Abstract
Objective
The aim of the current study was to investigate changes in the intrinsic inhibitory
interactions within the somatosensory system subsequent to a session of spinal manipulation
of dysfunctional cervical joints.
Method
Dual peripheral nerve stimulation somatosensory evoked potential (SEP) ratio technique
was used in 13 subjects with a history of reoccurring neck stiffness and/or neck pain
but no acute symptoms at the time of the study. Somatosensory evoked potentials were
recorded after median and ulnar nerve stimulation at the wrist (1 millisecond square
wave pulse, 2.47 Hz, 1 × motor threshold). The SEP ratios were calculated for the
N9, N11, N13, P14-18, N20-P25, and P22-N30 peak complexes from SEP amplitudes obtained
from simultaneous median and ulnar (MU) stimulation divided by the arithmetic sum
of SEPs obtained from individual stimulation of the median (M) and ulnar (U) nerves.
Results
There was a significant decrease in the MU/M + U ratio for the cortical P22-N30 SEP
component after chiropractic manipulation of the cervical spine. The P22-N30 cortical
ratio change appears to be due to an increased ability to suppress the dual input
as there was also a significant decrease in the amplitude of the MU recordings for
the same cortical SEP peak (P22-N30) after the manipulations. No changes were observed
after a control intervention.
Conclusion
This study suggests that cervical spine manipulation may alter cortical integration
of dual somatosensory input. These findings may help to elucidate the mechanisms responsible
for the effective relief of pain and restoration of functional ability documented
after spinal manipulation treatment.
Key Indexing Terms
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References
- Conservative management of mechanical neck pain: systematic overview and meta-analysis.Br Med J. 1996; 313: 1291-1296
- Effectiveness of chiropractic and physiotherapy in the treatment of low back pain: a critical discussion of the British randomized clinical trial.J Manipulative Physiol Ther. 1991; 14: 281-286
- Chronic spinal pain syndromes: a clinical pilot trial comparing acupuncture, a nonsteroidal anti-inflammatory drug, and spinal manipulation.J Manipulative Physiol Ther. 1999; 22: 376-381
- Manipulation and mobilization of the cervical spine. A systematic review of the literature.Spine. 1996; 21: 1746-1760
- The effectiveness and cost-effectiveness of chiropractic management of low-back pain.Pran Manga & Associates Inc, Ottawa1993
- Low back pain of mechanical origin: randomized comparison of chiropractic and hospital outpatient treatment.Br Med J. 1990; 300: 1431-1437
- Spinal manipulation as a valid treatment for low back pain.Del Med J. 1996; 68: 175-178
- Afferent signaling of vertebral displacement in the neck of the cat.Soc Neurosci Abstr. 1996; 22: 1802
- An in vivo method for studying afferent fibre activity from cervical paravertebral tissue during vertebral motion in anaesthetised cats.J Neurosci Methods. 1998; 85: 211-218
- Sacroiliac joint manipulation decreases the h-reflex.Electromyogr Clin Neurophysiol. 1995; 35: 87-94
- Paraspinal muscle evoked cerebral potentials in patients with unilateral low back pain.Spine. 1993; 18: 1096-1102
- Do cerebral potentials to magnetic stimulation of paraspinal muscles reflect changes in palpable muscle spasm, low back pain, and activity scores?.J Manipulative Physiol Ther. 2000; 23: 458-464
- Rapid modulation of human cortical motor outputs following ischaemic nerve block.Brain. 1993; 116: 511-525
- A primate model for studying focal dystonia and repetitive strain injury: Effects on the primary somatosensory cortex.Phys Ther. 1997; 77: 269-284
- Reorganization in motor cortex in amputees and in normal volunteers after ischemic limb deafferentation.Electroencephalogr Clin Neurophysiol-Suppl. 1999; 51: 183-187
- Plasticity of the sensorimotor cortex representation of the reading finger in Braille readers.Brain. 1993; 116: 39-52
- Transient deafferentation in humans induces rapid modulation of primary sensory cortex not associated with subcortical changes: a somatosensory evoked potential study.Neurosci Lett. 1997; 223: 21-24
- Neurophysiological evidence of neuroplasticity at multiple levels of the somatosensory system in patients with carpal tunnel syndrome.Brain. 1998; 121: 1785-1794
- Mechanisms of deafferentation-induced plasticity in human motor cortex.J Neurosci. 1998; 18: 7000-7007
- World federation of chiropractic's 9th biennial congress award winning paper (3rd prize): altered sensorimotor integration with cervical spine manipulation.J Manipulative Physiol Ther. 2008; 31: 115-126
- Transient modulation of intracortical inhibition following spinal manipulation.Chiropr J Aust. 2007; 37: 106-116
- Cervical spine manipulation alters sensorimotor integration: a somatosensory evoked potential study.Clin Neurophysiol. 2007; 118: 391-402
- Central somatosensory conduction in man: neural generators and interpeak latencies of the far-field components recorded from neck and right or left scalp and earlobes.Electroencephalogr Clin Neurophysiol. 1980; 50: 382-403
- Somatosensory evoked potentials: normal responses, abnormal waveforms and clinical applications in neurological diseases.in: Niedermeyer E. Electroencephalography: Basic principles, clinical applications, and related fields. Williams and Wilkins, Baltimore1999
- IFCN recommended standards for short latency somatosensory evoked potentials. Report of an IFCN committee. International federation of clinical neurophysiology.Electroencephalogr Clin Neurophysiol. 1994; 91: 6-11
- Human cortical potentials evoked by stimulation of the median nerve. II. Cytoarchitectonic areas generating long-latency activity.J Neurophysiol. 1989; 62: 711-722
- Human cortical potentials evoked by stimulation of the median nerve. II. Cytoarchitectonic areas generating short-latency activity.J Neurophysiol. 1989; 62: 694-710
- Potentials evoked in human and monkey cerebral cortex by stimulation of the median nerve. A review of scalp and intracranial recordings.Brain. 1991; 114: 2465-2503
- The selective gating of the n30 cortical component of the somatosensory evoked potentials of median nerve is different in the mesial and dorsolateral frontal cortex: evidence from intracerebral recordings.Clin Neurophysiol. 2003; 114: 981-991
- Astereognosis and dissociated loss of frontal or parietal components of somatosensory evoked potentials in hemispheric lesions. Detailed correlations with clinical signs and computerized tomographic scanning.Brain. 1983; 106: 271-311
- Non-invasive evaluation of input-output characteristics of sensorimotor cerebral areas in healthy humans.Electroencephalogr Clin Neurophysiol. 1987; 68: 88-100
- Abnormalities of short-latency somatosensory evoked potentials in parkinsonian patients.Electroencephalogr Clin Neurophysiol. 1989; 74: 277-289
- N30 and the effect of explorative finger movements: a model of the contribution of the motor cortex to early somatosensory potentials.Clin Neurophysiol. 1999; 110: 1589-1600
- Interactions between cutaneous and muscle afferent projections to cerebral cortex in man.Electroencephalogr Clin Neurophysiol. 1982; 53: 349-360
- Convergence in the somatosensory pathway between cutaneous afferents from the index and middle fingers in man.Exp Brain Res. 1983; 50: 415-425
- The interaction of the somatosensory evoked potentials to simultaneous finger stimuli in the human central nervous system. A study using direct recordings.Electroencephalogr Clin Neurophysiol. 1995; 96: 135-142
- Interaction of afferent impulses in the human primary sensorimotor cortex.Electroencephalogr Clin Neurophysiol. 1992; 82: 176-181
- Interactions of somatosensory evoked potentials: simultaneous stimulation of two nerves.Electroencephalogr Clin Neurophysiol. 1991; 80: 26-31
- Altered cortical integration of dual somatosensory input following the cessation of a 20-minute period of repetitive muscle activity.Exp Brain Res. 2007; 178: 488-498
- The assessment and analysis of handedness: the Edinburgh inventory.Neurophychologia. 1971; 9: 97-113
- Early somatosensory processing during tonic muscle pain in humans: relation to loss of proprioception and motor “defensive” strategies.Clin Neurophysiol. 2003; 114: 1351-1358
- The effects of stimulus rates upon median, ulnar and radial nerve somatosensory evoked potentials.Electroencephalogr Clin Neurophysiol. 1994; 92: 518-526
- Median nerve somatosensory evoked potentials: recording with cephalic and noncephalic references.Electromyogr Clin Neurophysiol. 1999; 39: 473-477
- Interexaminer reliability of palpation for cervical spine tenderness.J Manipulative Physiol Ther. 1994; 17: 591-595
- The accuracy of manual diagnosis for cervical zygapophysial joint pain syndromes.Med J Aust. 1988; 148: 233-236
- Interexaminer reliability in physical examination of the cervical spine.J Manipulative Physiol Ther. 1999; 22: 511-516
- Inter-examiner reliability in assessing passive intervertebral motion of the cervical spine.Man Ther. 2000; 5: 97-101
- Response of muscle proprioceptors to spinal manipulative-like loads in the anesthetized cat.J Manipulative Physiol Ther. 2001; 24: 2-11
- Specific gating of the early somatosensory evoked potentials during active movement.Electroencephalogr Clin Neurophysiol. 1987; 67: 537-548
- Gating of the early components of the frontal and parietal somatosensory evoked potentials in different sensory-motor interference modalities.Electroencephalogr Clin Neurophysiol. 1991; 80: 522-530
- Somatosensory evoked potentials during the ideation and execution of individual finger movements.Muscle Nerve. 1996; 19: 191-202
- Detailed analysis of the latencies of median nerve somatosensory evoked potential components. 1: Selection of the best standard parameters and the establishment of normal values.Electroencephalogr Clin Neurophysiol. 1996; 100: 319-331
- Abnormal central integration of a dual somatosensory input in dystonia. Evidence for sensory overflow.Brain. 2000; 123: 42-50
- Somatosensory evoked potential in man: far field potentials.Electroencephalogr Clin Neurophysiol. 1976; 41: 460-466
- Non-cephalic reference recording of early somatosensory potentials to finger stimulation in adult or aging normal man: differentiation of widespread n18 and contralateral n20 from the prerolandic p22 and n30 components.Electroencephalogr Clin Neurophysiol. 1981; 52: 553-570
- Short latency potentials recorded from the neck and scalp following median nerve stimulation in man.Electroencephalogr Clin Neurophysiol. 1977; 43: 853-863
- Amplitude abnormalities in the scalp far-field n18 of sseps to median nerve stimulation in patients with midbrain-pontine lesions.Electroencephalogr Clin Neurophysiol. 1992; 84: 232-242
- Origin of scalp far-field n18 of sseps in response to median nerve stimulation.Electroencephalogr Clin Neurophysiol. 1990; 77: 39-51
- Origin of the widespread n18 in median nerve sep.Electroencephalogr Clin Neurophysiol. 1992; 84: 418-425
- Widespread n18 in median nerve sep is preserved in a pontine lesion.Electroencephalogr Clin Neurophysiol. 1991; 80: 238-240
- Human brain plasticity: an emerging view of the multiple substrates and mechanisms that cause cortical changes and related sensory dysfunctions after injuries of sensory inputs from the body.Brain Res Rev. 2002; 39: 181-215
- Neuroplastic changes related to pain occur at multiple levels of the human somatosensory system: a somatosensory-evoked potentials study in patients with cervical radicular pain.J Neurosci. 2000; 20: 9277-9283
- Plastic interactions between hand and face cortical representations in patients with trigeminal neuralgia: a somatosensory-evoked potentials study.Neurosci. 2004; 127: 769-776
- Functional reorganization of the human primary somatosensory cortex after acute pain demonstrated by magnetoencephalography.Neurosci Lett. 2001; 298: 195-198
- Development of motor system dysfunction following whiplash injury.Pain. 2003; 103: 65-73
- A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache.Spine. 2002; 27: 1835-1843
- Vertical posture and head stability in patients with chronic neck pain.J Rehabil Med. 2003; 35: 229-235
- Dynamic posturography among patients with common neck disorders.J Vestib Res. 1993; 3: 383-389
- Reduced postural control in patients with chronic cervicobrachial pain syndrome.Gait Posture. 1995; 3: 241-249
- Effects of different treatments on postural performance in patients with cervical root compression: a randomized prospective study assessing the importance of the neck in postural control.J Vestib Res. 1996; 6: 439-453
- Impairment in the cervical flexors: a comparison of whiplash and insidious onset neck pain patients.Man Ther. 2004; 9: 89-94
- Balance performance in patients with whiplash associated disorders and patients with prolonged musculoskeletal disorders.Adv Physiother. 2001; 3: 120-127
- Postural stability following mild head or whiplash injuries.Am J Otol. 1995; 16: 216-221
Article info
Publication history
Accepted:
May 10,
2009
Received in revised form:
May 9,
2009
Received:
December 15,
2008
Footnotes
This study was conducted in the Human Neurophysiology and Rehabilitation Laboratory at the Department of Sport and Exercise Science, University of Auckland, Auckland, New Zealand.
Identification
Copyright
© 2010 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
