Influence of a cervical mobilization technique on respiratory and cardiovascular function

doi:10.1054/math.1997.0302

Manual Therapy

Volume 2, Issue 4, November 1997, Pages 216-220

https://doi.org/10.1054/math.1997.0302 Get rights and content

Abstract

SUMMARY. Spinal manipulative therapy techniques are frequently applied by physiotherapists to relieve pain of musculo-skeletal origin and to improve the quality of joint movement in a variety of musculo-skeletal conditions. However, there has been little research into the physiological effects of these techniques, or the mechanisms responsible for these effects. The aim of this study was to establish whether a grade III posteroanterior mobilization technique applied centrally to the cervical spine would affect respiratory and cardiovascular indicators of sympathetic nervous system function in pain-free, normal volunteers. A significant increase in respiratory rate, heart rate, systolic and diastolic blood pressure occurred during application of the technique to C5/6, when compared to the control and placebo conditions. There was little change in any of the measured variables during the placebo condition. This study provides objective evidence that application of this mobilization technique elicits changes in sympathetic nervous system activity distinct from placebo in pain-free individuals. These results provide a basis for further research into the physiological effects of manipulative procedures, and in particular, exploration of the mechanisms responsible for analgesia produced by this method.

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Cited by (63)

Autonomic Effects of Spinal Manipulative Therapy: Systematic Review of Randomized Controlled Trials
2019, Journal of Manipulative and Physiological Therapeutics
Citation Excerpt :
Ten trials had a crossover design with adequate washout period.18,20,25,26,48,50-53,56 Three studies comprised a symptomatic population,13,25,55 and 15 studies were conducted with asymptomatic participants.18-21,24,26,48-54,56,57 Mobilization techniques were performed in 12 studies,13,18-21,24-26,50-52,56 and MANIP techniques were performed in 6 trials.48,49,53-55,57
The purpose of this study was to systematically review the effects of spinal manipulative therapy (SMT) on autonomic nervous system (ANS)-mediated outcomes, in both symptomatic and healthy populations, and to assess the quality of evidence for the most prevalent outcomes with the Grading of Recommendations, Assessment, Development and Evaluation approach.
PubMed, Cochrane Library, PEDro, Web of Science, and EMBASE were searched from their inception to March 2014. Randomized controlled trials involving SMT, such as mobilization and manipulation, that reported at least 1 outcome related to the ANS, with placebo, control groups, or other SMT techniques as comparators, with either healthy or symptomatic samples were included. The Physiotherapy Evidence Database scale and the Grading of Recommendations, Assessment, Development and Evaluation approach were used to assess risk of bias and the quality of evidence, respectively.
Eighteen trials were included in this systematic review. Passive accessory intervertebral mobilization produced sympathoexcitation independently of the treated region (cervical, thoracic, or lumbar spine); although sustained natural apophyseal glides did not influence the ANS, conflicting results were observed regarding manipulation techniques. The overall quality of evidence for all analyzed outcomes ranged from low to very low quality.
There is evidence pointing toward the existence of sympathoexcitatory short-term effects following passive accessory intervertebral mobilization mobilizations, but not for sustained natural apophyseal glide mobilizations. There is conflicting evidence regarding the ability of manipulation to elicit sympathoexcitation. However, the low quality of the evidence precludes a definitive conclusion of such effects. Based on the current evidence, there is uncertainty regarding the true effect estimates of SMT on ANS-mediated outcomes.
Autonomic function and pressure pain threshold following thoracic mobilization in asymptomatic subjects: A randomized controlled trial
2018, Journal of Bodywork and Movement Therapies
To compare the effects of two different mobilization techniques and a placebo intervention applied to the thoracic spine on heart rate variability (HRV) and pressure pain threshold (PPT) in asymptomatic individuals.
Sixty healthy asymptomatic subjects aged between 18 and 40 years old were randomized to a single session of one of the three interventions: posterior-to-anterior (PA) rotatory thoracic passive accessory intervertebral mobilization (PAIVM) (PA group), unilateral thoracic PA in slump position (SLUMP group) or placebo intervention (Placebo group). HRV and PPT at C7 and T4 spinous process, first dorsal interossei muscles bilaterally, and muscle belly of tibialis anterior bilaterally were measured before and immediately after the intervention. A univariate analysis of covariance (ANCOVA) adjusted for baseline values assessed the effect of “Group”. Pairwise comparisons with Bonferroni adjustment for multiple comparisons were performed.
There were no significant between-group differences for HRV. A significant between-group difference for PPT in the ipsilateral tibia was found favoring the SLUMP group in comparison with the PA group. There were no significant between-group differences for PPT in the other landmarks.
A single treatment of thoracic PAIVM in prone lying and slump position did not alter PPT and HRV compared to placebo in asymptomatic subjects.
The immediate cardiovascular response to joint mobilization of the neck - A randomized, placebo-controlled trial in pain-free adults
2017, Musculoskeletal Science and Practice
Some normotensive patients can have a spike in resting systolic blood pressure (SBP) in response to acute neck pain. Applying the typical dosage of mobilization may potentially result in a sympatho-excitatory response, further increasing resting SBP. Therefore, there is a need to explore other dosage regimens that could result in a decrease in SBP.
To compare the blood pressure (BP) and heart rate (HR) response of pain-free, normotensive adults when receiving unilateral posterior-to-anterior mobilization (PA) applied to the neck versus its corresponding placebo (PA-P).
Double-Blind, Randomized Clinical Trial.
44 (18 females) healthy, pain-free participants (mean age, 23.8 ± 3.04 years) were randomly allocated to 1 of 2 groups. Group 1 received a PA-P in which light touch was applied to the right 6th cervical vertebra. Group 2 received a PA to the same location. BP and HR were measured prior to, during, and after the application of PA or PA-P. A mixed-effect model of repeated measure analysis was used for statistical analysis.
During-intervention, the PA group had a significant reduction in SBP, while the placebo group had an increase in SBP. The change in SBP during-intervention was significantly different between the PA and the placebo group (p-value = 0.003). There were no significant between-group differences found for HR and diastolic BP (DBP). The overall group-by-time interaction was statistically significant for SBP (p-value = 0.01).
When compared to placebo, the dosage of applied PA resulted in a small, short-lived drop in SBP not exceeding the minimal detectable change.
Trial registered at Germanctr.de (DRKS00005095)
Effect of cervical mobilization and ischemic compression therapy on contralateral cervical side flexion and pressure pain threshold in latent upper trapezius trigger points
2016, Journal of Bodywork and Movement Therapies
Studies have shown a clinical relationship between trigger points and joint impairments. However the cause-and effect relationship between muscle and joint dysfunctions in trigger points could not be established. The purpose of this study was to investigate effects of mobilization and ischemic compression therapy on cervical range of motion and pressure pain sensitivity in participants with latent trigger point in the upper trapezius muscle. Ninety asymptomatic participants with upper trapezius latent trigger point were randomized in to 3 groups: mobilization, ischemic compression and a control. The outcomes were measured over a 2 week period. Repeated measures ANOVA showed statistically and clinically significant pre to post improvement in both the interventional groups compared to control (p < 0.05). However the effect sizes between the intervention groups were small (<0.3) revealing minimal clinical detectable difference.
An investigation into the effects of applying a lumbar Maitland mobilisation at different frequencies on sympathetic nervous system activity levels in the lower limb
2015, Manual Therapy
Oscillatory Maitland mobilisations are commonly used in the management of lower back pain with research suggesting that mobilisations at 2 Hz may excite the sympathetic nervous system (SNS) more than sustained pressure glides or 0.5 Hz oscillatory mobilisations.
Investigate the effects of increasing the oscillation frequency greater than 2 Hz.
A double-blind, placebo-controlled, independent group experimental design.
Sixty healthy male volunteers were randomly allocated to one of four groups; a control group (no contact), placebo group (sustained static pressure to L4 vertebra), and two intervention groups receiving a centrally applied postero-anterior mobilisation applied at either 2 Hz or 3 Hz for three 1-min periods. SNS activity was recorded by a blinded data collector by continuous skin conductance (SC) activity levels in the feet using a Biopac MP35 electrodermal amplifier. Participants were blinded to their group allocation which was further validated by a post-experiment questionnaire (p > 0.05).
The magnitude of sympathoexcitatory response was greatest for the 3 Hz mobilisation (20%) compared with the 2 Hz mobilisation (12%), placebo (−1%) and control conditions (3%). Only the 3 Hz group demonstrated statistical significance when compared to placebo intervention (p = 0.002), and the control group (p = 0.02).
SC changes reflect those of previous studies using lumbar mobilisations at 2 Hz, however the 3 Hz group was found to have a greater magnitude of effect worthy of consideration within research and clinical settings. These findings provide preliminary evidence to support the use of 3 Hz oscillatory mobilisations to affect a greater magnitude of SNS activity than those previously reported (0.5, 1.5 and 2 Hz).
Effects of a diaphragm stretching technique on pulmonary function in healthy participants: A randomized-controlled trial
2015, International Journal of Osteopathic Medicine
Manual therapy has traditionally been included among the therapeutic approaches to respiratory pathologies.
The aim of this study was to evaluate the effects of a diaphragm stretching on pulmonary function and respiratory pressures in healthy adults.
Randomized placebo-controlled trial using a between-groups design.
The study was conducted at a university laboratory.
The outcomes were evaluated at baseline and immediately after treatment. Participants' spirometry was assessed at baseline, immediately after the intervention, and also at 5 and 20 min post-treatment.
A final sample of eighty healthy adults was included. Participants were randomized into two groups: experimental or placebo group.
The data analysis revealed that all measures significantly (p < 0.05) improved from pre- to post-test in the experimental group.
Diaphragm stretching is able to increase maximal respiratory pressures, forced vital capacity and forced expiratory volume in the first second.

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Original articleInfluence of a cervical mobilization technique on respiratory and cardiovascular function

Abstract

Original article
Influence of a cervical mobilization technique on respiratory and cardiovascular function