Trial reportBMC complementary and alternative medicine2017
Association of lumbar spine stiffness and flexion-relaxation phenomenon with patient-reported outcomes in adults with chronic low back pain - a single-arm clinical trial investigating the effects of thrust spinal manipulation.
Trial report in BMC complementary and alternative medicine, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 20 papers, 4 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Patient Response to Spinal Manipulation
Evaluating Specific and Non-Specific Mechanisms in Two Distinct Complementary/Integrative Interventions for Chronic Pain
Who cites it
20 citing papers in PubMed, 4 syntheses or guidelines pooled it, 51 citations in OpenAlex.
- Research Waste in Randomised Control Trials of Spinal Manipulative Therapy for Chronic Low Back Pain: Evidence From Trial Sequential Analysis.European journal of pain (London, England) · 2026Pooled it
- Baseline individual factors associated with clinical outcomes in adults with non-specific low back pain following manual therapy: a systematic review.BMC complementary medicine and therapies · 2025Pooled it
- The flexion relaxation phenomenon in nonspecific chronic low back pain: prevalence, reproducibility and flexion-extension ratios. A systematic review and meta-analysis.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2022Pooled it
- Benefits and harms of spinal manipulative therapy for the treatment of chronic low back pain: systematic review and meta-analysis of randomised controlled trials.BMJ (Clinical research ed.) · 2019Pooled it
- Effect of exercise and manual therapy or kinesiotaping on sEMG and pain perception in chronic low back pain: a randomized trial.BMC musculoskeletal disorders · 2024Trial
- Changes in pain sensitivity and spinal stiffness in relation to responder status following spinal manipulative therapy in chronic low Back pain: a secondary explorative analysis of a randomized trial.BMC musculoskeletal disorders · 2021Trial
- The effect on clinical outcomes when targeting spinal manipulation at stiffness or pain sensitivity: a randomized trial.Scientific reports · 2020Trial
- Trial
- Evidence for decreased Neurologic Pain Signature activation following thoracic spinal manipulation in healthy volunteers and participants with neck pain.NeuroImage. Clinical · 2019Trial
- Age-related variations in trunk muscle activation and kinematics during lifting in chronic low back pain: a cross-sectional study.Scientific reports · 2025Article
- Prognostic factors associated with improvement in patients with an episode of non-specific low back pain without radicular syndrome: a prospective observational exploratory study.Chiropractic & manual therapies · 2025Observational
- Neuromuscular Response to High-Velocity, Low-Amplitude Spinal Manipulation-An Overview.Medicina (Kaunas, Lithuania) · 2025Review
- Understanding the flexion-relaxation phenomenon in non-specific chronic low back pain patients throught immersive virtual reality feedback approach.Scientific reports · 2024Article
- Age-dependent flexion relaxation phenomenon in chronic low back pain patients.Frontiers in bioengineering and biotechnology · 2024Article
- Ultrasound Measurement of the Transverse Abdominis, Internal Oblique, and External Oblique Muscles Associated with Forward Head Posture and Reduced Cranio-Vertebral Angle.Medical science monitor : international medical journal of experimental and clinical research · 2021Article
- Distinguishing chronic low back pain in young adults with mild to moderate pain and disability using trunk compliance.Scientific reports · 2021Article
- Mechanical properties of a thoracic spine mannequin with variable stiffness control.The Journal of chiropractic education · 2021Article
- Impact of nonsurgical spinal decompression on paraspinal muscle morphology and mechanical properties in young adults with low back pain.The Journal of international medical research · 2020Article
- Temporal Associations Between Pain-Related Factors and Abnormal Muscle Activities in a Patient with Chronic Low Back Pain: A Cross-Lag Correlation Analysis of a Single Case.Journal of pain research · 2020Article
- Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
8 authors at 3 institutions in 2 countries.
Funding
Abstract
backgroundSpinal manipulation (SM) is used commonly for treating low back pain (LBP). Spinal stiffness is routinely assessed by clinicians performing SM. Flexion-relaxation ratio (FRR) was shown to distinguish between LBP and healthy populations. The primary objective of this study was to examine the association of these two physiological variables with patient-reported pain intensity and disability in adults with chronic LBP (>12 weeks) receiving SM.
methodsA single-arm trial provided 12 sessions of side-lying thrust SM in the lumbosacral region over 6 weeks. Inclusion criteria included 21-65 years old, Roland-Morris Disability Questionnaire (RMDQ) score ≥ 6 and numerical pain rating score ≥ 2. Spinal stiffness and FRR were assessed pre-treatment at baseline, after 2 weeks and after 6 weeks of treatment. Lumbar spine global stiffness (GS) were calculated from the force-displacement curves obtained using i) hand palpation, ii) a hand-held device, and iii) an automated indenter device. Lumbar FRR was assessed during trunk flexion-extension using surface electromyography. The primary outcomes were RMDQ and pain intensity measured by visual analog scale (VAS). Mixed-effects regression models were used to analyze the data.
resultsThe mean age of the 82 participants was 45 years; 48% were female; and 84% reported LBP >1 year. The mean (standard deviation) baseline pain intensity and RMDQ were 46.1 (18.1) and 9.5 (4.3), respectively. The mean reduction (95% confidence interval) after 6 weeks in pain intensity and RMDQ were 20.1 mm (14.1 to 26.1) and 4.8 (3.7 to 5.8). There was a small change over time in the palpatory GS but not in the hand-held or automated GS, nor in FRR. The addition of each physiologic variable did not affect the model-estimated changes in VAS or RMDQ over time. There was no association seen between physiological variables and LBP intensity. Higher levels of hand-held GS at L3 and automated GS were significantly associated with higher levels of RMDQ (p = 0.02 and 0.03, respectively) and lower levels of flexion and extension FRR were significantly associated with higher levels of RMDQ (p = 0.02 and 0.008, respectively) across the 3 assessment time points.
conclusionsImprovement in pain and disability observed in study participants with chronic LBP was not associated with the measured GS or FRR.
trial registrationNCT01670292 on clinicaltrials.gov, August 2, 2012.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.