• Gorrell LM
• Nyirö L
• Pasquier M
• Pagé I
• Heneghan NR
• Schweinhardt P
• Descarreaux M

• Affiliation / Institut Franco-Européen de Chiropraxie (IFEC)
• Affiliation / Université du Québec à Trois-Rivières (UQTR). Département d'anatomie
• Affiliation / Université du Québec à Trois-Rivières (UQTR). Département de chiropratique
• Affiliation / Université du Québec à Trois-Rivières (UQTR). Department of Human Kinetics
• Affiliation / University of Birmingham. School of Sport, Exercise and Rehabilitation Sciences. Centre of Precision Rehabilitation for Spinal Pain
• Affiliation / University of Zürich. Orthopaedic University Hospital Balgrist. Department of Chiropractic Medicine
• Biomechanical Phenomena
• Kinetics
• Manipulation, Spinal
• Musculoskeletal Pain
• Open Access Document
• Spine

Background: Spinal manipulation (SM) is a recommended and effective treatment for musculoskeletal disorders. Biomechanical (kinetic) parameters (e.g. preload/peak force, rate of force application and thrust duration) can be measured during SM, quantifying the intervention. Understanding these force-time characteristics is the first step towards identifying possible active ingredient/s responsible for the clinical effectiveness of SM. Few studies have quantified SM force-time characteristics and with considerable heterogeneity evident, interpretation of findings is difficult. The aim of this study was to synthesise the literature describing force-time characteristics of manual SM.

Methods: This scoping literature review is reported following the Preferred Reporting Items for Scoping Reviews (PRISMA-ScR) statement. Databases were searched from inception to October 2022: MEDLINE (Ovid), Embase, CINAHL, ICL, PEDro and Cochrane Library. The following search terms and their derivatives were adapted for each platform: spine, spinal, manipulation, mobilization or mobilisation, musculoskeletal, chiropractic, osteopathy, physiotherapy, naprapathy, force, motor skill, biomechanics, dosage, dose-response, education, performance, psychomotor, back, neck, spine, thoracic, lumbar, pelvic, cervical and sacral. Data were extracted and reported descriptively for the following domains: general study characteristics, number of and characteristics of individuals who delivered/received SM, region treated, equipment used and force-time characteristics of SM.

Results: Of 7,607 records identified, 66 (0.9%) fulfilled the eligibility criteria and were included in the analysis. Of these, SM was delivered to the cervical spine in 12 (18.2%), the thoracic spine in 40 (60.6%) and the lumbopelvic spine in 19 (28.8%) studies. In 6 (9.1%) studies, the spinal region was not specified. For SM applied to all spinal regions, force-time characteristics were: preload force (range: 0-671N); peak force (17-1213N); rate of force application (202-8700N/s); time to peak thrust force (12-938ms); and thrust duration (36-2876ms).

Conclusions: Considerable variability in the reported kinetic force-time characteristics of SM exists. Some of this variability is likely due to differences in SM delivery (e.g. different clinicians) and the measurement equipment used to quantify force-time characteristics. However, improved reporting in certain key areas could facilitate more sophisticated syntheses of force-time characteristics data in the future. Such syntheses could provide the foundation upon which dose-response estimates regarding the clinical effectiveness of SM are made.

Author keywords: Spinal manipulation - Biomechanics - Force-tine characteristics - Kinetics - Kinematics - Spine pain

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