This week from Dr. Cerami and Utah Sports and Wellness

From: The Journal of Alternative and Complementary Medicine, February 2016


Quick Summary:

This is the “first systematic review to investigate the evidence for administering SMT in conjunction with other modalities, such as exercise, on people with COPD. The manipulation used was any form of high-velocity, low-amplitude spinal manipulation. Chronic obstructive pulmonary disease (COPD) is characterized by progressive airflow limitation and is ranked sixth in the causes of death globally for both men and women. “Evidence suggests that manual therapy has the potential to alter respiratory mechanics in certain chronic respiratory diseases, such as chronic asthma and COPD. These changes include an increase in flexibility of the chest wall and thoracic excursion, which can indirectly lead to an improvement in exercise capacity and lung function.”“Improvements in lung function and exercise capacity were reported in three RCTs following a combination of SMT and exercise.” These findings “represent preliminary evidence that the combination of SMT with exercise may be more beneficial to people with COPD than exercise or SMT alone.”


To evaluate the methodologic quality of the evidence for the use of spinal manipulative therapy (SMT) with and without other therapies in the management of chronic obstructive pulmonary disease (COPD). Any participant of a primary research study that investigated the effect of SMT on COPD. Only studies with participants older than age 18 years with an existing diagnosis of COPD were included. Interventions included any form of high-velocity, low-amplitude spinal manipulation with or without other forms of manual therapy, exercise, and/or pharmacologic intervention.Six-minute walking test, forced expiratory volume in 1 second, forced vital capacity, residual volume, total lung capacity, Chronic Respiratory Questionnaire, St George’s Respiratory Questionnaire, and the Hospital Anxiety and Depression Scale. Six articles met all of the inclusion criteria and were included in the review: three randomized controlled trials (RCTs), one pre-post observational study, one case series, and one single case study. Sample sizes varied from 1 to 33 participants ranging in age from 55 to 85 years. Risk of bias was low for the three RCTs and high for the other studies. All three RCTs used SMT in conjunction with exercise from a pulmonary rehabilitation program. Five of the six studies reported improvements in lung function and exercise performance following SMT intervention. This review provides a methodologic evaluation of the evidence for using SMT with and without other therapies in the management of COPD. While the quality of the evidence provided by three RCTs was high, they were all conducted on small sample sizes. These results highlight the need for further research into the use of SMT in conjunction with exercise on people with COPD.

These authors also note:

  • Non-pharmacologic interventions benefit people with COPD.
  • One intervention that has the potential to address some of the changes in respiratory mechanics associated with declining lung function in COPD is manual therapy.”
  • “This intervention covers a range of techniques, including soft tissue therapy and joint mobilization/manipulation.”
  • “Spinal manipulative therapy (SMT), which uses a high-velocity, lowamplitude force to move a joint complex” is commonly used to “decrease pain and increase joint range of motion.”
  • Manual therapy and spinal manipulation may lead to improvements in exercise capacity in patients with COPD.
  • These authors suggest that the improved function in patients with COPD following manual therapy and spinal manipulation may be as a
  • consequence of “increase thoracic mobility” which would “reduce the work of breathing.”
  • “The importance of increasing exercise capacity even by indirect methods such as increasing thoracic mobility should not be underestimated because exercise capacity is a predictor of mortality in COPD.”
  • Minor adverse events are described following spinal manipulation. These include muscle soreness up to 24 hours after treatment that resolves with no further intervention.