately following (p < .001) and 30-minutes following (p < .001), but no differences between immediately following and 30-minutes following intervention (p = .10). The deactivated ultrasound group demonstrated a difference between baseline and immediately after intervention with a reduced PPT (p = .003), but no significant difference was found from baseline to 30-minutes (p = .11) or immediately after intervention to 30-minutes (p = 1.0).
A right sidelying lumbar manipulation increased PPT at the right PSIS immediately after that lasted to 30-minutes when compared to a deactivated ultrasound control group. Future studies should further explore beyond the immediate and short-term neurophysiological effects of lumbar SMT to validate these findings.
This study was retrospectively registered on 4 December 2023 in ClinicalTrials (database registration number NCT06156605).
腰椎推拿疗法（SMT）是一种常用于治疗下腰痛（LBP）的常见干预措施；然而，SMT 通过疼痛压力阈值（PPT）减轻疼痛的确切神经生理机制在参考对照组的即时时间范围（例如，立即或 5 分钟后）之外尚未得到充分探索。因此，本研究的目的是调查与失活超声相比，腰椎 SMT 在治疗后即刻和 30 分钟时对 PPT 的神经生理影响。
2023 年 9 月至 10 月进行了一项纵向、随机对照试验设计。将 55 名参与者随机分为对照组（失活超声，n=29）或治疗组（右侧侧卧位腰椎 SMT，n=26）。在干预前、治疗后即刻和 30 分钟时，记录每个参与者右侧髂后上棘（PSIS）的 PPT。采用重复测量方差分析，并用事后 Bonferroni 调整来评估组内和组间 PPT 的差异。事先设定显著性水平为 a < 0.05。
干预后即刻（p=0.05）和 30 分钟（p=0.02）时，失活超声组和腰椎 SMT 组之间存在统计学显著差异。腰椎 SMT 组从基线到治疗后即刻（p<0.001）和 30 分钟（p<0.001）有显著差异，但治疗后即刻与 30 分钟之间无差异（p=0.10）。失活超声组在干预后即刻与基线相比，PPT 降低（p=0.003），但从基线到 30 分钟（p=0.11）或干预后即刻到 30 分钟（p=1.0）无显著差异。
与失活超声对照组相比，右侧侧卧位腰椎推拿可立即增加右侧 PSIS 的 PPT，持续至 30 分钟。未来的研究应该进一步探索腰椎 SMT 的即时和短期神经生理效应之外的效果，以验证这些发现。
本研究于 2023 年 12 月 4 日在 ClinicalTrials（数据库注册编号 NCT06156605）进行了回顾性注册。
