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- MakaleAçık Erişim2026Scopus SJRQ3Spinal Manipulation, Dynamic Neuromuscular Stabilization, and Their Combination in Chronic Non-Specific Low Back Pain: A Four-Group Randomized Clinical Trial
Alak, İsmail; Hatik, Sefa Haktan; Büyükkirli, İlker Can; Aydin, Emine Busra
Spinal manipulation (SM) and stabilization-focused exercise are commonly used in chronic low back pain, yet evidence on their combined effects is limited. This randomized controlled trial compared SM and dynamic neuromuscular stabilization (DNS), alone or combined, in chronic non-specific low back pain. Forty-eight participants were randomized (1:1:1:1; n=12/group) using a computer-generated sequence with opaque sealed-envelope concealment to Control, SM, DNS, or SM+DNS (SMDNS). Interventions (except Control) were delivered twice weekly for 4 weeks. Outcomes (VAS, ODI, RMDQ, DNS-HS, PostureScreen) were assessed at baseline and follow-up. Assessor blinding was not feasible (treating physiotherapist also assessed outcomes); analyses used coded group labels.Within-group analyses showed significant improvements in most outcomes (p<0.05), except for postural deviation in the SM group and frontal postural deviation in the DNS and SMDNS groups. Between-group comparisons indicated greater early pain reduction with SMDNS at the second assessment (p<0.05). By week 4, pain decreased most in DNS and SMDNS (VAS Δ=−3), while SM showed Δ=−2 and Control showed no change. Disability improved most in DNS/SMDNS (ODI Δ=−13.39/−15.38; RMDQ Δ=−5.24/−5.77). Week-4 effect sizes favored SMDNS over Control and SM for key outcomes (VAS D2 g=2.07 vs Control, 1.24 vs SM; ODI PC2 g=1.73 vs Control, 1.05 vs SM; RMDQ PC2 g=1.34 vs Control, 0.23 vs SM). Overall, adding SM to DNS may enhance early pain relief; the magnitude of between-group differences (effect sizes with 95% CIs) supports interpretation, while clinical relevance should be considered alongside established MCIDs and confirmed in larger trials with longer follow-up.
- MakaleAçık Erişim2026Scopus SJRQ2Immediate effects of cervical spine and sacroiliac joint manipulations on the autonomic nervous system and pedobarographic analysis: Randomized controlled trial
Turgut, Hayriye; Büyükkırlı, İlker Can; Hatık, Sefa Haktan; Aydın, Emine Büşra
Background: This study aimed to investigate the immediate effects of cervical and sacroiliac joint manipulations on autonomic nervous system activity and baropodometric parameters. Methods: Participants were randomly assigned to three groups with equal gender distribution. The cervical manipulation group received chiropractic manipulation at the C3–C5 level, while the sacroiliac group received manipulation at the sacroiliac joint. The control group received no intervention. Pre- and post-treatment evaluations were conducted after a 30-minute interval. Plantar pressure was measured via a pedobarographic device. Autonomic nervous system activity was assessed using the Polar H10. Blood pressure and heart rate were manually recorded using a sphygmomanometer and pulse oximeter. Statistical significance was set at p < 0.05. Results: No significant differences were found among groups in terms of age, gender, height, or BMI (Kruskal-Wallis, p > 0.05). The cervical manipulation group showed significant decreases in systolic and diastolic blood pressure and heart rate post-intervention (Wilcoxon, p < 0.05). The sacroiliac group showed a significant increase in heart rate only (Wilcoxon, p < 0.05). No significant changes were observed in baropodometric parameters or autonomic activity within or between groups (Wilcoxon and Kruskal-Wallis, p > 0.05). However, post-intervention comparisons showed cervical manipulation led to a greater reduction in systolic blood pressure, while sacroiliac manipulation led to a greater increase in heart rate compared to controls (Mann-Whitney U with Bonferroni correction, p < 0.05). Conclusion: While no significant changes were observed in baropodometric or autonomic parameters, chiropractic manipulation demonstrated short-term effects on blood pressure and heart rate. The accuracy of heart rate variability assessments should be reviewed, and further studies are needed to evaluate long-term cardiovascular and autonomic outcomes.
