Blood Pressure and Heart Rate Response to Posteriorly Directed Pressure Applied to the Cervical Spine in Young, Pain-Free Individuals: A Randomized, Repeated-Measures, Double-Blind, Placebo-Controlled Study

Abstract

Study Design Randomized clinical trial. Objectives To compare the blood pressure (BP) and heart rate (HR) response of healthy volunteers to posteriorly directed (anterior-to-posterior [AP]) pressure applied to the cervical spine versus placebo. Background Manual therapists employ cervical spine AP mobilizations for various cervical-shoulder pain conditions. However, there is a paucity of literature describing the procedure, cardiovascular response, and safety profile. Methods Thirty-nine (25 female) healthy participants (mean ± SD age, 24.7 ± 1.9 years) were randomly assigned to 1 of 2 groups. Group 1 received a placebo, consisting of light touch applied to the right C6 costal process. Group 2 received AP pressure at the same location. Blood pressure and HR were measured prior to, during, and after the application of AP pressure. One-way analysis of variance and paired-difference statistics were used for data analysis. Results There was no statistically significant difference between groups for mean systolic BP, mean diastolic BP, and mean HR (P >.05) for all time points. Within-group comparisons indicated statistically significant differences between baseline and post-AP pressure HR (−2.8 bpm; 95% confidence interval: −4.6, −1.1) and between baseline and post-AP pressure systolic BP (−2.4 mmHg; 95% confidence interval: −3.7, −1.0) in the AP group, and between baseline and postplacebo systolic BP (−2.6 mmHg; 95% confidence interval: −4.2, −1.0) in the placebo group. No participants reported any adverse reactions or side effects within 24 hours of testing. Conclusion AP pressure caused a statistically significant physiologic response that resulted in a minor drop in HR (without causing asystole or vasodepression) after the procedure, whereas this cardiovascular change did not occur for those in the placebo group. Within both groups, there was a small but statistically significant reduction in systolic BP following the procedure. J Orthop Sports Phys Ther 2014;44(8):622–626. Epub 16 July 2014. doi:10.2519/jospt.2014.4820

A systematic review and meta-analysis on effect of spinal mobilization and manipulation on cardiovascular responses

“…The existing research literature regarding effect of spinal manipulation and mobilization on cardiovascular parameters is still ambiguous. Studies corroborate 11 , 13 , 14 , 15 , 16 , 17 , 18 , 21 , 22 , 23 , 26 , 27 , 28 as well as contradict 12 , 19 , 20 , 24 , 25 the effects of manual therapy on cardiovascular parameters. These studies also have various methodological flaws.…”

“…Table 1 summarizes the characteristics of the included studies. Most of the studies were done in USA (nine) 11 , 12 , 19 , 21 , 22 , 23 , 25 , 27 , 28 followed by Australia (two), 17 , 18 Spain (two), 13 , 24 Canada (two). 14 , 16 One study each was conducted in Brazil, 15 France 16 and Malaysia.…”

January 2015 Letter to the Editor-in-Chief

“…Substantial autonomic changes have already been described for these populations. 3,10,13,16 Moreover, the level of physical activity of the participants was not reported. Sedentary individuals usually demonstrate significantly higher sympathetic activity than their physically active counterparts.…”

“…Sedentary individuals usually demonstrate significantly higher sympathetic activity than their physically active counterparts. 10,16 Therefore, characteristics of participants enrolled in the study might have influenced the findings. The circadian rhythm can cause significant changes in HR 5 ; the type, volume, and composition of food intake can influence autonomic modulation 1 ; and respiratory rate has a direct effect on HR.…”

Die akuten Effekte von Gelenkmanipulationstechniken auf Marker der Aktivität des autonomen Nervensystems: Eine Literaturübersicht und Metaanalyse von randomisierten Sham-kontrollierten Studien

“…Es konnten 29 relevante Studien identifiziert werden. 16 Studien führten oszillatorische Mobilisationstechniken [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29], eine Studie führte atypische Mobilisationtechniken [30], 5 Studien führten anhaltende "natural apophyseal glides" (SNAGS)/"mobilization with movement" [31][32][33][34][35]…”