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Does inter-vertebral range of motion increase after spinal manipulation? A prospective cohort study.

Jonathan Branney¹, Alan C Breen²

¹Institute of Musculoskeletal Research & Clinical Implementation, Anglo-European College of Chiropractic, 13-15 Parkwood Road, Bournemouth BH5 2DF, UK ; The School of Health & Social Care, Bournemouth University, Royal London House, Christchurch Road, Bournemouth BH1 3LT, UK.

Chiropractic & Manual Therapies

|July 19, 2014

Summary

Spinal manipulation may increase inter-vertebral range of motion (IV-RoM) in the cervical spine, but this mechanical change did not improve patient-reported outcomes for neck pain. Palpation was unreliable for detecting restricted motion.

Keywords:

Fluoroscopy Manipulation Neck pain Patient-reported outcomes Spine kinematics

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Area of Science:

Biomedical Engineering
Orthopedics
Physical Therapy

Background:

Spinal manipulation is a common treatment for nonspecific neck pain.
Its mechanism is hypothesized to involve improving inter-vertebral range of motion (IV-RoM).
Measuring IV-RoM and linking it to clinical outcomes remains challenging.

Purpose of the Study:

To quantify changes in cervical spine flexion and extension IV-RoM after spinal manipulation.
To investigate the relationship between IV-RoM changes and clinical outcomes.
To compare palpation with quantitative fluoroscopy (QF) for detecting hypomobile segments.

Main Methods:

Thirty patients with neck pain and 30 controls underwent QF for IV-RoM measurement (C1-C6) at baseline and 4 weeks.
Patients received up to 12 spinal manipulations and completed outcome questionnaires.
QF accuracy, repeatability, and minimal detectable changes (MDC) were established.

Main Results:

QF demonstrated high accuracy and repeatability for IV-RoM measurement.
No significant correlation was found between IV-RoM increases above MDC and clinical outcomes.
A modest correlation existed between the number of manipulations and increased IV-RoM at specific spinal levels.
Palpation showed no agreement with QF in identifying hypomobile segments.

Conclusions:

Cervical sagittal IV-RoM did not differ between patients and controls.
Spinal manipulation showed a dose-response effect on segmental IV-RoM, indicating a mechanical impact.
Patient-reported outcomes were not associated with observed changes in IV-RoM.