Author: Koen Groot Zwaaftink
Supervisor: Johan Schelpe, MSc.Ost.
Introduction: Spinal manipulation and mobilization are commonly used for musculoskeletal and spine problems. Evidence about neurophysiological reactions indicates that spinal manipulation and mobilization initiate neurovegetativ e responses. Reports are about effects of separate manual techniques and neurophysiological effects following a manipulation or a mobilization. No research is done which analyses general neurovegetative reactions following spinal manipulation and mobilization. There are no studies been done on spinal technique efficiencies, outcome differences concerning neurovegetative reactions.
Research Questions: Primary research question: ‘Which significant changes in neurovegetative physiological parameters occur after manual spinal manipulation and mobilization in symptomatic and a-symptomatic adults in manual therapy, chiropractic or osteopathic medicine?’ and secondary research question: ‘Are there differences between manual spinal manipulation and mobilization on the objective changes in neurovegetative physiological parameters in symptomatic and a-symptomatic adults in manual therapy, chiropractic or osteopathic medicine?’
Objective: The objective of this literature review is to analyse evidence on neurovegetative responses following spinal manipulation and mobilization compared to a sham or control group. The secondary objective is to establish level of neurovegetative change and differences between manual spinal techniques.
Method: A systematic search in MEDLINE and Cochrane Library with (MeSH)terms: ‘spinal manipulation’, ‘chiropractic manipulation’, ‘osteopathic manipulative treatment’, ‘manual therapy’, ‘sympathetic nervous system’, ‘parasympathetic nervous system’, ‘autonomic nervous system’, ‘enteric nervous system’, blood supply’, ‘vasomotor system’, ‘blood flow velocity’, ‘sweat glands’, ‘viscera’, ‘visceral pain’, ‘piloerection’, ‘skin temperature’ and ‘pain’ for eligible RCTs and systematic reviews between 2000 and May 2016. Data were extracted and analysed. Quality of the studies is assessed according to the PEDro scale.
Findings: 13 RCTs were included. Statistically significant changes were seen with increased skin conductance, increased pressure pain thresholds, increased breathing rate, decreased pain on Visual Analog Scale, decreased local allodynia,hyperalgesia and changes in heart rate and heart rate variability. Inconsistent changes are seen in skin temperature. No significant changes are seen in thermal pain thresholds , pupillary reactions and cutaneous blood flow. No clear differences in spinal manual technique efficiency.
Discussion/conclusion: In conclusion, this literature review provide evidence that spinal manipulation and mobilization evoke neurovegetative reactions. Some parameters are consistent, but in other parameters there is an inconsistency in neurovegetative effect. Despite the evidence, neurophysiological mechanisms are still relatively unclear. Due to the unequal distribution of the number of mobilization repetitions, number of sessions, different measurement methods and treatment locations, it is not possible to make concrete statements which technique is superior.
Long-term effects of multi-technique sessions and multiple sessions are too scarce to draw clear practical conclusions. There is a need of high quality, large sample RCTs on selective symptomatic subjects with a multi-technique or intersession design. Only then is a representative therapeutic outcome measurable of strong clinical importance.
Keywords: neurovegetative nervous system, autonomic nervous system, spinal manipulation, spinal mobilization, osteopathy, chiropractic, manual therapy.