Treatment Effects of Spinal Manipulation on Proprioception in Subjects with Chronic Low Back Pain

Low back pain is a prevalent problem afflicting approximately 80% of the population during their lives. Subjects with back pain demonstrate deficits in trunk proprioception. Spinal manipulation is a treatment with known effects in pain control, increased motion and other neurophysiological effects. The purpose of this study was to examine the treatment effects of spinal manipulation on trunk proprioception in subjects with chronic low back pain (CLBP) and to determine if those effects lasted one week.Thirty-three subjects with CLBP, aged 24-54 years participated in this unbalanced, randomized controlled crossover design. Subjects presented for two or three testing sessions and agreed to a general physical examination followed by proprioception testing with joint position sense (JPS), threshold to detect passive motion (TTDPM), direction of motion (DM) and force reproduction (FR). After proprioception testing, each subject received either a lumbar manipulation or a sham procedure followed by retesting of proprioception. This procedure was repeated the following week using the opposite treatment. Those subjects receiving spinal manipulation in the second session returned for a third session and received the sham procedure a second time.Spinal manipulation produced a significant effect for TTDPM in the Manip 1st Group, the sham procedure produced a significant immediate effect for JPS in the Sham 1st Group, and manipulation resulted in a significant one-week residual effect for the Manip 1st Group. All other time comparisons were not significant. The results of this study minimally support the proposed hypotheses. The results of this study suggest that spinal manipulation has minimal effect on trunk proprioception in subjects with CLBP who are painfree at the time of testing. Subjects in this study did not demonstrate as large a deficit in proprioception as previously reported. This study might suggest that a lack of demonstrable deficit in painfree subjects at the time of testing is the result of diminished pain level. Strong conclusions cannot be made from these results but suggest further testing comparing manipulation with no intervention or other interventions while controlling for pain level, may be important for understanding the functional implications of the neurophysiological effect of spinal manipulation