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Wong M1,2,3, Yung E4,5,6, Oh C7,8, Grimes J4, Barton E9, Ali MI10, Breakey A11
1Azusa Pacific University, Physical Therapy, Azusa, United States, 2University of Southern California, Spine Fellowship Program, Los Angeles, United States, 3Southern California Kaiser Permanante, Orthopaedics and Sports Fellowship, and Spine Fellowship Programs, Los Angeles, United States, 4Sacred Heart University, Physical Therapy, Fairfield, United States, 5New York University, Ergonomics and Biomechanics, New York, United States, 6MGH Institute of Health Professions, Elevating Practice in Orthopaedic Physical Therapy, Boston, United States, 7New York University, Division of Biostatistics, Department of Population Health, New York, United States, 8NYU School of Medicine, Environmental Medicine, New York, United States, 9Kaiser Permanente, Regional Spine Center, Panorama City, United States, 10Performance Physical Therapy, Westport, United States, 11Backus Outpatient Care Center, Norwich, United States
Background: According to the 2015 Cochrane Review, cervical mobilization appears effective for reducing pain in mechanical neck pain and associated disorders (NAD), with anterior-to-posterior (AP) seemingly more effective than transverse/lateral technique of joint mobilization (JM). Blood pressure (BP) associated hypoalgesia is one mechanism evidently related to pain modulation via BP increase (suggesting sympatho-excitation). To date, this association has only been studied/demonstrated using lateral glide (LAT), dosed at 3 x 30 seconds. However, some patients exhibit a new onset BP increase (≥ 30mmHg) following acute pain and a further JM-related BP increase is not ideal. AP may be a reasonable technique for these patients because it was shown to decrease heart rate (HR) and systolic BP (suggesting sympatho-inhibition) in pain-free adults when uniquely dosed at 5 x 10 seconds. Therefore, it may be beneficial to investigate if either technique (uniquely dosed) reduces neck pain and if this pain reduction is associated with (cardiovascular) sympatho-inhibition.
Purpose: The purpose of this study was to:
(1) compare the cardiovascular effects of AP versus LAT; and
(2) associate these effects with neck pain reduction.
Methods: Forty-three (23 females) participants with acute NAD (mean age 29.00 ±SD 9.09 years) randomly received 5 x 10 seconds of either AP or LAT. Cardiovascular variables were measured before, during, and after the intervention. Neck pain was measured before and two days after the intervention. All baseline demographic and clinical characteristics were compared between AP and LAT groups using unpaired t tests for continuous data and chi-squared tests for categorical data. Mean differences between AP and LAT groups on HR, and systolic BP (SBP) were compared using multilevel mixed-effect modeling for repeated measures, adjusting for baseline characteristics by entering treatment, time, and baseline values (age, gender and body mass index) as covariates.
A linear regression model was used to evaluate the association between independent variables and a pain score reduction in a univariate manner. Subsequently, multivariate regression models were also fitted to the data using a stepwise variable selection approach to identify independent predictors of outcomes while controlling for confounders.
Results: There is no significant difference in average pain, BP and HR change between AP and LAT. Mixed-effect model ANOVA revealed a significant change in SBP over time (estimate -1.94 ±SD 0.70, p-value=0.016). Combined (AP+LAT) average pain significantly decreased (from mean 2.92 ±SD1.25 to 1.90 ±SD1.26, p-value .001). Baseline SBP (multivariate estimated coefficient -0.026 ±SD 0.012, p-value=0.032) is associated with average pain reduction. Within AP, the pain reduction was clinically significant (mean -2.23 ±SD 2.67).
Conclusion(s): Either technique could reduce pain and decrease SBP via sympathoinhibition. SBP is associated with average pain reduction, suggesting SBP-related hypoalgesia.
Implications: Using a unique dose of either technique, therapists could potentially reduce neck pain via sympathoinhibitory SBP-related hypoalgesia and this may be ideal for cases where dose-induced sympatho-excitatory BP increase is not desired.
Keywords: Acute neck pain, systolic blood pressure, sympatho-inhibition
Funding acknowledgements: This work was supported by the American Academy of Orthopaedic and Manual Physical Therapists (AAOMPT) OPTP Grant.
Purpose: The purpose of this study was to:
(1) compare the cardiovascular effects of AP versus LAT; and
(2) associate these effects with neck pain reduction.
Methods: Forty-three (23 females) participants with acute NAD (mean age 29.00 ±SD 9.09 years) randomly received 5 x 10 seconds of either AP or LAT. Cardiovascular variables were measured before, during, and after the intervention. Neck pain was measured before and two days after the intervention. All baseline demographic and clinical characteristics were compared between AP and LAT groups using unpaired t tests for continuous data and chi-squared tests for categorical data. Mean differences between AP and LAT groups on HR, and systolic BP (SBP) were compared using multilevel mixed-effect modeling for repeated measures, adjusting for baseline characteristics by entering treatment, time, and baseline values (age, gender and body mass index) as covariates.
A linear regression model was used to evaluate the association between independent variables and a pain score reduction in a univariate manner. Subsequently, multivariate regression models were also fitted to the data using a stepwise variable selection approach to identify independent predictors of outcomes while controlling for confounders.
Results: There is no significant difference in average pain, BP and HR change between AP and LAT. Mixed-effect model ANOVA revealed a significant change in SBP over time (estimate -1.94 ±SD 0.70, p-value=0.016). Combined (AP+LAT) average pain significantly decreased (from mean 2.92 ±SD1.25 to 1.90 ±SD1.26, p-value .001). Baseline SBP (multivariate estimated coefficient -0.026 ±SD 0.012, p-value=0.032) is associated with average pain reduction. Within AP, the pain reduction was clinically significant (mean -2.23 ±SD 2.67).
Conclusion(s): Either technique could reduce pain and decrease SBP via sympathoinhibition. SBP is associated with average pain reduction, suggesting SBP-related hypoalgesia.
Implications: Using a unique dose of either technique, therapists could potentially reduce neck pain via sympathoinhibitory SBP-related hypoalgesia and this may be ideal for cases where dose-induced sympatho-excitatory BP increase is not desired.
Keywords: Acute neck pain, systolic blood pressure, sympatho-inhibition
Funding acknowledgements: This work was supported by the American Academy of Orthopaedic and Manual Physical Therapists (AAOMPT) OPTP Grant.
Topic: Musculoskeletal: spine; Musculoskeletal; Orthopaedics
Ethics approval required: Yes
Institution: Azusa Pacific University
Ethics committee: Institutional Review Board
Ethics number: IRB #59-14
All authors, affiliations and abstracts have been published as submitted.
