Neurophysiological Response of Spinal Mobilization and Manipulation in Individuals With and Without Musculoskeletal Spine Disorders: A Scoping Review.

Spinal manipulation (SMA) and spinal mobilization (SMO) are two of the most widely used manual therapy techniques (SMT) for spine-related musculoskeletal pain management. Although their neuromuscular effects have been reported, emerging evidence suggests that SMT may also induce neurophysiological changes within the central nervous system (CNS). This review aimed to synthesize the current literature on the neurophysiological effects of SMT with multiple brain imaging and neurophysiological methods. A scoping review was conducted according to PRISMA guidelines. Eight databases were searched for studies using brain imaging techniques (e.g., transcranial magnetic stimulation [TMS], functional magnetic resonance imaging [fMRI] or electroencephalography [EEG]) to assess the impact of SMT on healthy individuals or those with musculoskeletal spine pain. Twenty-six studies were included: eight TMS, seven fMRI, five somatosensory evoked potential (SEP) and six with other imaging methods (e.g., EEG, positron emission tomography [PET] or magnetic resonance spectroscopy [MRS]). Most studies reported significant postintervention neurophysiological changes, particularly in motor cortex excitability (TMS), functional connectivity (fMRI) and sensorimotor integration (SEP). However, heterogeneity in study design, manipulation protocols, imaging outcomes and timing of assessments limited generalizability of the results. Although many studies reported reductions in pain intensity, none of them linked cortical changes directly to clinical improvements. Overall, SMT can induce changes in cortical activity and connectivity, particularly in pain processing and motor control regions. However, significant methodological variation across studies limits the strength of conclusions. Future research should aim for standardized protocols and investigate the clinical significance of neurophysiological changes in large, diverse populations.