Abstract
Background context: Despite clinical evidence for the benefits of spinal maniputation
and the apparent wide usage of it, the biological mechanisms underlying the effects
of spinal manipulation are not known. Although this does not negate the clinical effects
of spinal manipulation, it hinders acceptance by the wider scientific and health-care
communities and hinders rational strategies for improving the delivery of spinal manipulation.
Purpose: The purpose of this review article is to examine the neurophysiological basis
for the effects of spinal manipulation. Study design: A review article discussing primarily basic science literature and clinically oriented
basic science studies. Methods: This review article draws primarily from the peer-reviewed
literature available on Medline. Several textbook publications and reports are referenced.
A theoretical model is presented describing the relationships between spinal manipulation,
segmental biomechanics, the nervous system and end-organ physiology. Experimental
data for these relationships are presented. Results: Biomechanical changes caused
by spinal manipulation are thought to have physiological consequences by means of
their effects on the inflow of sensory information to the central nervous system.
Muscle spindle afferents and Golgi tendon organ afferents are stimulated by spinal
manipulation. Smaller-diameter sensory nerve fibers are likely activated, although
this has not been demonstrated directly. Mechanical and chemical changes in the intervertebral
foramen caused by a herniated intervertebral disc can affect the dorsal roots and
dorsal root ganglia, but it is not known if spinal manipulation directly affects these
changes. Individuals with herniated lumbar discs have shown clinical improvement in
response to spinal manipulation. The phenomenon of central facilitation is known to
increase the receptive field of central neurons, enabling either subthreshold or innocuous
stimuli access to central pain pathways. Numerous studies show that spinal manipulation
increases pain tolerance or its threshold. One mechanism underlying the effects of
spinal manipulation may, therefore, be the manipulation's ability to alter central
sensory processing by removing subthreshold mechanical or chemical stimuli from paraspinal
tissues. Spinal manipulation is also thought to affect reflex neural outputs to both
muscle and visceral organs. Substantial evidence demonstrates that spinal manipulation
evokes paraspinal muscle reflexes and alters motoneuron excitability. The effects
of spinal manipulation on these somatosomatic reflexes may be quite complex, producing
excitatory and inhibitory effects. Whereas substantial information also shows that
sensory input, especially noxious input, from paraspinal tissues can reflexively elicit
sympathetic nerve activity, knowledge about spinal manipulation's effects on these
reflexes and on end-organ function is more limited. Conclusions: A theoretical framework
exists from which hypotheses about the neurophysiological effects of spinal manipulation
can be developed. An experimental body of evidence exists indicating that spinal manipulation
impacts primary afferent neurons from paraspinal tissues, the motor control system
and pain processing. Experimental work in this area is warranted and should be encouraged
to help better understand mechanisms underlying the therapeutic scope of spinal manipulation.
Keywords
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Article info
Publication history
Accepted:
May 15,
2002
Received:
February 23,
2001
Footnotes
☆FDA device/drug status: not applicable.
☆☆Nothing of value received from a commercial entity related to this research.
★This study was supported by the Consortial Center for Chiropractic Research through cooperative agreement 1-U24AR5166 funded by National Institutes of Health, National Center for Complementary and Alternative Medicine and by the National Institute of Neurological Disease and Stroke Grant NS35300 on behalf of the Office of Alternative Medicine.
Identification
Copyright
© 2002 Elsevier Science Inc. Published by Elsevier Inc. All rights reserved.
