Targeting SMT Application – Importance of Segmental Pain vs. Stiffness
- Details
- Dr. Shawn Thistle
RRS Education is happy to present a special guest Review by one of our brightest young researchers - Dr. Casper Nim (Denmark)! He is investigating the importance of targeting SMT toward painful vs. stiff vertebral segments - really interesting work!
Spinal manipulative therapy (SMT) is often recommended in clinical guidelines to treat spinal pain. SMT is a clinician-guided therapy attempting to reduce pain and improve disability and its efficacy appears to be on par with other guideline-recommended interventions. Interestingly though, SMT does not heavily out-perform sham SMT interventions, suggesting that physical touch has a potential clinical effect that is not affected by actual therapeutic input to the spine.
A likely and potential factor affecting SMT’s efficacy is where the treatment is applied or targeted (i.e. the application site). While there are numerous options for applying SMT, the two most common are the indication of: 1) a stiff or 2) a tender vertebra.
Animal-based research has found biomechanical effects on the tissues and cell structures specific to the application site of SMT. Yet, the clinical translation of such effects is not as straightforward, and there is no good evidence for selecting one area over another. However, suppose specific effects can be shown to be related to the application site? In that case, the clinical outcomes should differ depending on the SMT application site.
This Research Review will investigate if the clinical effects of SMT are dependent on the application site using two different methods:
1. We performed a randomized controlled trial (RCT) that randomly allocated patients with persistent low back pain (LBP) to receive four SMT sessions at either the stiffest or most painful vertebra (most common indicators); and
2. a systematic literature review (SR) to assess the effect of applying SMT at candidate sites (clinically-relevant sites) compared to any control site (not clinically-relevant sites).
2. a systematic literature review (SR) to assess the effect of applying SMT at candidate sites (clinically-relevant sites) compared to any control site (not clinically-relevant sites).
THIS WEEK'S RESEARCH REVIEW: “Targeting SMT Application – Importance of Segmental Pain vs. Stiffness” (2 papers guested Reviewed by Dr. Casper Nim)
These papers were published in Nature Scientific Reports (2020 & 2021) and this Review is posted in Recent Reviews, Spinal Manipulation - Mechanisms of Action, Low Back Pain and the 2022 Archive.
