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Table 6

Detailed findings from literature review on effect of SMT on pain

ArtEffect of SMT on painSite of SMT/painValuesLocal/regional/ systemic effectSame/opposite sideAbove/belowPain form
[37]
The application of a cervical SMT, but not thoracic SMT, resulted in immediate bilateral hypoalgesic effect in patients with lateral epicondylitis.
SMT C5-C6 and T5-T8 /PPT both epicondyles
Changes PPT in KiloPascals (differences) PPT Cervical Thoracic affected side 88.6 (35.1%) 18.6 (0.8%) unaffected side 95.6 (25.4%) -40.5 (−0.9%)
Effect within the same segment. Used SMT caudal level as placebo with no effect.
No significant differences between L and R side
Effect within the same segment. Used SMT caudal level as placebo with no effect.
Pressure
[42]
On deltoid, small effect at the same segment. Didn't work on trapezius and C5
SMT C5-C6 right / PPT upper trapezius, deltoid and C5 spinous process
Changes PPT in Kg/cm² (differences) PPT SMT Control Trapezius ipsilateral 0.2 0.3 Trapezius contralateral 0.4 0.1 Deltoid ipsilateral 0.3 -0.2 Deltoid contralateral 0.2 -0.2 C5 spinous process 0.1 -0.1
Small effect within the same segment
Comparison of sides baseline in Table Table2,2, but no differences p>.523 Bilateral increases of PPT
-
Pressure
[23]
SMT reduced TSS (temporal sensory summation) but not PPT
Lower cervical and upper thoracic region / T° on hand + popliteal fossa
PPT increased for all groups (not only SMT) from pre to post SMT (F=9.6, partial N²=0.10)= SMT produced a significant reduction in TSS (p=.003)
Averages of lower extremity values were higher than upper extremity values
-
SMT worked at the same level or below
Pressure and Temperature (T°)
[28]
No effect
Cervical mobilization left C5-C6 / PPT left and right articular pillar of C5-C6
Differences PPT pre/post treatment Kpa F=0.168 p=0.168 Treatment 15.98 (+/− 4.8%) Manual contact 4.61 (+/− 0.2%) No contact 12.29 (+/− 3.5%)
No effect at same segment
-
-
Pressure
[29]
Small immediate increase of PPT
SMT atlantooccipital/ PPT on trigger points in the masseter and temporalis muscles
Differences before/after SMT in Kg/cm²: SMT = 0.29 (10%) Soft mobilization = 0.00 control= 0.019
Regional effect of atlantooccipital SMT and effect on trigeminal area
-
-
Pressure
[44]
Hypoaglesia significant at test site and without differences between the rates of mobilization
Lumbar mobilization/L2 dermatome(thigh), L5 (foot), hand and L5 paraspinal
Mean of changes: 19,6% paraspinal muscles 14,2% L2 dermatome 13,4% L5 dermatom 12% hand (this suggest that changes are systemic)
lumbar hypoalgesia was greater than distal (P=0.0028)
-
SMT more effective on lumbar dermatomes than more cephalad dermatomes
Pressure
[38]
Small effect regionally
SMT atlantooccipital/ PPT over both sides of sphenoid bone (V)
PPT effect on group and time F=14.4 (p<0.001) SMT = 3.5 kg/cm² control = − 0.1 kg/cm²
Regional level.
-
-
Pressure
[30]
Mobilization had a stronger effect on pain than SMT
SMT 1 segment below marked PPT (lumbar)
Mobilization = small increase (0.434 kg/cm² d= 0.78) SMT = decrease ( −0.173 d= 0.36) Control = small decrease (−0.105 d= 0.25) but ANOVA further revealed non signification between groups.
Local and systemic effect but PPT values increase in a caudal direction
-
-
Pressure
[43]
No differences between amplitudes (p= 0.864)
lumbar mobilization/ 1- right erector spinae (L3) 2- left patella (L3 dermatome) 3- proximal lateral sruface of left 5th metatarsal (S1 dermatome) 4- deltoid
PPT A B C 1 18.73% 14.57% 15.48% 2 17.93% 9.93% 10.67% 3 10.53% 15.57% 8.81% 4 19.06% 18.60% 11.69%
Local and systemic effect
-
-
Pressure
[18]
Significant changes in temporal summation, only for SMT
Lumbar SMT/ temporal summation on plantar surface (non dominant) and palmar surface (non dominant). Aδ fibers mediated pain sensitivity in non dominant forearm and calf
Lumbar (local response): A- Aδ fibers sensibility: no differences between groups at 47°C(p= .73), or 49°C (p= . 96) No effect of time at 47°C (p= .31) or 49°C (p= . 94) No changes in Aδ fibers B- temporal summation: F= 3,41 (p= . 05), different by group assignment = Changes in temporal summation Cervical (general response): A- No changes in Aδ fibers B- temporal summation: SMT group F= 6,78 (p= . 40), all groups had a decrease in temporal summation = Changes in temporal summation
Systemic effect, except for first pain.
-
-
T°differences Numeric Rating Scale (0–100) Before/after: Bike = −3,7 LE Exercise = 2,5 SMT= 19,9
[19]
Effect demonstrated for PPT but not for T°
SMT C5-C6 dominant side (right) / PPT , thermal pain thresholds (HPT - CPT) on lateral epicondyles (both sides)
Differences SMT Control PPT ipsilateral 121.5 (44.2%) 13.3 ( 4.4%) PPT contralateral 74.4 (17.7%) 6.1(1.7%) HPT ipsilateral (°C) 1.2 (2.9%) 0.7 (2.2%) HPT contralateral 1.5 (4.1%) -0.9 (1.9%) CPT ipsilateral −0.25(9.2%) -1.5 (9.6%) CPT contralateral 0.9 ( 18.1%)-1.0 (17.4%)
Same segment
Bilateral increase of PPT. No significant changes for T°
-
Pressure and T°
[39]
SMT changes PPT in both R and L C5-C6 zygapophyseal joints in healthy subjects
SMT C7-T1 / PPT C5-C6 zygapophyseal joints
Differences on PPT before/after: Right side SMT dominant: 53.1 SMT non-dominant: 80.7 Placebo: -2.7 Left side SMT dominant: 45.9 SMT non-dominant: 48.0 Placebo: -3.9
Effect at regional level
SMT changes PPT in both R and L C5-C6 zygapophyseal. joints in healthy subjects
SMT is also effective above and below of segment treated
Pressure
[20]
SMT changes pressure pain sensitivity in triggers points in the upper trapezius
SMT C3-C4 / PPT upper trapezius trigger points (TrPs)
Differences pre/post SMT in Kg/cm² Difference Placebo SMT Pre post −0.06 d=0.35 0.08 d=0.4 Pre - 5' -0.2 d=1.1 0.1 d=0.5 Pre - 10' -0.22 d=1.1 0.12 d=0.44
Regional level
-
-
Pressure
[31]
SMT changes pressure pain sensitivity in epicondyles
SMT C5-C6 both sides / PPT on lateral epicondyles (both sides)
Differences in Kg/cm² SMT ipsilateral 0.8 ( 35.5%) SMT contralateral 0.5 (24.8%) Placebo Ipsilateral 0.003(0.5%) Placebo contralateral 0.006 (0.4%) Control ipsilateral 0.003(0.5%) Control contralateral 0.006 (2.1%)
Same segment
No differences between L and R sides
-
Pressure
[36]
SMT produces hypoalgesia in lumbar area but not in cervical (control) but no effect on 1st pain
Lumbar SMT/ TSS in plantar surface (non dominant) and palmar surface (non dominant). Aδ fibers mediated pain sensitivity in non dominant forearm and calf
Lumbar Innervated NRS Change 47°C 13.2 (17.2) 12.9 (17.9) 23.5 (17.3) NRS Change 49°C 1.2 (20.2) 6.3 (22.4) 12.1 (19.7) Cervical Innervated NRS Change 47°C −3.0 (13.7) 0.3 (11.6) 0.3 (10.2) NRS Change 49°C 1.9 (9.0) -0.4 (10.1) 1.7 (10.8) NRS= Numeric rating scale
Effect at regional level but not at systemic level
-
Effect at the same level, but not above

[40]
Allodynia and hyperalgesia decrease with SMT
Non specific thoracic SMT / left and right forearm (capsaicin)
Pre-SMT Post-SMT Pre-sham Post-Sham Hyperalgesia(cm²) 53 31 39 56 Allodynia (cm²) 40 18 28 40 Spontaneous pain (ratings) 4.9 3.3 3.9 4.2
SMT decreases allodynia at regional level
-
-
Capsaicin
[21]
Effect on PPT
SMT C5-C6 / PPT over symptomatic segment, T°PT
PPT increases p: < 0.05 +/− 0.? % control +/− 2.?% placebo +/− 22.55 SMT VAS didn't work
Regional level
-
-
Pressure
[32]
Mobilization has an effect on pressure pain, not on temperature
Mobilization C5-C6 / PPT both elbows
PPT increases p: < 0.05 +/− −4.? % control +/− −7.?% placebo +/− 29 % SMT TPT didn't work
Regional level.
-
-
Pressure and T°
[33]
Increase of PPT
SMT cervical C5-C6 / PPT both elbows
Changes pre/post treatment SMT +/− 26% Placebo +/− −12% Control +/− 0.2%
Regional level.
-
-
Pressure
[41]
Elevation of pain tolerance in manipulated group
Thoracic manipulation/ Electric thresholds left and right articular pillar
Intensity of current in mAmp SMT Control Baseline 1.37 1.62 30'' 2.05 1.46 2 min 2.43 1.46 5 min 2.70 1.56 10 min 3.30 1.86
Local level.
-
-
Electrical induction
[34]
No significant differences
SMT C0-C1/ PPT C2
preHVLA-HVLA -5’ -39.37 (76.07) Kpa (SD) preHVLA-HVLA-30’ -15.89 (87.50) preMET-MET-5’ -42.03 (62.37) preMET-MET-30’ -30.00 (69.53) preControl-Control-5’ -15.88 (83.62) preControl-Control-30’ -16.12 (62.49)
Local level.
-
-
Pressure
[35]Mobilization and manipulation both produced a statistically significant increase in PPT in the thoracic spines of asymptomatic subjects. Mobilization more than SMT.Thoracic manipulation T1-T4/ PPT on most tender thoracic vertebraDifferences PPT pre/post treatment Kpa (SD) Manipulation Mobilisation Control Pre-intervention 243.70 (95.22) 204.6 (85.52) 218.71 (82.91) Post-intervention 244.64 (91.59) 216.51 (90.50) 47.13 (96.87) Difference 0.94 (35.07) 11.88 (31.83) 28.42 (39.68)Local level.--Pressure

T° = temperature.

PPT = pressure pain thresholds.

HPT = hot pain threshold.

CPT = cold pain threshold.

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