The use of low intensity laser therapy in the treatment of myofascial trigger points: an updated critical review

Abstract

Objectives: This review describes the possible factors that may have contributed to the variability of the results between studies that have assessed the efficacy of low intensity laser therapy (LILT) in treating myofascial trigger points (MTrPs). Furthermore, it aims to make recommendations to overcome the methodological shortcomings identified.

Methods: A search of the literature was conducted by a single reviewer. Only randomised controlled and clinical trials were included.

Results: Sixteen studies were critically reviewed and showed considerable variability in treatment parameters, techniques, symptoms duration and diagnoses.

Discussion: Studies that have investigated the use of LILT in treating MTrPs produce conflicting results regarding the efficacy of this treatment modality. However, these are probably due to varying symptoms duration, treatment parameters and techniques, non-homogenous populations, and inaccessible and/or poor laser machine specifications.     

Statin-induced new onset of diabetes in dyslipidemic patients: a retrospective study

Background: Previously conducted studies with statins shows an increased risk of developing new onset of diabetes. This study helps in analyzing the risk of statins to cause new onset of diabetes.

Objective: To assess the prevalence, causality, severity, preventability and risk factors of statin-induced new onset of diabetes in dyslipidemic patients.

Methods: The study was conducted in a tertiary care hospital. A 6-month retrospective study was carried out in the cardiology department and analyzed between year 2013-2017medical records of dyslipidemic patients treated with statins of age >18 years. Patients with congenital diabetes, previous history of diabetes, patients using antipsychotics and steroids, and patients with incomplete data were excluded. Patients were reported as diabetic according to the American Diabetes Association’s classification. Patients who developed statin-induced new onset of diabetes were assessed by the WHO probability scale, Naranjo’s causality assessment scale, Hartwig’s severity assessment scale, and Modified Schumock and Thornton preventability scale.

Results: Out of 270 dyslipidemic patients, 19 patients developed statin-induced new onset of diabetes and 69 were classified as pre-diabetic. The major risk factors were: dose, gender, age, geriatric patients, and duration of the therapy. Patients who developed statin-induced new onset of diabetes were managed by dose reduction and treatment with anti-diabetic medications.

Conclusion The prevalence of statin-induced new onset of diabetes is 7.03%. The main risk factors identified in the study were in older patients (≥60 years), rosuvastatin therapy, high dose and longer duration of statin therapy.     

Randomised Controlled Trials on the Efficacy Of Spinal Manipulation Therapy in The Treatment of Low Back Pain

Abstract

Low back pain presents a major challenge to health care professionals within both primary and secondary care. Spinal manipulation therapy is one option from a range of treatment techniques which until recently has lacked credibility, in part due to a dearth of published, plausible explanations of the mechanisms through which it works. Such explanations are starting to emerge but rigorous evaluations of spinal manipulation therapy over other treatment modalities remain few in number. This paper builds on the review by Mohseni-Bandpei et al. (Mohseni-Bandpei MA, Stephenson R, Richardson B. Spinal manipulation in the treatment of low back pain: a review of the literature with particular emphasis on randomised controlled trials. Phys Ther Rev 1998; 3:185–94), by reviewing literature in particular randomised controlled trials published in the field since that date. It is concluded that the efficacy of manipulation for patients with acute or chronic low back pain remains unconvincing and that the literature remains blighted by inconsistency of definitions of interventions and by methodological flaws.     

Spinal manipulative therapy for low back pain: A systematic review

Abstract

Objectives: Gather and analyse relevant literature on spinal manipulative therapy for low back pain through systematic review to present a balanced and impartial summary of the findings. The aim of this systematic review was to investigate the efficacy of spinal manipulative therapy in patients with low back pain.

Methods: Databases searched included COCHRANE, MEDLINE, EMBASE, PEDro, PUBMED, WEB OF KNOWLEDGE, INGENTA CONNECT and GOOGLE SCHOLAR between January 2000 and January 2008. Sixteen articles were retrieved. Standardised inclusion and exclusion criteria were applied to select articles relevant to the review question. Seven studies were excluded and nine studies were included. In the next step, the methodological quality of the included studies was assessed with the PEDro scale, which rated the studies from 0 to 10.

Results: Methodological quality scores ranged from 4 to 8 out of a possible 10. Spinal manipulative therapy can be preferred for short-term relief of low back pain when compared with general exercise and dynamic strengthening exercises, which is revealed by a high quality study, moderate quality studies and a low quality study. Spinal manipulative therapy combined with exercise is more effective than exercise alone, which is revealed by a high quality study.

Conclusions: Further studies are needed to improve the quality of the evidence. There is evidence that spinal manipulative therapy combined with exercise is more effective than other procedures like spinal manipulative therapy, exercise or physician consultation alone.     

Ethics knowledge in physical therapy: a narrative review of the literature since 2000

Abstract

Objective: The purpose of this narrative review is to assess current physical therapy ethics knowledge by synthesizing literature published since 2000.

Method: This review builds on an earlier analysis.6 A rigorous search of major databases (including Medline, CINAHL, and PubMed) was conducted using specific keywords and explicit inclusion and exclusion criteria. The final review included 27 peer-reviewed articles and three editorials/lectures.

Results: Four themes of papers were identified that focused on (1) development of physical therapy ethics knowledge, (2) ethical issues related to conducting research, (3) how ethical issues are identified and managed and how ethical practice is taught, and (4) development of theoretical ethical decision-making models.

Discussion: The literature reflects a steady growth in interest in physical therapy ethics. Some 'gaps' in knowledge have been addressed but others have not, such as the impact of the institutional environment and cultural dimensions of practice on ethical reasoning. Research studies, using mostly qualitative approaches, identify similar issues but a synthesis of the findings is made difficult by lack of consistency in purpose and study design. While inclusion of ethics content in physical therapy curricula is recommended, little is known about how this is currently being achieved. Ethical theories are poorly integrated into the discussion of ethics in practice.

Conclusion: This review reveals the continuing need to ensure the development of physical therapy ethical knowledge by consistently incorporating both ethical theories and practice knowledge in education curricula and establishing a rigorous research agenda that accurately reflects the unique and multidimensional nature of clinical practice.     

N-terminal pro brain natriuretic peptide reflects long-term complications in type 1 diabetes

Abstract

Purpose. To evaluate N-terminal pro brain natriuretic peptide (NT-proBNP) as a marker of long-term micro- and macrovascular complications in type 1 diabetes. Methods. This was a cross-sectional study of 208 long-term surviving type 1 diabetic patients from a population-based cohort from Fyn County, Denmark. In a clinical examination in 2007–2008, NT-proBNP was measured and related to proliferative diabetic retinopathy (PDR), nephropathy, neuropathy and macrovascular disease. Results. Median age and duration of diabetes was 58.7 and 43 years, respectively. Median NT-proBNP concentration was 78 pg/ml (10th–90th percentile 25–653 pg/ml). The NT-proBNP level (89 vs. 71 pg/ml, p = 0.02) was higher in women. In univariate analyses, NT-proBNP was associated with age, duration of diabetes, diastolic blood pressure (inversely), nephropathy, neuropathy and macrovascular disease. For instance, median NT-proBNP concentrations were 70, 91 and 486 pg/ml for patients with normo-, micro- and macroalbuminuria, respectively (p < 0.01). When adjusted for age, sex, duration of diabetes, high sensitivity CRP, HbA_1c, diastolic blood pressure and smoking, higher NT-proBNP concentrations (4th vs. 1st quartile) were related to nephropathy (odds ratio [OR] 5.03; 95% confidence interval [CI] 1.77–14.25), neuropathy (OR 4.08; 95% CI 1.52–10.97) and macrovascular disease (OR 5.84; 95% CI 1.65–20.74). There was no association with PDR. Conclusions. NT-proBNP has traditionally been described as a marker of heart failure and left ventricular dysfunction. In this study of long-term surviving type 1 diabetic patients, we found NT-proBNP associated with nephropathy, neuropathy and macrovascular disease. If confirmed by prospective studies, NT-proBNP might be a useful prognostic marker of diabetes-related complications.     

Corneal Confocal Microscopy: A Biomarker for Diabetic Peripheral Neuropathy

PurposeDiagnosing early diabetic peripheral neuropathy remains a challenge due to deficiencies in currently advocated end points. The cornea is densely innervated with small sensory fibers, which are structurally and functionally comparable to intraepidermal nerve fibers. Corneal confocal microscopy is a method for rapid, noninvasive scanning of the living cornea with high resolution and magnification.MethodsThis narrative review presents the framework for the development of biomarkers and the literature on the use and adoption of corneal confocal microscopy as an objective, diagnostic biomarker in experimental and clinical studies of diabetic peripheral neuropathy. A search was performed on PubMed and Google Scholar based on the terms “corneal confocal microscopy,” “diabetic neuropathy,” “corneal sensitivity,” and “clinical trials.”FindingsA substantial body of evidence underpins the thesis that corneal nerve loss predicts incident neuropathy and progresses with the severity of diabetic peripheral neuropathy. Corneal confocal microscopy also identifies early corneal nerve regeneration, strongly arguing for its inclusion as a surrogate end point in clinical trials of disease-modifying therapies.ImplicationsThere are sufficient diagnostic and prospective validation studies to fulfill the US Food and Drug Administration criteria for a biomarker to support the inclusion of corneal confocal microscopy as a primary end point in clinical trials of disease-modifying therapies in diabetic neuropathy.     

Does osteoprotegerin relate to micro- and macrovascular complications in long-term type 1 diabetes?

Abstract

Purpose. Markers of micro- and macrovascular disease are needed in type 1 diabetes in order to identify patients at risk of severe complications. Osteoprotegerin (OPG) is expressed in vascular myocytes, and increasing levels have been reported in type 1 diabetes. Consequently, we investigated OPG as a non-invasive marker of micro- and macrovascular complications in long-term type 1 diabetic patients. Methods. This was a cross-sectional study of 200 type 1 diabetic patients with long diabetes duration from a population-based cohort from Fyn County, Denmark. Patients were examined in 2007–2008, and OPG was measured and correlated to diabetes-associated complications: retinopathy, nephropathy, neuropathy and macrovascular disease. Results. Median age and duration of diabetes was 58.7 years (range 37.7–84.4 years) and 43 years (range 34–70 years), respectively. Median level of OPG was 1257 pg/ml (range 379–5706 pg/ml). In univariate analyses, OPG was related to age, duration of diabetes, female gender, nephropathy and inversely to diastolic blood pressure. In an age- and sex-adjusted model, higher levels of OPG were associated with a higher risk of nephropathy (OR 2.54, 95% confidence interval 1.09–5.90 for third vs. first tertile). Statistical significance was, however, lost in a multivariate model, and proliferative diabetic retinopathy, neuropathy and macrovascular disease was not associated with OPG in either model. Conclusions. Some associations of OPG and nephropathy were found in a long-term type 1 diabetic cohort. Prospective studies are needed in order to determine whether OPG can be used to predict nephropathy.     

Relevance of nerve conduction velocity in the assessment of balance performance in older adults with diabetes mellitus

Purpose This study investigated the relationship between peripheral nerve conduction velocity (NCV) and balance performance in older adults with diabetes. Methods Twenty older adults with diabetes were recruited to evaluate the NCV of their lower limbs and balance performance. The balance assessments comprised the timed up and go (TUG) test, Berg balance scale (BBS), unipedal stance test (UST), multidirectional reach test (MDRT), maximum step length (MSL) test and quiet standing with eyes open and closed. The relationship between NCV and balance performance was evaluated by Pearson’s correlation coefficients, and the balance performances of the diabetic patients with and without peripheral neuropathy were compared by using Mann–Whitney U tests. Results The NCV in the lower limbs exhibited a moderate to strong correlation with most of the balance tests including the TUG (r?=??0.435 to??0.520, p?r?=?0.406–0.554, p?r?=?0.409–0.647, p?P?p?p?p?p?p?Conclusion Our findings revealed that a decline in peripheral nerve conduction in the lower limb is not only an indication of nerve dysfunction, but may also be related to the impairment of balance performance in patients with diabetes.

• Implications for Rehabilitation

• Nerve conduction velocity in the lower limbs of diabetic older adults showed moderate to strong correlations with most of the results of balance tests, which are commonly used in clinics.

• Decline in nerve conduction velocity of the lower limbs may be related to the impairment of balance control in patients with diabetes.

• Diabetic older adults with peripheral neuropathy exhibited greater postural instability than those without peripheral neuropathy.

     

Risk of fall for people with diabetes

Abstract

Purpose: To examine the risk of fall for people with diabetes compared with healthy control subjects. Correlation between tactile sensation and postural control was examined for subjects with diabetes. Methods: Subjects with type 2 diabetes were classified into two groups: (i) diabetes without neuropathy (n?=?23) and (ii) diabetic peripheral neuropathy (DPN) (n?=?9). Age-matched healthy control subjects (n?=?32) were recruited. Tactile sensation, equilibrium scores (ES), strategy scores and sensory analysis scores from the Sensory Organization Test (SOT) were compared among the groups. Results: Subjects with diabetes without neuropathy demonstrated impaired postural control upon the disruption of somatosensory inputs. Subjects with DPN lost balance upon being deprived of visual inputs. A decrease in tactile sensation was associated with a decrease in the ESs in all subjects with diabetes (r?=??0.35 to ?0.77; p?<?0.05), and they tend to use more hip strategy for postural control upon being deprived of visual inputs. Conclusions: Different postural control strategies are adopted by various subgroups of subjects with diabetes. Subjects with DPN demonstrated a significant shift from ankle to hip strategies for balance tests when vision was deprived.

• Implications for Rehabilitation

• The severity of diabetic peripheral neuropathy (DPN) is associated with the risk of fall.

• Different compensatory strategies in balance control have been adopted by different subgroups of people with diabetes.

• In order to minimize the risk of fall, specific balance training program should be offered to different subgroups of people with diabetes.

• The balance training should emphasize on optimizing the competence of their existing compensatory postural control strategies.

     

Profile of disabilities and their associated factors in patients with type 2 diabetes evaluated by the Canadian occupational performance measure: the Rio De Janeiro type 2 diabetes cohort study

Purpose: To investigate the profile of disability in patients with type 2 diabetes and to evaluate its associated variables.

Method: The Canadian Occupational Performance Measure (COPM) assessed disabilities in 475 type 2 diabetic individuals. The activities were categorised by the International Classification of Functioning, Disability and Health. The Medical Outcomes Study 36-item Short-Form Health Survey (SF-36) was used to evaluate pain, emotional and physical functioning domains of life-quality. Multivariable logistic regression assessed the independent correlates of better/worse performance.

Results:: Median COPM score was 4.5 (interquartile range 3–6). Problems in mobility (53.6%), self-care (21.1%) and daily-life (13.0%) were most frequently self-reported. Presence of restriction/pain in the upper limbs (odds ratio [OR]: 1.66; 95% CI: 1.11–2.47; p=0.013) and of peripheral neuropathy (OR: 1.64; 95% CI: 1.06–2.53; p=0.026) were associated with greater chance of worse performance. Higher values of SF-36 in pain and emotional domains (each 10 point increase; OR: 0.92 95% CI: 0.85–0.98; p=0.011; OR: 0.96; 95% CI: 0.92–1.00; p=0.063, respectively) and physical activity (OR: 0.63; 95% CI: 0.41–0.98; p=0.042) were associated with better performance.

Conclusions:: Type 2 diabetic patients frequently reported disabilities in mobility, self-care and daily-life domains; and its associated factors were the presence of depression, upper limb pain and diabetic peripheral neuropathy.

• Implications for Rehabilitation

• The Canadian Occupational Performance Measure (COPM) instrument can be applied to patients with diabetes, as it identifies several disabilities, mostly in mobility, self-care and domestic life areas.

• Rehabilitation directed to upper limb pain/limitation and to lower limb peripheral neuropathy shall be implemented and may improve diabetic patients’ performance and quality of life.

• A patient-centered rehabilitation strategy, guided by the COPM, may enable greater independence and autonomy, but this should be confirmed in future intervention studies.

     

Small fiber neuropathy in coeliac disease and gluten sensitivity

Objectives: The commonest types of peripheral neuropathy in the context of Coeliac Disease (CD) and gluten sensitivity (GS) are length-dependent symmetrical sensorimotor neuropathies and sensory ganglionopathies. In patients with such neuropathy, (gluten neuropathy), peripheral neuropathic pain is prevalent suggesting involvement of small fibers. The purpose of this report was to describe the clinical characteristics of patients with CD or GS and pure small fiber neuropathy (SFN).

Methods: We reviewed the records of all patients that had been referred to the Gluten-Related Neurological Disorders clinic who had clinical and neurophysiological evidence of SFN. All patients had serological evidence of gluten sensitivity (GS) prior to commencing GFD. All patients were offered a duodenum biopsy. Patients with comorbidities that could cause SFN were excluded.

Results: We identified 13 patients (9 males) with SFN and gluten sensitivity. Of 11 patients who underwent duodenal biopsy 10 had evidence of enteropathy (CD). Mean age at onset of pain was 53.5 ± 11.4 years (range 34–72) and mean age of CD/GS diagnosis was 50.8 ± 10.4 years (range 34–68). In 8 patients (61.5%) pain was the presenting feature.

Neurophysiological assessment suggested a length-dependent small fiber neuropathy in 11 patients, whereas in 2, a non-length dependent pattern was identifying suggesting that the predominant pathology lies in the dorsal root ganglia.

Conclusion: SFN can be a presenting feature of CD and GS and, therefore, screening for CD and GS should be included in the diagnostic workup of patients with idiopathic SFN.     

The Chiropractic Subluxation: Implications for Manual Medicine

Abstract

Objectives: Studies investigating the efficacy of intra-oral myofascial therapies (IMT) for chronic temporomandibular disorder (TMD) are rare. The objective of this randomized, controlled pilot study was to compare the effects of IMT and the addition of self-care and education over 6 months on four common TMD outcome measures: inter-incisal opening range, jaw pain at rest, jaw pain upon opening, and jaw pain upon clenching.

Participants: Thirty myogenous TMD participants between the ages of 18 and 50 years, experiencing chronic jaw pain of longer than 3-month duration, were recruited for the present study.

Intervention: Included patients were randomized into one of three groups: (1) IMT consisting of two treatment interventions per week for 5 weeks; (2) IMT plus 'self-care' involving education and exercises; and (3) wait list control.

Main outcome measures: Range of motion findings were measured in millimetres by vernier callipers and pain scores were quantified using an 11-point self-reported graded chronic pain scale. Measurements were taken at baseline, 6 weeks post-treatment, and 6 months post-treatment.

Results: The results showed statistically significant differences in resting, opening, and clenching pain and opening range scores (P<0.05) in both treatment groups compared to control at 6 months. No significant differences were observed between the two treatment groups during the course of the trial.

Conclusions: This study suggests that IMT alone or with the addition of self-care may be of some benefit in the management of chronic TMD over the short-medium term. A larger scale study over a longer term (1–2 years) may be of further value.     

Clinical relevance of the modified physical performance test versus the short physical performance battery for detecting mobility impairments in older men with peripheral arterial disease

Abstract

Purpose: The study is to compare the Modified Physical Performance Test (MPPT) and Short Physical Performance Battery (SPPB) as metrics of mobility and function in older men with peripheral arterial disease (PAD).

Materials and methods: A total of 51 men (55–87?years) with PAD underwent functional testing including the SPPB, MPPT, Walking Impairment Questionnaire (WIQ), stair ascent, and 6-min walk distance. Individuals were grouped according to SPPB and MPPT scores as not limited on either, limited only on the MPPT, or limited on both.

Results: The MPPT identified a higher proportion of patients as being functionally limited than the SPPB (p?<?0.001). Men identified as limited only by the MPPT, and not the SPPB, were subsequently confirmed to have lower function on all measures compared to those not identified as limited by either the SPPB or the MPPT (p?<?0.02).

Conclusions: These findings suggest the MPPT is an appropriate measure to identify early declines in men with PAD and may identify global disability better than SPPB.

• Implications for rehabilitation

• Individuals with peripheral arterial disease have low activity levels and are at risk for a loss of independence and global disability.

• Early detection of decline in mobility and global function would allow for interventions before large changes in ambulatory ability or a loss of functional independence occur.

• This study shows the Modified Physical Performance Test may be an appropriate test to identify early decline in function in men with peripheral arterial disease.

     

Relaxation as treatment for chronic musculoskeletal pain – a systematic review of randomised controlled studies

Abstract

Objectives: To review studies on relaxation treatment for chronic musculoskeletal pain.

Methods: Searches in the databases PubMed, PEDro, CINAHL, Amed, the electronic library information navigator (ELIN), and the British Medical Journal and Science Direct, found 12 relevant studies. Inclusion criteria were: randomised controlled trials (RCTs); studies including a total of at least 25 subjects at the end of intervention; relaxation techniques as single treatment, or combined with education, with the participants being active in the treatment.

Results: A total of 12 studies fulfilled all inclusion criteria and were reviewed. Quality assessment showed that all studies were of medium quality. The relaxation techniques used were: progressive muscle relaxation ad modum Jacobson (most common), autogenic training ad modum Schultz, hypnosis, guided imagery and biofeedback. Positive effects were found regarding decreases in pain intensity, anxiety, depression, and fatigue (in fibromyalgia). Even decreases in medication and health costs were seen. Increased mobility and use of coping strategies were also reported.

Conclusion: Relaxation training could be effective for patients with chronic musculoskeletal pain. The experimental study designs need to be of improved scientific quality and should, for example, include clear self-training relaxation protocols and suitable control groups. RCTs of high quality are necessary.     

Gluteal muscle dysfunction and the role of specific strengthening in hip osteoarthritis: a review

Abstract

Background: The muscle system provides essential support to a joint, and muscle weakness and atrophy may occur in the presence of joint pathology, such as osteoarthritis (OA). The gluteal muscles – gluteus medius and gluteus maximus – provide an important stability role in the hip joint and evidence exists for gluteal weakness in hip OA. Therefore, rehabilitation should address such dysfunction.

Objectives: To identify the use of gluteal strengthening in exercise-based randomised controlled trials or randomised clinical trials of hip OA.

Methods: A structured literature search was undertaken to review the evidence for use of gluteal strengthening in hip OA clinical trials.

Results: Eleven randomised controlled or randomised clinical trials of strengthening-based exercise in hip OA were identified and searched for evidence of gluteal strengthening. None of the studies reported specific strengthening of the gluteal muscles and details of the strengthening regimes used were poorly described in most of the studies. This lack of specificity may be one of the reasons why only small effect sizes and short-term benefits have been found for exercise therapy in the management of hip OA.     

Aphasia and reperfusion therapies in hyper-acute settings: A scoping review

Abstract

Purpose: Reperfusion therapies are medical treatments that restore blood flow either by surgical removal of a blood clot or with medications that dissolve clots. The introduction of reperfusion therapies has the potential to change the presentation of aphasia following acute ischaemic stroke (AIS). This scoping study will explore the relationship between aphasia and reperfusion therapies from a speech-language pathology perspective.

Method: A systematic literature search was performed on studies published up until October 2016. Relevant studies that reported on aphasia and reperfusion therapy were assessed for quality and the relationship between the two.

Results: Overall, 27 studies were identified, these studies were heterogeneous in nature. Despite speech-language pathologists filling a central role in management of aphasia, only seven of these studies mentioned involvement of speech-language pathologists, with minimal information about the precise nature of the involvement of speech-language pathology services.

Conclusion: Based on this scoping review, reperfusion therapy appears to be impacting on the presentation of aphasia. A prospective study into reperfusion therapy and aphasia is required to inform speech-language pathologists on this patient population.     

Role of neuropeptides in skin inflammation and its involvement in diabetic wound healing

Importance of the field: In 2010, the world prevalence of diabetes is 6.4%, affecting 285 million adults. Diabetic patients are at risk of developing neuropathy and delayed wound healing that can culminate in incurable diabetic foot ulcerations (DFUs) or even foot amputation.

Areas covered in this review: The contrast between cellular and molecular events of wound healing and diabetic wound healing processes is characterized. Neuropeptides released from the autonomous nervous system and skin cells reveal a major role in the immunity of wound healing. Therefore, the signaling pathways that induce pro/anti-inflammatory cytokines expression and its involvement in diabetic wound healing are discussed. The involvement of neuropeptides in the activation, growth, migration and maturation of skin cells, like keratinocytes, Langerhans cells, macrophages and mast cells, are described.

What the reader will gain: This review attempts to address the role of neuropeptides in skin inflammation, focusing on signal transduction, inflammatory mediators and pro/anti-inflammatory function, occurring in each cell type, as well as, its connection with diabetic wound healing.

Take home message: Understanding the role of neuropeptides in the skin, their application on skin wounds could be a potential therapy for skin pathologies, like the problematic and prevalent DFUs.     

The temporal effects of a single session of high-velocity,low-amplitude thrust manipulation on subjects with spinal pain

Abstract

Background: A high velocity, low amplitude thrust manipulation (HVLAT) is an intervention commonly used in the treatment of patients with spinal pain. Recent studies have reported on the possible neurophysiological effects of this technique which may be pertinent to the therapeutic value of these procedures. However, few studies have examined the temporal neurophysiological nature of a HVLAT beyond the immediate effects.

Objectives: The purpose of this review is to summarize the literature on the temporal neurophysiological effects of a single HVLAT in patients with spinal pain.

Methods: A systematic search of English articles was conducted using MEDLINE, CINAHL, and PEDro. Additional studies were identified with a hand search of the references of relevant articles. Search terms included spinal manipulation, chiropractic manipulation, osteopathic manipulation, spinal adjustment, cervical manipulation, lumbar manipulation, sacroiliac manipulation, neck pain, back pain, and sacroiliac pain. Quality scoring of the included articles was based on the Newcastle–Ottawa criteria.

Results: Of the 478 articles identified, five articles ultimately met inclusion criteria into this review. These studies were of moderate to high quality. In all, follow-up measures after a single HVLAT were taken within a 30-minute to 5-hour period.

Conclusion: In the absence of concurrent intervention, the neurophysiological effects seen after administration of a HVLAT were observed to be immediate in nature, with a return to baseline or reduction in effect noted at follow-up. Future studies examining the mechanisms of HVLAT should include dedicated follow-up periods to establish the temporal changes related to these techniques.