Journal of Manipulative and Physiological Therapeutics
Volume 33, Issue 2 , Pages 117-124, February 2010

The Relationship of the Audible Pop to Hypoalgesia Associated With High-Velocity, Low-Amplitude Thrust Manipulation: A Secondary Analysis of an Experimental Study in Pain-Free Participants

  • Joel E. Bialosky, PT, PhD

      Affiliations

    • Clinical Assistant Professor, University of Florida Department of Physical Therapy, Gainesville, Fla
    • Corresponding Author InformationSubmit requests for reprints to: Joel E. Bialosky, PT, PhD, Clinical Assistant Professor, University of Florida Department of Physical Therapy, P.O. Box 100154, Gainesville, FL 32610
    • ,
  • Mark D. Bishop, PT, PhD

      Affiliations

    • Assistant Professor, University of Florida Department of Physical Therapy, Gainesville, Fla
    • ,
  • Michael E. Robinson, PhD

      Affiliations

    • Professor, University of Florida Department of Clinical and Health Psychology, Gainesville, Fla
    • ,
  • Steven Z. George, PT, PhD

      Affiliations

    • Assistant Professor, University of Florida Department of Physical Therapy, Gainesville, Fla

Received 26 March 2009; received in revised form 17 July 2009; accepted 29 July 2009.

Abstract 

Objective

High-velocity, low-amplitude (HVLA) manipulation is an effective treatment of low back pain (LBP); however, the corresponding mechanisms are undetermined. Hypoalgesia is associated with HVLA manipulation and suggests specific mechanisms of action. An audible pop (AP) is also associated with HVLA manipulation; however, the influence of the AP on the hypoalgesia associated with HVLA manipulation is not established. The purpose of the current study was to observe the influence of the AP on hypoalgesia associated with HVLA manipulation.

Methods

The current study represents a secondary analysis of 40 participants. All participants underwent thermal pain sensitivity testing to their leg and low back using protocols specific to Aδ fiber-mediated pain and temporal summation. Next, participants received HVLA manipulation to their low back, and the examiner recorded whether an AP was perceived. Finally, participants underwent immediate follow-up thermal pain sensitivity testing using the same protocols. Separate repeated-measure analyses of variance (ANOVAs) were used to observe changes in pain sensitivity before and immediately after HVLA manipulation.

Results

Hypoalgesia of Aδ fiber-mediated pain was observed in the low back after HVLA (P < .05), and this was independent of whether an AP was perceived (P > .05). Hypoalgesia of temporal summation was observed in the lower extremity after HVLA (P < .05), and this was independent of whether an AP was perceived (P = .08). However, a moderate effect size for temporal summation was observed favoring participants in whom an AP was perceived.

Conclusion

The current study suggests hypoalgesia is associated with HVLA manipulation and occurs independently of a perceived AP. Inhibition of lower extremity temporal summation may be larger in individuals in whom an AP is perceived, but further study is necessary to confirm this finding.

Key Indexing Terms: Manipulation, Spinal, Low Back Pain, Pain, Rehabilitation

 

 The project was supported by grant no. R-21 AT002796-01 from the National Institutes of Health—National Center for Complimentary and Alternative Medicine (SZG, MDB, MER).

 JEB received support from the National Institutes of Health T-32 Neural Plasticity Research Training Fellowship (T32HD043730)

PII: S0161-4754(09)00320-0

doi:10.1016/j.jmpt.2009.12.008

Journal of Manipulative and Physiological Therapeutics
Volume 33, Issue 2 , Pages 117-124, February 2010

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