Effect of Osteopathic Visceral Manipulation on Pain, Cervical Range of Motion, and Upper Trapezius Muscle Activity in Patients with Chronic Nonspecific Neck Pain and Functional Dyspepsia: A Randomized, Double-Blind, Placebo-Controlled Pilot Study.

Andréia Cristina De Oliveira Silva,Adriano Oliveira Andrade,Daniela Aparecida Biasotto-Gonzalez,Fábio Henrique Monteiro Oliveira,Fernanda De Córdoba Lanza,Cid André Fidelis De Paula Gomes,César Ferreira Amorim,Fabiano Politti

doi:10.1155/2018/4929271

Abstract

Previous studies have reported that visceral disturbances can lead to increased musculoskeletal tension and pain in structures innervated from the corresponding spinal level through viscerosomatic reflexes. We designed a pilot randomised placebo-controlled study using placebo visceral manipulation as the control to evaluate the effect of osteopathic visceral manipulation (OVM) of the stomach and liver on pain, cervical mobility, and electromyographic activity of the upper trapezius (UT) muscle in individuals with nonspecific neck pain (NS-NP) and functional dyspepsia. Twenty-eight NS-NP patients were randomly assigned into two groups: treated with OVM (OVMG; n = 14) and treated with placebo visceral manipulation (PVMG; n = 14). The effects were evaluated immediately and 7 days after treatment through pain, cervical range, and electromyographic activity of the UT muscle. Significant effects were confirmed immediately after treatment (OVMG and PVMG) for numeric rating scale scores (p < 0.001) and pain area (p < 0.001). Significant increases in EMG amplitude were identified immediately and 7 days after treatment for the OVMG (p < 0.001). No differences were identified between the OVMG and the PVMG for cervical range of motion (p > 0.05). This study demonstrated that a single visceral mobilisation session for the stomach and liver reduces cervical pain and increases the amplitude of the EMG signal of the UT muscle immediately and 7 days after treatment in patients with nonspecific neck pain and functional dyspepsia.

Highlights

Nonspecific neck pain (NS-NP) is a musculoskeletal disorder characterised by pain in the structures located between the superior nuchal line and the spinous process of the first thoracic vertebra [1], which is not associated with a particular disease or modification of anatomical structures [2]
Criteria for inclusion were neck pain for at least three months, Numeric Pain Rating Scale (NPRS) [21] between 3 and 8, Neck Disability Index (NDI) [22] between 10 and 24, and the presence of symptoms related to functional dyspepsia, according to the diagnostic criteria of Rome III [20]
Anthropometric data and clinical characteristics assessed by NDI did not differ between the Muscle fiber conduction velocity (MFCV) gRMS ( V)

Summary

Introduction

Nonspecific neck pain (NS-NP) is a musculoskeletal disorder characterised by pain in the structures located between the superior nuchal line and the spinous process of the first thoracic vertebra [1], which is not associated with a particular disease or modification of anatomical structures [2]. Sensory nerves enter the spinal cord, and those destined to terminate locally end in the grey matter of the spinal cord where they produce local segmental responses such as excitation, facilitation and reflex actions In this way, a sensory stimulus may directly affect a motor or sympathetic nerve, or do so through an intermediary interneuron. The ongoing afferent stimulation produced from restriction of the mobility of tissues innervated by the phrenic nerve (subdiaphragmatic peritoneum, liver capsule, coronary, and falsiform ligaments) [13, 14] could promote facilitation (irritability) of the internuncial neurons at the levels at which their neural roots are found (between C3 and C5 [13]) This results in increased trapezius muscle tension, as this muscle is innervated by nerve fibres originating from the same medullary segment (C3 and C4)

Methods

Discussion

Conclusion