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Chiropractic Research Review

Understanding the Mechanisms behind Manipulation

There is speculation that manipulation may selectively stimulate a specific descending pain inhibitory system (DPIS). However, the precise mechanisms of manipulation are still subject to debate, and research has yet to fully study or understand the effects of the adjustment on different pain modalities in symptomatic subjects.

This study investigated a proposed model in which manipulation produces an initial hypoalgesic and sympathoexcita-tory effect by activation of a DPIS.

Twenty-four patients diagnosed with chronic lateral epicondylalgia were assigned to a placebo group, a control group, or a group receiving chiropractic intervention in the form of cervical spine lateral-glide oscillatory manipulation.

Results: Manipulative intervention produced significantly greater hypoal-gesic and sympathoexcitatory changes compared with the placebo or control groups. A significant correlation was noted between the latencies of manipulation-induced hypoalgesia and sympathoexcitation.
The authors conclude that the adjustment produces a treatment-specific initial hypoalgesic/sympathoexcitatory effect beyond that of placebo or control, and contend that the relationship between the two effects suggests that manipulation may activate a central mechanism.

Vicenzino B, Collins D, Benson H, et al. An investigation of the interrelationship between manipulative therapy-induced hypoalgesia and sympathoex-citation. Journal of Manipulative and Physiological Therapeutics, Sept. 1998:21(7), pp448-53.
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Chiropractic Research Review

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