Original Article| Volume 36, ISSUE 6, P333-341, July 2013

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Immediate Effects of Spinal Manipulative Therapy on Regional Antinociceptive Effects in Myofascial Tissues in Healthy Young Adults



      The purpose of this study was to investigate if spinal manipulative therapy (SMT) can evoke immediate regional antinociceptive effects in myofascial tissues by increasing pressure pain thresholds (PPTs) over myofascial trigger points in healthy young adults.


      A total of 36 participants (19 men, 17 women; age, 28.0 [5.3] years; body mass index, 26.5 [5.7] kg/m2) with clinically identifiable myofascial trigger points in the infraspinatus and gluteus medius muscles were recruited from the University of Guelph, Ontario, Canada. Participants were randomly allocated to 2 groups. Participants in the test group received chiropractic SMT targeted to the C5-C6 spinal segment. Participants in the control group received sham SMT. The PPT was recorded from the right infraspinatus and gluteus medius muscles at baseline (preintervention) and 1, 5, 10, and 15 minutes postintervention.


      Three participants were disqualified, resulting in a total of 33 participants analyzed. Significant increases in the PPT (decreased pain sensitivity) were observed in the test infraspinatus group when compared with test gluteus medius, control infraspinatus, and control gluteus medius groups (P < .05). No significant differences in PPT were observed at any time point when comparing test gluteus medius, control infraspinatus, and control gluteus medius groups (P > .05).


      This study showed that SMT evokes short-term regional increases in PPT within myofascial tissues in healthy young adults.

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        • Clauw DJ
        • Crofford LJ
        Chronic widespread pain and fibromyalgia: what we know, and what we need to know.
        Best Pract Res Clin Rheumatol. 2003; 17: 685-701
        • Drewes AM
        • Jennum P
        Epidemiology of myofascial pain, low back pain, morning stiffness and sleep-related complaints in the general population.
        J Musculoskeletal Pain. 1995; 3: 121
        • Podichetty VK
        • Mazanec DJ
        • Biscup RS
        Chronic non-malignant musculoskeletal pain in older adults: clinical issues and opioid intervention.
        Postgrad Med J. 2003; 79: 627-633
        • Kinsella K
        • He W
        An aging world: 2008. U.S. Department of Health and Human Services. National Institutes of Health.
        National Institute on Aging, Baltimore, MD2009
        • Koes BW
        • Assendelft WJ
        • van der Heijden GJ
        • Bouter LM
        Spinal manipulation for low back pain. An updated systematic review of randomized clinical trials.
        Spine (Phila Pa 1976). 1996; 21: 2860-2871
        • Rubinstein SM
        • van MM
        • Assendelft WJ
        • de Boer MR
        • van Tulder MW
        Spinal manipulative therapy for chronic low-back pain.
        Cochrane Database Syst Rev. 2011; 2: CD008112
        • Bronfort G
        • Haas M
        • Evans R
        • Kawchuk G
        • Dagenais S
        Evidence-informed management of chronic low back pain with spinal manipulation and mobilization.
        Spine J. 2008; 8: 213-225
        • Farabaugh RJ
        • Dehen MD
        • Hawk C
        Management of chronic spine-related conditions: consensus recommendations of a multidisciplinary panel.
        J Manipulative Physiol Ther. 2010; 33: 484-492
        • Vicenzino B
        • Collins D
        • Benson H
        • Wright A
        An investigation of the interrelationship between manipulative therapy-induced hypoalgesia and sympathoexcitation.
        J Manipulative Physiol Ther. 1998; 21: 448-453
        • Farrell JP
        • Twomey LT
        Acute low back pain. Comparison of two conservative treatment approaches.
        Med J Aust. 1982; 1: 160-164
        • Abenhaim L
        • Bergeron AM
        Twenty years of randomized clinical trials of manipulative therapy for back pain: a review.
        Clin Invest Med. 1992; 15: 527-535
        • Haldeman S
        Principles and practice of chiropractic.
        3rd ed. McGraw-Hill, New York2005
        • Bialosky JE
        • Bishop MD
        • Price DD
        • Robinson ME
        • George SZ
        The mechanisms of manual therapy in the treatment of musculoskeletal pain: a comprehensive model.
        Man Ther. 2009; 14: 531-538
        • Vernon H
        Qualitative review of studies of manipulation-induced hypoalgesia.
        J Manipulative Physiol Ther. 2000; 23: 134-138
        • Ge HY
        Prevalence of myofascial trigger points in fibromyalgia: the overlap of two common problems.
        Curr Pain Headache Rep. 2010; 14: 339-345
        • Giamberardino MA
        • Affaitati G
        • Fabrizio A
        • Costantini R
        Effects of treatment of myofascial trigger points on the pain of fibromyalgia.
        Curr Pain Headache Rep. 2011; 15: 393-399
        • Srbely JZ
        • Dickey JP
        • Lee D
        • Lowerison M
        Dry needle stimulation of myofascial trigger points evokes segmental anti-nociceptive effects.
        J Rehabil Med. 2010; 42: 463-468
        • Lautenbacher S
        • Kunz M
        • Strate P
        • Nielsen J
        • Rendt-Nielsen L
        Age effects on pain thresholds, temporal summation and spatial summation of heat and pressure pain.
        Pain. 2005; 115: 410-418
        • Simons DG
        The nature of myofascial trigger points.
        Clin J Pain. 1995; 11: 83-84
        • Srbely JZ
        • Dickey JP
        • Lowerison M
        • Edwards AM
        • Nolet PS
        • Wong LL
        Stimulation of myofascial trigger points with ultrasound induces segmental antinociceptive effects: a randomized controlled study.
        Pain. 2008; 139: 260-266
        • Srbely JZ
        • Dickey JP
        • Bent LR
        • Lee D
        • Lowerison M
        Capsaicin-induced central sensitization evokes segmental increases in trigger point sensitivity in humans.
        J Pain. 2010; 11: 636-643
        • Chesterton LS
        • Barlas P
        • Foster NE
        • Baxter GD
        • Wright CC
        Gender differences in pressure pain threshold in healthy humans.
        Pain. 2003; 101: 259-266
        • Triano JJ
        • Schultz AB
        Motions of the head and thorax during neck manipulations.
        J Manipulative Physiol Ther. 1994; 17: 573-583
        • Sillevis R
        • Cleland J
        Immediate effects of the audible pop from a thoracic spine thrust manipulation on the autonomic nervous system and pain: a secondary analysis of a randomized clinical trial.
        J Manipulative Physiol Ther. 2011; 34: 37-45
        • Herzog W
        • Zhang YT
        • Conway PJ
        • Kawchuk GN
        Cavitation sounds during spinal manipulative treatments.
        J Manipulative Physiol Ther. 1993; 16: 523-526
        • Vernon H
        • MacAdam K
        • Marshall V
        • Pion M
        • Sadowska M
        Validation of a sham manipulative procedure for the cervical spine for use in clinical trials.
        J Manipulative Physiol Ther. 2005; 28: 662-666
        • Vernon HT
        • Triano JJ
        • Ross JK
        • Tran SK
        • Soave DM
        • Dinulos MD
        Validation of a novel sham cervical manipulation procedure.
        Spine J. 2012; 12: 1021-1028
        • Kanitakis J
        Anatomy, histology and immunohistochemistry of normal human skin.
        Eur J Dermatol. 2002; 12: 390-399
        • Nilson N
        • Christejsen HW
        • Hartvigsen DC
        Lasting changes in passive range of motion after spinal manipulation: a randomised, blind, controlled trial.
        J Manipulative Physiol Ther. 1996; 19: 165-168
        • Glover JR
        • Morris JG
        • Khosla T
        Back pain: a randomized clinical trial of rotational manipulation of the trunk.
        Br J Ind Med. 1974; 31: 59-64
        • Terrett AC
        • Vernon H
        Manipulation and pain tolerance. A controlled study of the effect of spinal manipulation on paraspinal cutaneous pain tolerance levels.
        Am J Phys Med. 1984; 63: 217-225
        • Ruiz-Saez M
        • Fernandez-de-Las-Penas C
        • Blanco CR
        • Martinez-Segura R
        • Garcia-Leon R
        Changes in pressure pain sensitivity in latent myofascial trigger points in the upper trapezius muscle after a cervical spine manipulation in pain-free subjects.
        J Manipulative Physiol Ther. 2007; 30: 578-583
        • George SZ
        • Bishop MD
        • Bialosky JE
        • Zeppieri G
        • Robinson ME
        Immediate effects of spinal manipulation on thermal pain sensitivity: an experimental study.
        BMC Musculoskelet Disord. 2006; 7: 68
        • de CV
        • Burquerque-Sendin F
        • Berzin F
        • Stefanelli VC
        • de Souza DP
        • Fernandez-de-Las-Penas C
        Immediate effects on electromyographic activity and pressure pain thresholds after a cervical manipulation in mechanical neck pain: a randomized controlled trial.
        J Manipulative Physiol Ther. 2011; 34: 211-220
        • Fernandez-Carnero J
        • Fernandez-de-Las-Penas C
        • Cleland JA
        Immediate hypoalgesic and motor effects after a single cervical spine manipulation in subjects with lateral epicondylalgia.
        J Manipulative Physiol Ther. 2008; 31: 675-681
        • Vernon H
        • Puhl A
        • Reinhart C
        Systematic review of clinical trials of cervical manipulation: control group procedures and pain outcomes.
        Chiropr Man Therap. 2011; 19: 3
        • Vernon H
        • Humphreys BK
        Chronic mechanical neck pain in adults treated by manual therapy: a systematic review of change scores in randomized controlled trials of a single session.
        J Man Manipulative Ther. 2008; 16: E42-E52
        • Mansilla-Ferragut P
        • Fernandez-de-Las PC
        • Burquerque-Sendin F
        • Cleland JA
        • Bosca-Gandia JJ
        Immediate effects of atlanto-occipital joint manipulation on active mouth opening and pressure pain sensitivity in women with mechanical neck pain.
        J Manipulative Physiol Ther. 2009; 32: 101-106
        • Porreca F
        • Ossipov MH
        • Gebhart GF
        Chronic pain and medullary descending facilitation.
        Trends Neurosci. 2002; 25: 319-325
        • Basbaum AI
        • Fields HL
        Endogenous pain control systems: brainstem spinal pathways and endorphin circuitry.
        Annu Rev Neurosci. 1984; 7: 309-338
        • Vanderah TW
        • Suenaga NM
        • Ossipov MH
        • Malan TP
        • Lai J
        • Porreca F
        Tonic descending facilitation from the rostral ventromedial medulla mediates opioid-induced abnormal pain and antinociceptive tolerance.
        J Neurosci. 2001; 21: 279-286
        • Le Bars D
        The whole body receptive field of dorsal horn multireceptive neurones.
        Brain Res Brain Res Rev. 2002; 40: 29-44
        • Morgan MM
        • Heinricher MM
        • Fields HL
        Inhibition and facilitation of different nocifensor reflexes by spatially remote noxious stimuli.
        J Neurophysiol. 1994; 72: 1152-1160
        • Park G
        • Kim CW
        • Park SB
        • Kim MJ
        • Jang SH
        Reliability and usefulness of the pressure pain threshold measurement in patients with myofascial pain.
        Ann Rehabil Med. 2011; 35: 412-417
        • Fischer AA
        Pressure algometry over normal muscles. Standard values, validity and reproducibility of pressure threshold.
        Pain. 1987; 30: 115-126
        • Fischer AA
        Reliability of the pressure algometer as a measure of myofascial trigger point sensitivity.
        Pain. 1987; 28: 411-414
        • O'Driscoll S
        • Jayson M
        The clinical significance of the pain threshold measurement.
        Rheumatol Rehabil. 1982; 21: 31-35
        • Ross JK
        • Bereznick DE
        • McGill SM
        Determining cavitation location during lumbar and thoracic spinal manipulation: is spinal manipulation accurate and specific?.
        Spine (Phila Pa 1976). 2004; 29: 1452-1457
        • Fillingim R
        • Maixner W
        Gender diferences in the response to noxious stimuli.
        Pain Forum. 1995; 4: 209-221
        • Berkley K
        Sex differences in pain.
        Behav Brain Sci. 1997; 20 ([discussion 435–13]): 371-380