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Efeitos neurofisiológicos imediatos da manipulação versus a mobilização torácica em indivíduos assintomáticos
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Advisor(s)
Abstract(s)
Introdução: A evidência sugere a mobilização/manipulação vertebral (MMV) como um tratamento
efetivo para dor lombar e cervical. Os efeitos clínicos benéficos da MMV foram inicialmente
definidos como resultado de alterações biomecânicas, mas atualmente são teorizados como
resultado de efeitos neurofisiológicas (NF). No entanto existe inconsistência na evidência no que
diz respeito a esses efeitos em indivíduos assintomáticos e com dor músculo-esquelética, pelo
que é relevante contribuir para o conhecimento a esse nível.
Objetivo: O estudo investigou os efeitos imediatos da manipulação (MA) torácica versus a
mobilização (MO) torácica vs o ultrassom (US) ao nível dos limiares de deteção térmica, dos
limiares dolorosos térmicos e mecânicos e da somação temporal da dor em indivíduos saudáveis.
Metodologia: Foi realizado um estudo aleatorizado, cego e controlado de sessão única. Os
resultados primários foram os parâmetros do Quantitative Sensory Testing (QST) medidos na
coluna Dorsal e Pé, avaliados antes e após a aplicação da intervenção. Sessenta e um voluntários
assintomáticos foram aleatoriamente distribuídos para receber uma das três intervenções (HVLAT,
mobilização ou ultrassom) na coluna Dorsal. A análise dos resultados intergrupos foi feita
recorrendo ao teste não paramétrico Kruskal-Wallis, seguido da comparação múltipla das ordens
e os resultados intragrupo recorrendo ao teste de Wilcoxon (valor P≤0,05).
Resultados: O principal resultado deste estudo é que existiu redução significativa da somação
temporal (hipoalgesia) imediatamente após MMV (MA p=0.01e MO p=0.015) a nível local (região
da coluna Dorsal), em comparação com o grupo placebo (US) (a=0.05). No grupo da MO também
existiu um aumento significativo do limiar de dor ao calor (hipoalgesia) em relação ao grupo de
US, tanto a nível da região do Pé (p=0.041) como da coluna Dorsal (p=0,05). No entanto, não
existiram diferenças significativas entre as técnicas de MA e MO para nenhuma das variáveis
testadas (a=0.05).
Conclusão: Os nossos resultados confirmam que a Hipoalgesia associada à MMV em indivíduos
assintomáticos, é potencialmente um fenómeno NF local, sugerindo redução da excitabilidade do
Corno Posterior, envolvido na transmissão ou amplificação da entrada nociceptiva e mediado
pelas fibras C.
Backgroud: Evidence recommends spinal mobilization / manipulation (MMV) as an effective treatment for low back pain and cervical pain. The beneficial clinical effects of MMV were initially defined as a result of biomechanical changes, but are currently theorized as a result of neurophysiological effects. However, there is inconsistency in the evidence with respect to these effects in asymptomatic individuals and in individuals with musculoskeletal pain. Therefore, it is important to contribute to knowledge at this level. Aim: The purpose of the current study is to investigate the immediate effects after application of High-Velocity Low-Amplitude Thrust (HVLAT) versus directed mobilization (MO) at the thoracic spine versus ultrasound (US), on thermal detection thresholds, thermal and mechanical pain thresholds and temporal summation, in asymptomatic individuals. Methods: A single-session blinded randomized controlled trial was conducted. The primary outcomes were Quantitative Sensory Testing (QST) parameters measured in the thoracic spine and foot, assessed before and after the intervention. Sixty-one asymptomatic volunteers were randomly assigned to receive one of three interventions (HVLAT, mobilization or ultrasound) in the thoracic spine. Intergroup results were analyzed using the nonparametric Kruskal-Wallis test, followed by multiple order comparison, and intragroup using Wilcoxon test (P≤0.05). Results: The main result of this study is that there was a significant reduction in temporal summation (hypoalgesia) immediately after MMV (MA p = 0.01e MO p = 0.015) at the local level (Dorsal Spine Region) compared to the placebo group (US ). In the MO group there was also a significant increase in the heat pain threshold (hypoalgesia) compared to the US group, both in the Foot region (p = 0.041) and the Dorsal spine (p = 0.05). However, there were no significant differences between the MA and OM techniques for any of the variables tested (a = 0.05). Conclusion: Our results confirm that MMV-associated hypoalgesia in asymptomatic individuals is potentially a local neurophysiological phenomenon, suggesting a reduction in Posterior Horn excitability, involved in the transmission or amplification of the nociceptive input and mediated by C-fibers.
Backgroud: Evidence recommends spinal mobilization / manipulation (MMV) as an effective treatment for low back pain and cervical pain. The beneficial clinical effects of MMV were initially defined as a result of biomechanical changes, but are currently theorized as a result of neurophysiological effects. However, there is inconsistency in the evidence with respect to these effects in asymptomatic individuals and in individuals with musculoskeletal pain. Therefore, it is important to contribute to knowledge at this level. Aim: The purpose of the current study is to investigate the immediate effects after application of High-Velocity Low-Amplitude Thrust (HVLAT) versus directed mobilization (MO) at the thoracic spine versus ultrasound (US), on thermal detection thresholds, thermal and mechanical pain thresholds and temporal summation, in asymptomatic individuals. Methods: A single-session blinded randomized controlled trial was conducted. The primary outcomes were Quantitative Sensory Testing (QST) parameters measured in the thoracic spine and foot, assessed before and after the intervention. Sixty-one asymptomatic volunteers were randomly assigned to receive one of three interventions (HVLAT, mobilization or ultrasound) in the thoracic spine. Intergroup results were analyzed using the nonparametric Kruskal-Wallis test, followed by multiple order comparison, and intragroup using Wilcoxon test (P≤0.05). Results: The main result of this study is that there was a significant reduction in temporal summation (hypoalgesia) immediately after MMV (MA p = 0.01e MO p = 0.015) at the local level (Dorsal Spine Region) compared to the placebo group (US ). In the MO group there was also a significant increase in the heat pain threshold (hypoalgesia) compared to the US group, both in the Foot region (p = 0.041) and the Dorsal spine (p = 0.05). However, there were no significant differences between the MA and OM techniques for any of the variables tested (a = 0.05). Conclusion: Our results confirm that MMV-associated hypoalgesia in asymptomatic individuals is potentially a local neurophysiological phenomenon, suggesting a reduction in Posterior Horn excitability, involved in the transmission or amplification of the nociceptive input and mediated by C-fibers.
Description
Keywords
Terapia Manual Manipulação Vertebral Thrust Mobilização vertebral Manual Therapy Vertebral Manipulation Vertebral Mobilization Quantitative Sensory Testing