Influence of osteopathic manipulation on blood flow velocity of the cerebral circulation in chronic mechanical neck pain

Abstract

BACKGROUND AND OBJECTIVES:Osteopathic manipulation is indicated for pain, myofascial tensions and/or decreased movement amplitude. This study aimed at checking whether osteopathic manipulation with cervical rhythmic articulatory technique generates abnormal blood flow velocity oscillations or risks to internal carotid, vertebral and basilar arteries circulation. METHODS:The sample was made up of 58 individuals with chronic mechanical cervical pain (40 females and 18 males), with mean age of 36 years, submitted to internal carotid, vertebral and basilar arteries ultrasound before and after a single osteopathic manipulation with cervical rhythmic articulatory technique. Individuals were evaluated by ultrasound in three moments: control evaluation, rest control evaluation and study evaluation. Separation was sequential and methods were randomly and blindly applied. RESULTS: Ultrasound has shown no significant differences in the comparison of flow velocity variables means among evaluations. However, a slight increase in vertebral, intracranial and basilar arteries blood flow was observed after osteopathic manipulation with cervical rhythmic articulatory technique in the study evaluation, without statistical significance. CONCLUSION: In this studied population, osteopathic manipulation with cervical rhythmic articulatory technique has not generated significant blood flow velocity oscillation of internal carotid, vertebral and basilar arteries and has not posed risk to brain circulation. Keywords: Carotid arteries, Cervical pain, Doppler Ultrasound, Spine manipulation, Vertebral artery. Influence of osteopathic manipulation on blood flow velocity of the cerebral circulation in chronic mechanical neck pain*

Influence of osteopathic cervical manipulation on blood flow velocity of the cerebral circulation in chronic neck pain: analysis of three groups

“…This can cause microtraumas on the cervical vertebrae and myofascial periarticular tissues 1,2 . If these injuries are followed by an articular vertebral restriction, it can be called vertebral somatic dysfunction, which induces the sensitization of the neural circuit, associated to the sympathetic hyperactivity, increase in vascular tone, and myofascial tensions 5,6 . Neck pain by mechanical dysfunction can alter the posture control system and create a body imbalance (sensation of instability or dizziness), due to the relationship with the central nervous system, proprioceptive afferents of the somatosensorial system, vestibular system, control of eye movement and the vision 7,9 .…”

“…Neck pain by mechanical dysfunction can alter the posture control system and create a body imbalance (sensation of instability or dizziness), due to the relationship with the central nervous system, proprioceptive afferents of the somatosensorial system, vestibular system, control of eye movement and the vision 7,9 . However, the body imbalance is usually attributed to the visual system and labyrinth disease 8,9 , or even to the vertebrobasilar insufficiency, which can be confirmed by cervical flexion-rotation clinical tests 10.11 and by vascular ultrasound that checks the blood flow velocity (BFS) of the internal carotid arteries (ICA), vertebral arteries (VA) and basilar (BA) 5,12 . On the other hand, in individuals with common neck pain, the VA, BA and ICA blood flow is not impaired by the rhythmic osteopathic manipulation of the cervical spine 5 .…”

“…However, the body imbalance is usually attributed to the visual system and labyrinth disease 8,9 , or even to the vertebrobasilar insufficiency, which can be confirmed by cervical flexion-rotation clinical tests 10.11 and by vascular ultrasound that checks the blood flow velocity (BFS) of the internal carotid arteries (ICA), vertebral arteries (VA) and basilar (BA) 5,12 . On the other hand, in individuals with common neck pain, the VA, BA and ICA blood flow is not impaired by the rhythmic osteopathic manipulation of the cervical spine 5 . The objective of the osteopathic manipulative treatment (OMT) is to treat the vertebral somatic dysfunctions or vertebral hypomobilities that can be among the causes of neck pain, posture alteration, cervical-related dizziness, some headaches, etc.…”

“…The objective of the osteopathic manipulative treatment (OMT) is to treat the vertebral somatic dysfunctions or vertebral hypomobilities that can be among the causes of neck pain, posture alteration, cervical-related dizziness, some headaches, etc. 5,6,[13][14][15][16][17] . It is possible to have oscillations after a cervical vertebral manipulation, sometimes with an increase in the BFS 5,15,16 , an improvement in muscle strength and enduranve 17 , increase in cervical ROM, and reduction of cervical pain 6,13 and headache 18 .…”

“…5,6,[13][14][15][16][17] . It is possible to have oscillations after a cervical vertebral manipulation, sometimes with an increase in the BFS 5,15,16 , an improvement in muscle strength and enduranve 17 , increase in cervical ROM, and reduction of cervical pain 6,13 and headache 18 . Among the several osteopathic manipulation (OM) techniques is the cervical rhythmic articulatory technique (CRAT) with rotation and sliding 5,6,15 .…”