Spinal Manipulation and Pain

Spinal Manipulation appeared to reduce pain on palpation in this study. In common with previous studies it concludes that manipulation produces reduced pain levels in the short term. Further complementary studies would help establish if these clinical improvements were maintained in the long term. Enjoy the read!

Immediate Effects on Pressure Pain Threshold Following a Single Cervical  Spine Manipulation in Healthy Subjects

Fernández-de-las-Peñas, C et al2007



A placebo, control, repeated-measures, single-blinded randomized study.


To compare the immediate effects on pressure pain threshold (PPT) tested over the lateral elbow region following a single cervical high-velocity low-amplitude (HVLA) manipulation, a sham (placebo), a control condition.


A lack of studies exploring the effect of cervical manipulative interventions.


15 asymptomatic volunteers, attended 3 experimental sessions on 3 separate days, at least 48 hours apart. At each session, subjects received either the manipulation, placebo, or control intervention. Manipulation was directed at the posterior joint of the C5-6 vertebral level. PPT over the lateral epicondyle of both elbows.


The analysis of variance detected a significant effect for intervention (F = 31.46, P<.001) and for time (F = 33.81, P<.001), but not for side (F = 0.303, P0.5). A significant interaction between intervention and time (F = 15.74, P<.001) was also found. Gender did not influence the comparative analysis (F = 0.252, P..6). Post hoc analysis revealed that the application of a HVLA thrust manipulation produced a greater increase of PPT in both elbows, as compared to placebo or control interventions (P<.001). No significant changes in PPT levels were found after the placebo and control interventions (P..6). Within-group effect sizes were large for PPT levels in both elbows after the manipulative procedure (d.1.0), but small after placebo or control intervention (d<0.1).


The application of a manipulative intervention directed at the posterior joint of the C5-6 vertebral level produced an immediate increase in PPT over the lateral epicondyle of both elbows in healthy subjects, whereas effect sizes for both placebo and control procedures were small, suggesting no significant effect.

  • J Orthop Sports Phys Ther 2007;37(6):325-329.
  • doi:10.2519/jospt.2007.2542