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Mecanismos neurofisiológicos subjacentes aos efeitos das técnicas de tensão e deslize neural em sujeitos saudáveis: estudo piloto
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Abstract(s)
Introdução e Objetivos: Os mecanismos neurofisiológicos subjacentes aos efeitos das
técnicas de mobilização neural (MN) não são totalmente conhecidos. Tem sido
utilizado o Quantitative Sensory Testing (QST) para avaliar os mecanismos de
produção de dor, nomeadamente a sensitização do sistema nervoso periférico (SNP) e
central (SNC), a somação temporal que se refere a um aumento da perceção da dor após
aplicação de uma série de estímulos nociceptivos e os mecanismos inibitórios
descendentes da dor. O objetivo principal deste estudo foi o de investigar a existência
de um mecanismo neurofisiológico de inibição de dor ao nível do corno posterior da
medula espinal (ME) subjacente à técnica de deslize neural. Secundariamente
pretendeu-se investigar se os mecanismos de inibição das vias descendentes da dor
estão relacionados com o mecanismo de ação das técnicas. Metodologia: 30
participantes assintomáticos foram divididos em 3 grupos, tensão neural (n=10), deslize
neural (n=10) e placebo (n=10). Realizaram avaliação dos limiares de deteção/dor
térmicos, limiares de dor à pressão e somação temporal, antes e depois da respetiva
intervenção na região tenar, volar e tibial anterior. Foi realizada análise estatística
através do programa SPSS Statistics 20.0. Testes estatísticos não-paramétricos foram
aplicados para comparações intra e intergrupos respetivamente. Valores de p <.05
foram considerados estatisticamente significativos. Resultados: Não foram observados
resultados estatisticamente significativos intergrupos (grupo x tempo). Na interação
deslize neural com placebo verifica-se um aumento do limiar de dor ao quente no tibial
anterior após aplicação da técnica placebo (p=0.02). Na comparação tensão neural com
placebo verifica-se a existência de um resultado estatisticamente significativo (p=0.04)
após aplicação da técnica tensão neural no limiar de dor ao frio (região tenar)
representando um efeito negativo (diminuição do limiar). Comparação intragrupos: na
região tenar, após tensão neural, observa-se uma diminuição no limiar de dor ao frio (p
= 0.01). No tibial anterior, após intervenção placebo, observa-se uma subida do limiar
de dor ao calor (p = 0.01). Ainda nesta região, observa-se um aumento do limiar de dor
ao frio após a intervenção de deslize neural (p = 0.02). Não se observam resultados significativos nos limiares de dor à pressão e na somação temporal. Conclusões: Parece
não existir um mecanismo de ação inibitório da dor na técnica de deslize e tensão neural
representado pelos limiares de dor térmicos. Ao nível da somação temporal os nossos
resultados demonstram um efeito inibitório e uma tendência para que a variação do
efeito seja superior no grupo de tensão neural, contudo é necessário confirmar esta ideia
em sujeitos sintomáticos e verificar se as técnicas mantêm o efeito inibitório. Nos
mecanismos inibitórios descendentes não foram verificadas diferenças significativas
antes e depois da intervenção, nem entre grupos nos limiares de dor à pressão medidos
distalmente ao local da lesão. No entanto, o nosso estudo sugere que o deslize neural é
a única técnica que apresenta uma variação no sentido do aumento dos limiares de dor
à pressão ao nível do tibial anterior pós-intervenção.
Introduction and Objectives: The neurophysiological mechanisms underlying the effects of neural mobilization techniques are not fully understood. Quantitative Sensory Testing has been used to evaluate mechanisms of pain production, namely peripheral and central nervous system sensitization, temporal summation that refers to an increase in pain perception after application of a series of nociceptive stimuli and the descending pain inhibitory mechanisms. The main objective of this study was investigate the existence of a neurophysiological mechanism of pain inhibition at posterior horn of spinal cord underlying the neural glide technique. Secondarily, it was intended to investigate if the mechanisms of descending pain inhibitory pathways are related to the mechanism of action of the techniques. Methodology: 30 asymptomatic participants were divided into 3 groups, neural tension (n = 10), neural glide (n = 10) and placebo (n = 10). They performed the thermal pain/detection thresholds, pressure pain thresholds and temporal summation assessment before and after the intervention in the thenar eminence, volar surface and tibialis anterior regions. Statistical analysis was performed through the SPSS Statistics 20.0 program. Non-parametric statistical tests were applied for intra and intergroup comparisons respectively. Values of p <.05 were considered statistically significant. Results: There were no statistically significant intergroups results (group x time). In the neural glide interaction with placebo, there is an increase on threshold of heat pain (tibialis anterior) after application of placebo technique (p = 0.02). In the neural tension comparison with placebo, a statistically significant result (p = 0.04) was observed after applying the neural tension technique to cold pain threshold (thenar eminence) representing a negative effect (threshold decrease). Intragroup comparison: in the thenar eminence, after neural tension, a decrease in threshold was observed in cold pain (p = 0.01). In the tibialis anterior, after a placebo intervention, a rise in the heat pain threshold was observed (p = 0.01). Also, in this region, an increase in pain threshold after the neural glide intervention was observed (p = 0.02). No significant results were observed in pressure pain thresholds and temporal summation. Conclusions: There seems to be no mechanism of inhibitory action of pain in the glide and neural tension technique represented by thermal pain thresholds. At the level of temporal summation our results demonstrate an inhibitory effect and a tendency for the variation to be higher in the neural tension group, however, it is necessary to confirm this idea in symptomatic subjects and to verify if the techniques maintain the inhibitory effect. In descending inhibitory mechanisms, no significant differences were found before and after the intervention, nor between groups at pressure pain thresholds measured distally to the lesion site. However, our study suggests that neural glide is the only technique that exhibits a variation in the direction of increasing pressure pain thresholds at the level of the tibialis anterior postintervention.
Introduction and Objectives: The neurophysiological mechanisms underlying the effects of neural mobilization techniques are not fully understood. Quantitative Sensory Testing has been used to evaluate mechanisms of pain production, namely peripheral and central nervous system sensitization, temporal summation that refers to an increase in pain perception after application of a series of nociceptive stimuli and the descending pain inhibitory mechanisms. The main objective of this study was investigate the existence of a neurophysiological mechanism of pain inhibition at posterior horn of spinal cord underlying the neural glide technique. Secondarily, it was intended to investigate if the mechanisms of descending pain inhibitory pathways are related to the mechanism of action of the techniques. Methodology: 30 asymptomatic participants were divided into 3 groups, neural tension (n = 10), neural glide (n = 10) and placebo (n = 10). They performed the thermal pain/detection thresholds, pressure pain thresholds and temporal summation assessment before and after the intervention in the thenar eminence, volar surface and tibialis anterior regions. Statistical analysis was performed through the SPSS Statistics 20.0 program. Non-parametric statistical tests were applied for intra and intergroup comparisons respectively. Values of p <.05 were considered statistically significant. Results: There were no statistically significant intergroups results (group x time). In the neural glide interaction with placebo, there is an increase on threshold of heat pain (tibialis anterior) after application of placebo technique (p = 0.02). In the neural tension comparison with placebo, a statistically significant result (p = 0.04) was observed after applying the neural tension technique to cold pain threshold (thenar eminence) representing a negative effect (threshold decrease). Intragroup comparison: in the thenar eminence, after neural tension, a decrease in threshold was observed in cold pain (p = 0.01). In the tibialis anterior, after a placebo intervention, a rise in the heat pain threshold was observed (p = 0.01). Also, in this region, an increase in pain threshold after the neural glide intervention was observed (p = 0.02). No significant results were observed in pressure pain thresholds and temporal summation. Conclusions: There seems to be no mechanism of inhibitory action of pain in the glide and neural tension technique represented by thermal pain thresholds. At the level of temporal summation our results demonstrate an inhibitory effect and a tendency for the variation to be higher in the neural tension group, however, it is necessary to confirm this idea in symptomatic subjects and to verify if the techniques maintain the inhibitory effect. In descending inhibitory mechanisms, no significant differences were found before and after the intervention, nor between groups at pressure pain thresholds measured distally to the lesion site. However, our study suggests that neural glide is the only technique that exhibits a variation in the direction of increasing pressure pain thresholds at the level of the tibialis anterior postintervention.
Description
Relatório do Projeto de Investigação apresentado para cumprimento dos requisitos
necessários à obtenção do grau de Mestre em Fisioterapia, área de especialização em
Fisioterapia em Condições Músculo-Esqueléticas
Keywords
Mobilização neural QST Mecanismos de ação neurofisiológicos Neural mobilization neurophysiological mechanisms of action
Citation
Publisher
Instituto Politécnico de Setúbal. Escola Superior de Saúde