Last weekend I spoke at Parker Seminars Las Vegas about our current scientific understanding of the mechanisms of action of spinal manipulation. In that 60-minute talk I touched on neurophysiology, biomechanics, immunology and contextual factors. I included the study reviewed this week in the neurophysiology section of that talk - this is certainly an emerging and complex area of study, but our talented researchers are starting to put these pieces together!
IMG 1022
The clinical rationale for SMT has long been mechanical in nature; however, a purely biomechanical mechanism remains debatable, as studies have failed to link specific mechanical effects to meaningful clinical improvement. It has been theorized that SMT’s therapeutic mechanism of action may be partially mediated by functional CNS changes.
In light of this, these authors performed a secondary analysis of two fMRI studies investigating the effect of thoracic SMT on pain-related brain activity. Using a multivariate brain-based model of physical pain called the Neurologic Pain Signature (NPS), the authors explored the effect of SMT on brain activity within brain regions predictive of physical pain. Therein, the authors endeavored to: 1) Introduce brain-based models of pain for spinal pain and manual therapy research; 2) characterize the distributed central mechanisms of SMT and; 3) advance the preliminary validation of brain-based models as potential clinical biomarkers of pain. Their results are illuminating and also pave the way for future work - VERY cool!
THIS WEEK'S RESEARCH REVIEW: “Thoracic Spinal Manipulation Alters Pain-Related Brain Activity”
This paper was published in Neuroimage: Clinical (2019) and this Review is posted in Recent Reviews, Spinal Manipulation - Mechanisms of Action, Thoracic Spine - Manipulation/Mobilization, Pain - Neuroplasticity and the 2020 Archive.
Thoracic SMT Brain