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Tuttle N1, Rocha C2, Evans K3
1Griffith University, School of Allied Health Sciences, Gold Coast, Australia, 2Universidade Federal do Rio Grande do Sul, Curso de Fisioterapia, Porto Alegre, Brazil, 3University of Sydney, Faculty of Health Sciences, Discipline of Physiotherapy, Sydney, Australia
Background: Reduced active range of movement is often associated with neck pain. Although mechanisms underpinning the effectiveness of manual therapy remain unclear, it has been shown to have immediate effects on pain and range of movement. Whilst there is evidence that manual therapy produces global, centrally mediated responses, there is also evidence that manual therapy can have localised, segmental effects. It may be that different people respond differently to manual therapy depending on a variety of internal (e.g. underlying pathology, genetic) and external (e.g. therapeutic alliance) factors. To our knowledge, no previous studies have examined changes in three-dimensional cervical spine segmental kinematics following treatment.
Purpose: Investigate how three-dimensional segmental kinematics change following targeted mobilisation and whether such changes differ between people with different levels of pain.
Methods: Participants were a subgroup from an ongoing larger trial with inclusion criteria: 1) a limitation of cervical rotation of > 15°; 2) able to tolerate maintaining rotation at the onset of pain for at least four minutes; and 3) localised hypomobility considered to contribute to their symptoms. Four participants were selected, two with the lowest pain ratings and two with the highest pain ratings (maximum pain in the past week, 1/10 and >6/10 respectively). Each participant had three magnetic resonance imaging (MRI) scans. One in a neutral position and a second with their head rotated to the onset of pain in the limited direction. Manual therapy was performed specifically targeting the selected location until their range of movement increased by at least 10° or for a maximum of eight minutes. A third MRI was taken with the participant in the same degree of rotation as the second MRI. It was hypothesised that if the effect of manual therapy was localised, changes in kinematics would be similar to changes that occur with known loss of segmental movement (e.g. surgical fusion). That is, for the same range of motion, the contribution of the targeted location would increase following treatment. If, the effect of manual therapy was more centrally mediated, more global changes in kinematics would be expected. Semi-automated software (Mimics® and 3Matic®) was used to segment, align and measure three-dimensional segmental kinematics of the movement from the neutral to each of the rotated positions.
Results: For participants with low pain ratings, the movement at the targeted location increased by an average of 4.2° compared with an average change of 0.1° at other levels. For participants with higher pain ratings, movement at the targeted location decreased by 2.0° compared with an average change of 1.0° at all other levels.
Conclusion(s): Changes in segmental kinematics in response to localised mobilisation differ between individuals. Participants with less pain responded as would be expected if the mobilisation had a local, segmental effect while participants with more pain responded as would be expected if the effect of mobilisation was more centrally mediated.
Implications: These findings support the notion that different mechanisms of effect of manual therapy may predominate for different individuals. Recognition of such variability may influence both research study design and clinical practice.
Keywords: Manual therapy, treatment mechanisms, spinal kinematics
Funding acknowledgements: This study was supported by funds from the International Maitland Teachers Assocaition.
Purpose: Investigate how three-dimensional segmental kinematics change following targeted mobilisation and whether such changes differ between people with different levels of pain.
Methods: Participants were a subgroup from an ongoing larger trial with inclusion criteria: 1) a limitation of cervical rotation of > 15°; 2) able to tolerate maintaining rotation at the onset of pain for at least four minutes; and 3) localised hypomobility considered to contribute to their symptoms. Four participants were selected, two with the lowest pain ratings and two with the highest pain ratings (maximum pain in the past week, 1/10 and >6/10 respectively). Each participant had three magnetic resonance imaging (MRI) scans. One in a neutral position and a second with their head rotated to the onset of pain in the limited direction. Manual therapy was performed specifically targeting the selected location until their range of movement increased by at least 10° or for a maximum of eight minutes. A third MRI was taken with the participant in the same degree of rotation as the second MRI. It was hypothesised that if the effect of manual therapy was localised, changes in kinematics would be similar to changes that occur with known loss of segmental movement (e.g. surgical fusion). That is, for the same range of motion, the contribution of the targeted location would increase following treatment. If, the effect of manual therapy was more centrally mediated, more global changes in kinematics would be expected. Semi-automated software (Mimics® and 3Matic®) was used to segment, align and measure three-dimensional segmental kinematics of the movement from the neutral to each of the rotated positions.
Results: For participants with low pain ratings, the movement at the targeted location increased by an average of 4.2° compared with an average change of 0.1° at other levels. For participants with higher pain ratings, movement at the targeted location decreased by 2.0° compared with an average change of 1.0° at all other levels.
Conclusion(s): Changes in segmental kinematics in response to localised mobilisation differ between individuals. Participants with less pain responded as would be expected if the mobilisation had a local, segmental effect while participants with more pain responded as would be expected if the effect of mobilisation was more centrally mediated.
Implications: These findings support the notion that different mechanisms of effect of manual therapy may predominate for different individuals. Recognition of such variability may influence both research study design and clinical practice.
Keywords: Manual therapy, treatment mechanisms, spinal kinematics
Funding acknowledgements: This study was supported by funds from the International Maitland Teachers Assocaition.
Topic: Musculoskeletal: spine; Musculoskeletal
Ethics approval required: Yes
Institution: Griffith University
Ethics committee: Human Research Ethics Committee
Ethics number: PES/34/11/HREC
All authors, affiliations and abstracts have been published as submitted.
