ArticleFrontiers in integrative neuroscience2021
Force Distribution Within Spinal Tissues During Posterior to Anterior Spinal Manipulative Therapy: A Secondary Analysis.
Article in Frontiers in integrative neuroscience, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
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Who cites it
7 citing papers in PubMed, 11 citations in OpenAlex.
- Clinical Practice and Mechanism Exploration on Traditional Chinese Spinal Manipulative Therapy for Spinal Degenerative Diseases: A Review.Chinese journal of integrative medicine · 2026Review
- From mechanotransduction to manual therapy: advances in piezo/TRP channels and lumbar degeneration.Frontiers in physiology · 2026Review
- Mechanical transmission of impulsive instrument-assisted spinal manipulation: contact-site-dependent biomechanical coupling in theFrontiers in bioengineering and biotechnology · 2026Article
- The role of force-sensing devices in spinal manipulative therapy research, education, and clinical practice.The Journal of the Canadian Chiropractic Association · 2025Article
- Investigation of the factors influencing spinal manipulative therapy force transmission through the thorax: a cadaveric study.Chiropractic & manual therapies · 2023Article
- Measurement of Force and Intramuscular Pressure Changes Related to Thrust Spinal Manipulation in an In Vivo Animal Model.Biology · 2022Article
- In vivo measurement of intradiscal pressure changes related to thrust and non-thrust spinal manipulation in an animal model: a pilot study.Chiropractic & manual therapies · 2022Article
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Authors and funding
7 authors at 4 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundPrevious studies observed that the intervertebral disc experiences the greatest forces during spinal manipulative therapy (SMT) and that the distribution of forces among spinal tissues changes as a function of the SMT parameters. However, contextualized SMT forces, relative to the ones applied to and experienced by the whole functional spinal unit, is needed to understand SMT's underlying mechanisms.
aimTo describe the percentage force distribution between spinal tissues relative to the applied SMT forces and total force experienced by the functional unit.
methodsThis secondary analysis combined data from 35 fresh porcine cadavers exposed to a simulated 300N SMT to the skin overlying the L3/L4 facet joint via servo-controlled linear motor actuator. Vertebral kinematics were tracked optically using indwelling bone pins. The functional spinal unit was then removed and mounted on a parallel robotic platform equipped with a 6-axis load cell. The kinematics of the spine during SMT were replayed by the robotic platform. By using serial dissection, peak and mean forces induced by the simulated SMT experienced by spinal structures in all three axes of motion were recorded. Forces experienced by spinal structures were analyzed descriptively and the resultant force magnitude was calculated.
resultsDuring SMT, the functional spinal unit experienced a median peak resultant force of 36.4N (IQR: 14.1N) and a mean resultant force of 25.4N (IQR: 11.9N). Peak resultant force experienced by the spinal segment corresponded to 12.1% of the total applied SMT force (300N). When the resultant force experienced by the functional spinal unit was considered to be 100%, the supra and interspinous ligaments experienced 0.3% of the peak forces and 0.5% of the mean forces. Facet joints and ligamentum flavum experienced 0.7% of the peak forces and 3% of the mean forces. Intervertebral disc and longitudinal ligaments experienced 99% of the peak and 96.5% of the mean forces.
conclusionIn this animal model, a small percentage of the forces applied during a posterior-to-anterior SMT reached spinal structures in the lumbar spine. Most SMT forces (over 96%) are experienced by the intervertebral disc. This study provides a novel perspective on SMT force distribution within spinal tissues.
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