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Spinal Manipulation

A Retrospective Analysis of the Incidence of Severe Adverse Events Among Recipients of Chiropractic Spinal Manipulative Therapy

By |June 24, 2024|Adverse Events, Spinal Manipulation|

A Retrospective Analysis of the Incidence of Severe Adverse Events Among Recipients of Chiropractic Spinal Manipulative Therapy

The Chiro.Org Blog

SOURCE:   Sci Rep 2023 (Jan 23); 13 (1): 1254


Eric Chun-Pu Chu • Robert J Trager • Linda Yin-King Lee • Imran Khan Niazi

New York Chiropractic and Physiotherapy Centre,
EC Healthcare, 41/F Langham Place Office Tower,
8 Argyle Street, Kowloon, Hong Kong.

This study examined the incidence and severity of adverse events (AEs) of patients receiving chiropractic spinal manipulative therapy (SMT), with the hypothesis that < 1 per 100,000 SMT sessions results in a grade ≥ 3 (severe) AE. A secondary objective was to examine independent predictors of grade ≥ 3 AEs. We identified patients with SMT-related AEs from January 2017 through August 2022 across 30 chiropractic clinics in Hong Kong. AE data were extracted from a complaint log, including solicited patient surveys, complaints, and clinician reports, and corroborated by medical records. AEs were independently graded 1–5 based on severity (1–mild, 2–moderate, 3–severe, 4–life-threatening, 5–death). Among 960,140 SMT sessions for 54,846 patients, 39 AEs were identified, two were grade 3, both of which were rib fractures occurring in women age > 60 with osteoporosis, while none were grade ≥ 4, yielding an incidence of grade ≥ 3 AEs of 0.21 per 100,000 SMT sessions (95% CI 0.00, 0.56 per 100,000). There were no AEs related to stroke or cauda equina syndrome. The sample size was insufficient to identify predictors of grade ≥ 3 AEs using multiple logistic regression. In this study, severe SMT-related AEs were reassuringly very rare.

Subject terms:   Adverse effects, Rehabilitation

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Spinal Manipulative Therapy Has an Immediate Effect

By |May 1, 2017|Pain Relief, Spinal Manipulation, Thermal Pain Sensitivity|

Spinal Manipulative Therapy Has an Immediate Effect on Thermal Pain Sensitivity in People With Low Back Pain: A Randomized Controlled Trial

The Chiro.Org Blog

SOURCE:   Phys Ther. 2009 (Dec); 89 (12): 1292–1303

Parvaneh Mohammadian, PhD, Antonio Gonsalves, DC, Chris Tsai, DC, Thomas Hummel, MD, and
Thomas Carpenter, DC

Department of Physical Therapy,
University of Florida,
Gainesville, FL 32610-0154, USA.

BACKGROUND:   Current evidence suggests that spinal manipulative therapy (SMT) is effective in the treatment of people with low back pain (LBP); however, the corresponding mechanisms are unknown. Hypoalgesia is associated with SMT and is suggestive of specific mechanisms.

OBJECTIVE:   The primary purpose of this study was to assess the immediate effects of SMT on thermal pain perception in people with LBP. A secondary purpose was to determine whether the resulting hypoalgesia was a local effect and whether psychological influences were associated with changes in pain perception.

DESIGN:   This study was a randomized controlled trial.

SETTING:   A sample of convenience was recruited from community and outpatient clinics.

PARTICIPANTS:   Thirty-six people (10 men, 26 women) currently experiencing LBP participated in the study. The average age of the participants was 32.39 (SD=12.63) years, and the average duration of LBP was 221.79 (SD=365.37) weeks.

INTERVENTION AND MEASUREMENTS:   Baseline demographic and psychological measurements were obtained, followed by quantitative sensory testing to assess temporal summation and Adelta fiber-mediated pain perception. Next, participants were randomly assigned to ride a stationary bicycle, perform low back extension exercises, or receive SMT. Finally, the same quantitative sensory testing protocol was reassessed to determine the immediate effects of each intervention on thermal pain sensitivity.

RESULTS:   Hypoalgesia to A-delta fiber-mediated pain perception was not observed. Group-dependent hypoalgesia of temporal summation specific to the lumbar innervated region was observed. Pair-wise comparisons indicated significant hypoalgesia in participants who received SMT, but not in those who rode a stationary bicycle or performed low back extension exercises. Psychological factors did not significantly correlate with changes in temporal summation in participants who received SMT.

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Subluxation Neurology Section


Effects of 12 Weeks of Chiropractic Care on Central Integration of Dual Somatosensory Input in Chronic Pain Patients

By |March 3, 2017|Neurology, Spinal Manipulation|

Effects of 12 Weeks of Chiropractic Care on Central Integration of Dual Somatosensory Input in Chronic Pain Patients: A Preliminary Study

The Chiro.Org Blog

SOURCE:   J Manipulative Physiol Ther. 2017 (Feb 10) [Epub]

Heidi Haavik, PhD, BSc (Chiro), Imran Khan Niazi, PhD,
Kelly Holt, PhD, BSc (Chiro), Bernadette Murphy, PhD, DC

Centre for Chiropractic,
New Zealand College of Chiropractic,
Mount Wellington,
Auckland, New Zealand.

OBJECTIVE:   The purpose of this preliminary study was to assess whether the dual somatosensory evoked potential (SEP) technique is sensitive enough to measure changes in cortical intrinsic inhibitory interactions in patients with chronic neck or upper extremity pain and, if so, whether changes are associated with changes in pain scores.

METHODS:   The dual peripheral nerve stimulation SEP ratio technique was used for 6 subjects with a history of chronic neck or upper limb pain. SEPs were recorded after left or right median and ulnar nerve stimulation at the wrist. SEP ratios were calculated for the N9, N13, P14-18, N20-P25, and P22-N30 peak complexes from SEP amplitudes obtained from simultaneous median and ulnar stimulation divided by the arithmetic sum of SEPs obtained from individual stimulation of the median and ulnar nerves. Outcome measures of SEP ratios and subjects’ visual analog scale rating of pains were recorded at baseline, after a 2-week usual care control period, and after 12 weeks of multimodal chiropractic care (chiropractic spinal manipulation and 1 or more of the following: exercises, peripheral joint adjustments/manipulation, soft tissue therapy, and pain education).

RESULTS:   A significant decrease in the median and ulnar to median plus ulnar ratio and the median and ulnar amplitude for the cortical P22-N30 SEP component was observed after 12 weeks of chiropractic care, with no changes after the control period. There was a significant decrease in visual analog scale scores (both for current pain and for pain last week).

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Neurology subsection


Metabolic Syndrome Components Are Associated with Intervertebral Disc Degeneration

By |January 8, 2017|Somato-visceral, Spinal Manipulation|

Metabolic Syndrome Components Are Associated with Intervertebral Disc Degeneration: The Wakayama Spine Study

The Chiro.Org Blog

SOURCE:   PLoS One. 2016 (Feb 3); 11 (2): e0147565 ~ FULL TEXT

Masatoshi Teraguchi, Noriko Yoshimura,
Hiroshi Hashizume, Shigeyuki Muraki, et al

Department of Orthopaedic surgery,
Wakayama Medical University,
811-1 Kimiidera,
Wakayama, 641-8509, Japan.

OBJECTIVE:   The objective of the present study was to examine the associations between metabolic syndrome (MS) components, such as overweight (OW), hypertension (HT), dyslipidemia (DL), and impaired glucose tolerance (IGT), and intervertebral disc degeneration (DD).

DESIGN:   The present study included 928 participants (308 men, 620 women) of the 1,011 participants in the Wakayama Spine Study. DD on magnetic resonance imaging was classified according to the Pfirrmann system. OW, HT, DL, and IGT were assessed using the criteria of the Examination Committee of Criteria for MS in Japan.

RESULTS:   Multivariable logistic regression analysis revealed that OW was significantly associated with cervical, thoracic, and lumbar DD (cervical: odds ratio [OR], 1.28; 95% confidence interval [CI], 0.92-1.78; thoracic: OR, 1.75; 95% CI, 1.24-2.51; lumbar: OR, 1.87; 95% CI, 1.06-3.48). HT and IGT were significantly associated with thoracic DD (HT: OR, 1.54; 95% CI, 1.09-2.18; IGT: OR, 1.65; 95% CI, 1.12-2.48). Furthermore, subjects with 1 or more MS components had a higher OR for thoracic DD compared with those without MS components (vs. no component; 1 component: OR, 1.58; 95% CI, 1.03-2.42; 2 components: OR, 2.60; 95% CI, 1.62-4.20; ≥3 components: OR, 2.62; 95% CI, 1.42-5.00).

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Non-musculoskeletal Disorders and Chiropractic


The Physiological Role of Tumor Necrosis Factor in Human Immunity and Its Potential Implications in Spinal Manipulative Therapy

By |October 1, 2016|Immune Function, Spinal Manipulation|

The Physiological Role of Tumor Necrosis Factor in Human Immunity and Its Potential

Implications in Spinal Manipulative Therapy:   A Narrative Literature Review

The Chiro.Org Blog

SOURCE:   J Chiropractic Medicine 2016 (Sep)

Liang Zhang, MD, PhD, Chao Hua Yao, MD

Palmer College of Chiropractic,
Florida Campus, Port Orange, FL;
Palmer Laboratory of Cell & Molecular Biology,
Palmer Center for Chiropractic Research,
Port Orange, FL.

OBJECTIVE:   Although tumor necrosis factor (TNF) is a well-known inflammatory cytokine in the pathological development of various human diseases, its physiological roles are not widely understood nor appreciated. The molecular mechanisms underlying spinal manipulation therapy (SMT) remain elusive. The relationship between TNF and SMT is unclear. Thus, we performed this literature review to better understand TNF physiology and its potential relationship with SMT, and we propose a novel mechanism by which SMT may achieve clinical benefits by using certain beneficial features of TNF.

METHODS:   We searched several databases for relevant articles published between 1975 and 2015 and then reexamined the studies from current immunophysiological perspectives.

RESULTS:   The history and recent progresses in TNF physiology research were explored. Conflicting reports on the relationship between TNF and SMT were identified. Based on the newly discovered interaction between TNF and regulatory T cells, we proposed a putative biphasic TNF response to SMT, which may resolve the conflicts in the reported observations and interpretations.

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Chiropractic Subluxation Page


Visceral Responses to Spinal Manipulation

By |September 10, 2016|Spinal Manipulation, Visceral Disease|

Visceral Responses to Spinal Manipulation

The Chiro.Org Blog

SOURCE:   J Electromyogr Kinesiol. 2012 (Oct); 22 (5): 777–784

Philip Bolton, Brian Budgell

School of Biomedical Sciences & Pharmacy,
Faculty of Health,
University of Newcastle,
Callaghan NSW 2308, Australia.

While spinal manipulation is widely seen as a reasonable treatment option for biomechanical disorders of the spine, such as neck pain and low back pain, the use of spinal manipulation to treat non-musculoskeletal complaints remains controversial. This controversy is due in part to the perception that there is no robust neurobiological rationale to justify using a biomechanical treatment of the spine to address a disorder of visceral function. This paper therefore looks at the physiological evidence that spinal manipulation can impact visceral function. A structured search was conducted, using PubMed and the Index to Chiropractic Literature, to construct of corpus of primary data studies in healthy human subjects of the effects of spinal manipulation on visceral function. The corpus of literature is not large, and the greatest number of papers concerns cardiovascular function. Authors often attribute visceral effects of spinal manipulation to somato-autonomic reflexes. While this is not unreasonable, little attention is paid to alternative mechanisms such as somato-humoural pathways. Thus, while the literature confirms that mechanical stimulation of the spine modulates some organ functions in some cohorts, a comprehensive neurobiological rationale for this general phenomenon has yet to appear.


From the FULL TEXT Article:


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Non-musculoskeletal Disorders
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