Chiropractic & Manual Therapies最新文献

{"title":"Whole health and chiropractic: a commentary on historical roots, contemporary relevance, and future directions.","authors":"Michele Maiers, Krista Ward, Michael Ramcharan, Logan Benjamin, Wren Burton, Zachary Cupler, Maruti Ram Gudavalli, Stephanie Halloran, Benjamin Holmes, Steven Huybrecht, Jeremy Jenkins, Claire D Johnson, Nathaniel C Majoris, Alex Margrave, Elizabeth Moos, Vanessa Morales, Ryan D Muller, Steven Passmore, Morgan R Price, Stacie Salsbury, Kent J Stuber, Stephanie G B Sullivan, Alexander R Sundin, Maithy Ta, Qian Zhang","doi":"10.1186/s12998-026-00676-6","DOIUrl":"10.1186/s12998-026-00676-6","url":null,"abstract":"<p><strong>Background: </strong>This commentary describes perspectives from workshop attendees at a North American educational conference on the chiropractic profession and its relationship with whole health. Whole Health is a paradigm shift within healthcare settings and funding agencies in the United States that utilizes a systems framework to transform healthcare. Whole health frameworks emphasize biopsychosocial well-being as defined by individuals, families, and communities, and leverages interprofessional, team-based approaches to promote well-being, disease prevention, and restoration of health.</p><p><strong>Main body: </strong>Two separate, 60-minute workshop sessions were convened at the 2025 Association of Chiropractic Colleges Education Conference and Research Agenda Conference to discuss whole health and chiropractic. Attendees (n = 105) included chiropractic academicians, researchers, practitioners, students, and organizational leaders from institutions largely based in the United States. Participants in 14 small groups discussed (1) ways the chiropractic profession aligns with whole health, and (2) how chiropractors can contribute to whole health in clinical practice and healthcare education. Notes taken by group scribes were collected from each workshop and generated 401 distinct comments. Thematic analysis with an inductive approach was used to group and define key topics that emerged from the data. Aspects of the chiropractic profession were described as historically being aligned with whole health for its foundational philosophy in innate healing and resilience, and for espousing person-centeredness and patient values. Themes describing the future contribution of chiropractic to whole health include evidence-based practice; communication and advocacy; integration into the broader healthcare system; and forward-facing education. There was overlap between past and future when considering holism; therapeutic alliance and patient empowerment for self-care; direct access; therapeutic conservatism; preventive health and lifestyle medicine; and longitudinal care.</p><p><strong>Conclusions: </strong>The whole health paradigm presents an opportunity for chiropractors to be recognized contributors within multidisciplinary teams, using their expertise to aid chronic disease prevention, patient empowerment, and health care delivery innovations. Continued education and training, policy changes, and further research are required for the chiropractic profession to best serve patients and provide value within a whole health framework.</p>","PeriodicalId":48572,"journal":{"name":"Chiropractic & Manual Therapies","volume":"34 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13536578/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148882162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Educational approaches to the relationship between cervical adjusting and risk of cervical artery dissection; a survey of chiropractic faculty.","authors":"Chad Lambert, Kathryn Ross, Christine Major, Kara Burnham, Shawn Hatch, Brian Anderson","doi":"10.1186/s12998-026-00675-7","DOIUrl":"10.1186/s12998-026-00675-7","url":null,"abstract":"<p><strong>Background: </strong>Cervical artery dissection (CeAD) remains a rare but clinically important condition that has generated longstanding debate regarding its potential association with cervical spinal manipulative therapy (cSMT). Although biomechanical and epidemiologic studies have examined this relationship, little is known about how chiropractic educational programs address CeAD or how individual faculty member's perceptions shape instructional practices. This study surveyed chiropractic faculty members who actively teach cervical manipulation to understand how educators conceptualize CeAD risk and incorporate safety considerations into curricula.</p><p><strong>Methods: </strong>An anonymous twelve-item electronic survey was distributed via Qualtrics to institutional gatekeepers from 28 English-speaking chiropractic programs between February and March 2025. Gatekeepers then distributed the survey to instructors with hands-on experience teaching cervical manipulation within the prior five years. Survey items assessed teaching setting, beliefs about the cSMT-CeAD relationship, and whether perceived risk influenced screening procedures and technique modification. Quantitative data were analyzed using descriptive statistics, Pearson's chi-square tests, and Fisher's exact test; qualitative free-text responses underwent keyword extraction and keyword-based thematic analysis.</p><p><strong>Results: </strong>Individual faculty members from 17 of the 28 invited chiropractic programs participated (61% program response rate), yielding 103 responses with 85 meeting inclusion criteria (46 classroom, 38 clinical, 1 undisclosed). Teaching setting was significantly associated with faculty perspectives of CeAD causation (p = 0.013); classroom faculty more frequently characterized the cSMT - CeAD relationship as associational (73% vs. 27%), while clinical faculty more frequently endorsed a causal relationship mediated by modifiable risk factors (63% vs. 33%). Most respondents (72%) reported that CeAD risk influenced their instructional approach, primarily through pretreatment screening and technique modification. Qualitative analysis of free-text responses (n = 19) identified four themes: Clinical Assessment & Management (89.5% of responses), Risk & Safety (52.6%), Education & Training (31.6%), and Evidence Base (21.1%).</p><p><strong>Conclusions: </strong>Teaching setting significantly influenced how chiropractic faculty members conceptualize and communicate CeAD risk. Findings reveal opportunities to strengthen evidence-aligned patient safety education and establish instructional guidance across chiropractic programs. The gatekeeper-led sampling approach limits individual level response rate calculation and generalizability.</p>","PeriodicalId":48572,"journal":{"name":"Chiropractic & Manual Therapies","volume":"34 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13536808/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148882148","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Practical guide to structuring the Background section in clinical and epidemiological studies.","authors":"Charlotte Leboeuf-Yde, Claire Gudex","doi":"10.1186/s12998-026-00643-1","DOIUrl":"10.1186/s12998-026-00643-1","url":null,"abstract":"<p><p>This is the first of three articles that provide step-by-step guides on how to structure the content of a scientific article to ensure a coherent and relevant text. This article deals with the Background section, with extra focus on the research objectives. We introduce the four typical elements of a Background section: (i) justification of the study topic, (ii) sufficient information for the reader to understand the research project, (iii) presentation of the research gaps that justify the research objectives, and (iv) well-constructed research objectives that indicate the study design and may include a purpose statement. Because the whole text is driven by the research objectives, we first suggest some tips for making these as informative as possible. We then provide a step-by-step approach for planning the structure and contents of the Background section as preparation for writing the full text later. We illustrate our explanations with text examples selected from this journal to show how authors have approached crucial aspects of the Background section. Finally, we discuss some pros and cons of using artificial intelligence during the writing process, and how its use can be reported. We hope that this practical guide to the structuring process will provide authors with a useful framework for the later addition of the full text and relevant references.</p>","PeriodicalId":48572,"journal":{"name":"Chiropractic & Manual Therapies","volume":"34 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13531733/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148875846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Practical guide to structuring the Methods and Results sections in clinical and epidemiological studies.","authors":"Claire Gudex, Charlotte Leboeuf-Yde","doi":"10.1186/s12998-026-00644-0","DOIUrl":"10.1186/s12998-026-00644-0","url":null,"abstract":"<p><p>This is the second of three articles that provide step-by-step guides on how to structure the content of a scientific article to ensure a coherent and relevant text. This article deals with the Methods and Results sections. We start by explaining the purpose and content of these sections and then provide a practical guide for planning the structure of each section as preparation for writing the full text later. Thus, we describe ten steps for structuring the Methods section and six steps for structuring the Results section. We illustrate our explanations with text examples selected from this journal to show how authors have approached various aspects of these two sections. After some tips for constructing informative tables and figures, we discuss the use of artificial intelligence when preparing the Methods and Results sections. The Methods section is fundamental to your reader understanding your study and trusting the validity of your findings, while the Results section provides answers to your stated research objectives or questions. Transparency and completeness are essential in both sections to assist your reader and reflect your academic integrity.</p>","PeriodicalId":48572,"journal":{"name":"Chiropractic & Manual Therapies","volume":"34 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13531827/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148875946","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Practical guide to structuring the Discussion section in clinical and epidemiological studies.","authors":"Charlotte Leboeuf-Yde, Claire Gudex","doi":"10.1186/s12998-026-00645-z","DOIUrl":"10.1186/s12998-026-00645-z","url":null,"abstract":"<p><p>This is the last of three articles that provide step-by-step guides on how to structure the content of a scientific article to ensure a coherent and relevant text. The current article aims to help authors produce relevant and stringent Discussion sections that reflect clarity of thought and critical analysis, with contents driven by the research objectives. We first describe the purpose of the six typical elements of the typical Discussion section: (i) Summary of Findings, (ii) Explanation of Findings, (iii) Comparison of own results with other studies, (iv) Critique of own work, (v) Perspectives, and (vi) Conclusion. We show different placements and combinations of these and explain what they should include. We then suggest how to write a simple Summary of Findings and how to avoid re-writing the Background section in the Explanation of Findings. We show how to use the previously identified research gaps when comparing own results with similar studies, suggest different approaches for Critique of own work, define the types of Perspectives that are common in clinical and epidemiological studies, and explain how to provide relevant and memorable information in the Conclusion. Examples of how authors have dealt with different elements of the Discussion section have been selected from this journal. Finally, we discuss the use of artificial intelligence in the writing process. We hope that the three articles will help authors to plan their writing in a meaningful manner, thus saving time for themselves and resulting in articles that are easy to read and understand.</p>","PeriodicalId":48572,"journal":{"name":"Chiropractic & Manual Therapies","volume":"34 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13536823/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148875902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of national consensus-based recommendations for history taking, examination and clinical management of infants in chiropractic practice.","authors":"Freja Gomez Overgaard, Lise Hestbæk, Elisabeth Davidson","doi":"10.1186/s12998-026-00671-x","DOIUrl":"10.1186/s12998-026-00671-x","url":null,"abstract":"<p><strong>Background: </strong>Chiropractors in many countries provide care for infants, yet few structured, evidence-informed recommendations exist to guide history taking, examination, and clinical management in this population. In Denmark, variation in practice and limited public understanding of chiropractic care for infants highlighted the need for national recommendations to support safe, consistent, and transparent care.</p><p><strong>Objective: </strong>To describe the development of national recommendations outlining the minimum requirements for history taking, examination, and clinical management considerations for infants aged 0-12 months in chiropractic practice.</p><p><strong>Methods: </strong>These recommendations were commissioned by the Danish Society of Chiropractic and initially developed in 2020, with an update in 2025. The manuscript was reported with consideration of the RIGHT Statement. Recommendation development was informed by a targeted literature review, a national knowledge-sharing workshop involving 71 chiropractors, expert review by a seven-member panel with extensive paediatric experience, and external stakeholder consultation. Feedback from each stage was incorporated through an iterative drafting process.</p><p><strong>Results: </strong>The recommendations describe minimum requirements for medical history taking, red flag screening, general and musculoskeletal examination, referral, and clinical management considerations for infants. Minimum and supplementary assessment components are presented in structured tables to support consistent clinical assessment and decision-making.</p><p><strong>Conclusions: </strong>These national recommendations establish minimum requirements for history taking, examination, and clinical management considerations for infants in chiropractic practice. Developed through a structured process integrating a targeted literature review, practice-based input, expert review, and stakeholder consultation, they provide a transparent and practical framework to support safe, consistent, and collaborative paediatric care. Transparent reporting of the development process may facilitate the adaptation of these recommendations and the development of similar recommendations in other healthcare settings.</p>","PeriodicalId":48572,"journal":{"name":"Chiropractic & Manual Therapies","volume":"34 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13499300/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148799637","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The use of high-velocity, low-amplitude techniques in paediatric osteopathic care: two multinational cross-sectional surveys on clinical practice and educational curricula.","authors":"Patrick L S van Dun, Lucas Bohlen, Julie Ellwood, Ana Paula A Ferreira, Amie Steel, Jerry Draper-Rodi, Paul Vaucher","doi":"10.1186/s12998-026-00670-y","DOIUrl":"10.1186/s12998-026-00670-y","url":null,"abstract":"<p><strong>Background: </strong>Up to one osteopathic consultation out of four involve infants and children. Although the clinical effectiveness of osteopathic care in paediatric populations remains inconclusive, available evidence suggests that it is generally safe. In contrast, high velocity, low amplitude technique (HVLA) has been associated with potential adverse effects. To inform a professional position on the use of HVLA techniques in paediatric care, this study investigated (1) the use of HVLA techniques by osteopathic practitioners in the treatment of infants, children, and adolescents, and (2) the extent to which HVLA techniques are included in osteopathic training programmes for these paediatric age groups.</p><p><strong>Methods: </strong>Two online cross-sectional surveys were conducted. The first targeted osteopathic practitioners and consisted of seven close-ended questions. The second survey was directed at osteopathic education institutes (OEIs) in Europe, Australia, Brazil, Israel, and New Zealand and consisted of three close-ended questions. Surveys were implemented via REDCap and made available in 11 languages. Participants were recruited between October 2025 and January 2026.</p><p><strong>Results: </strong>Among responding practitioners (n = 2607, response rate: 10.7%), 6.5% reported using HVLA in newborns or infants, 43.5% in children, and 78.3% in adolescents. Most respondents (54%) who apply HVLA to newborns and infants reported doing so \"rarely\". Of the 62 responding OEIs (response rate: 30.7%), 91.4% offered osteopathic paediatric education; however, only 4.8% reported teaching HVLA for newborns and infants, 11.3% for children, and 56.4% for adolescents. Most respondents (70.2%) held an HVLA-opposed stance. Among the distinct practitioner profiles identified in the prioritisation of conditions for HVLA use in newborns and infants, the precaution-informed stance (11.2%) was the most strongly associated with paediatric practice and with the highest reported HVLA use in this age group.</p><p><strong>Conclusions: </strong>Most respondents did not use HVLA in newborns and infants, with utilisation increasing in older paediatric age groups, and the majority expressed opposition to paediatric HVLA. More permissive stances were associated with greater HVLA use and more training. The generalisability of the findings is limited by potential coverage and self-selection bias, possible duplicate responses, and the low and variable response rate to the survey of osteopathic practitioners. Given its continued application, an evidence-based position statement and robust research on the safety and effectiveness of HVLA in paediatrics are urgently needed.</p>","PeriodicalId":48572,"journal":{"name":"Chiropractic & Manual Therapies","volume":"34 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13471349/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148727823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prediction, pain, and the power of context: toward a contemporary identity for the chiropractic profession.","authors":"Dave Newell, Solomon Segal, Giacomo Rossettini, Søren O'Neill, Tim Lothe-Raven, Lise Lothe, Steven Weiniger, Alister DuRose, Brad Beira, Keith Walker, Jorge E Esteves, Mick Thacker","doi":"10.1186/s12998-026-00669-5","DOIUrl":"10.1186/s12998-026-00669-5","url":null,"abstract":"<p><strong>Background: </strong>Musculoskeletal (MSK) pain is a leading cause of disability worldwide, with low back and neck pain among the largest contributors to years lived with disability. For many people with persistent pain, mechanisms are increasingly understood as arising from altered regulation at multiple loci rather than simple ongoing tissue injury. This challenges chiropractic's long-standing reliance on body focused explanatory models centred on correcting structural lesions or dysfunction.</p><p><strong>Main body: </strong>Active Inference (AIF) provides a contemporary framework for understanding pain perception as an embodied, context-sensitive process of sense-making. Here, inferences concerning threat or safety are informed by information generated across multiple interacting levels (neural, physiological, psychological, behavioural, and socio-cultural), and pain emerges when threat-related inferences remain persistently weighted as trustworthy. From this perspective, manual therapy may be understood as a coherent ensemble of interacting sensory, affective, interpersonal, and contextual cues that together reshape expectations, meaning, and action. We revisit the concept of Contextually Aided Recovery (CARe), a lens that sees the therapeutic encounter as a rich space of potential contextual modulation and affordances and argue that chiropractic's distinctive contribution lies in combining skilled manual contact with the deliberate shaping of context to support adaptive regulation.</p><p><strong>Conclusion: </strong>We propose that integrating AIF and CARe offers the chiropractic profession a coherent, evidence-aligned route toward a more contemporary identity, with implications for practice and education.</p>","PeriodicalId":48572,"journal":{"name":"Chiropractic & Manual Therapies","volume":"34 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13487956/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148799716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Manual therapists and people living with borderline personality disorder (BPD): a commentary on building safety, trust, and therapeutic effectiveness in physical care.","authors":"Stanley Innes, Karthika Kasiviswanathan, Lee Daffin, Helen Mildred","doi":"10.1186/s12998-026-00666-8","DOIUrl":"10.1186/s12998-026-00666-8","url":null,"abstract":"<p><strong>Background: </strong>Borderline personality disorder (BPD) is a complex and often stigmatised mental health condition frequently comorbid with chronic pain and musculoskeletal disorders. Despite regularly encountering individuals with BPD, manual therapists (e.g., physiotherapists, chiropractors, osteopaths, and massage therapists) receive limited training on how emotional dysregulation, trauma, and relational sensitivity may influence physical-care encounters.</p><p><strong>Discussion: </strong>This clinically informed commentary explores how BPD's psychological and neurobiological features intersect with bodily pain, therapeutic touch, and clinical communication. It highlights the potential for both therapeutic benefit and unintended harm within manual therapy interactions, and identifies a need for trauma-informed, psychologically attuned care. Drawing primarily on the National Institute for Health and Care Excellence (NICE) guideline for BPD (CG78, 2024 update), this paper cautiously adapts selected principles-such as collaboration, continuity, clear boundaries, and support for clinicians-to manual therapy contexts. The National Health and Medical Research Council (NHMRC) guideline (2012) is used selectively to provide additional operational detail where not explicitly addressed in NICE.</p><p><strong>Conclusion: </strong>While these considerations offer a pragmatic framework for enhancing safety and therapeutic engagement, their application requires careful adaptation to context, scope of practice, and resource availability. Further research, particularly co-designed with people with lived experience of BPD, is needed to evaluate feasibility and refine these approaches within manual therapy settings.</p>","PeriodicalId":48572,"journal":{"name":"Chiropractic & Manual Therapies","volume":"34 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13412130/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148608767","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spinal manipulation in acute low back pain patients is associated with reduced motor-unit firing variability without altering bilateral coordination: a single-motor-unit EMG study of the lumbar multifidus.","authors":"Lise R Lothe, Tim J L Raven, Gunnar Sandbæk, Torsten Eken","doi":"10.1186/s12998-026-00664-w","DOIUrl":"10.1186/s12998-026-00664-w","url":null,"abstract":"<p><strong>Background: </strong>The neurophysiology of high velocity, low amplitude spinal manipulation (HVLA-SM) is poorly understood. We have characterized motor unit (MU) discharge in acute low back pain (ALBP) patients after spinal manipulation and compared with pre-manipulation findings in the same subjects.</p><p><strong>Methods: </strong>Fine-wire electrodes were implanted bilaterally into the deep lumbar multifidus muscle at the painful spinal level in 9 ALBP patients with pain of less than three weeks duration in March-April 2007. HVLA-SM was applied to the painful spinal level. EMG activity was recorded during manipulation and during spontaneous and voluntary force production while standing and sitting, and individual MUs were identified and their discharge characteristics described. All subjects were compared to their own data recorded before HVLA-SM for effects on gross EMG activity duration, MU discharge rate, interspike interval variability quantified as inter-quartile range for differences between consecutive inter-spike intervals (∆ISI IQR), and common drive coefficient between concurrently active MUs.</p><p><strong>Results: </strong>No effects on MU discharge rate were evident in the first seconds after HVLA-SM. ∆ISI IQR was reduced by 5.25 ms (95% confidence interval 0.68-9.82; P = 0.025) after spinal manipulation compared with pre-manipulation findings, while median MU discharge rate and total duration of gross activity remained unchanged. Notably, the common drive coefficient was lower for bilateral than unilateral MU pairs (- 0.149; 95% confidence interval - 0.087 to - 0.210; P < 0.0001). This is in agreement with findings in the same ALBP population before HVLA-SM and in contrast to previous findings during spontaneous standing in pain free subjects, where common drive to uni- and bilateral pairs was not significantly different. MUs showed signs of self-sustained firing, but rotation between units was not observed.</p><p><strong>Conclusions: </strong>We have established a methodological framework for future investigations using spontaneous muscle activity rather than forced movements to understand the influence of spinal manipulation on the role of the nervous system in postural support. HVLA-SM was associated with reduced MU firing variability, suggesting a shift toward more stable motoneuron output in the deep lumbar multifidus. Longitudinal recovery data are needed to discriminate whether the reduced common drive to bilateral muscle pairs represents a pre-existing trait or a pain-driven state.</p>","PeriodicalId":48572,"journal":{"name":"Chiropractic & Manual Therapies","volume":"34 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13548485/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148907590","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}