Abstract
BackgroundPhysiotherapists often use thoracic spine mobilization (TSM) to reduce pain in patients with back disorders via a reduction of sympathetic activity. There is a “trade-off” in the activity of the sympathetic and parasympathetic nervous system activity. A sympathetic/parasympathetic balance (SPB) is needed to guarantee body homeostasis. However, body homeostasis is seldom considered as an aim of the treatment from the perspective of most physiotherapists. Strong empirical evidence for the effects of TSM on the SPB is still lacking.Some studies showed that spinal manipulation may yield beneficial effects on SPB. Therefore, it could be hypothesized that TSM is feasible and could influence SPB reactions. The primary aim was to describe the participants’ adherence to the intervention and to the measurement protocol, to identify unexpected adverse events (UAE) after TSM, to evaluate the best method to measure SPB parameters (heart rate variability (HRV), blood pressure (BP), heart rate (HR), skin perfusion and erythema) and to estimate the investigation procedure. The secondary aim was to assess the effects of TSM on SPB parameters in a small sample of healthy participants.MethodsThis crossover pilot study investigated TSM using posterior-anterior mobilization (PAM) and anterior-posterior mobilization (APM) on segments T6 to T12 in twelve healthy participants during two consecutive days. To evaluate feasibility, the following outcomes were assessed: adherence, UAE, data collection and data analysis. To evaluate the effect of TSM on SPB, HRV, BP, HR, skin perfusion and erythema were measured.ResultsThe adherence was 100%. No UAE were reported. PAM showed larger effect sizes compared to APM in many secondary variables.ConclusionsAlthough 100% maximal adherence was reached and no UAE were observed, data recording in future studies should be done during a second time interval while the data transfer from device to the computer software should occur immediately after completion of each participant’s measurement. The results of this pilot study suggest that PAM can reduce HRV HF and HRV ratio LF/HF and increase HR.Trial registrationClinicalTrail.gov (NCT02832141).
Highlights
Physiotherapists often use thoracic spine mobilization (TSM) to reduce pain in patients with back disorders via a reduction of sympathetic activity
A total of twelve participants volunteered in this pilot study (Table 1)
It was found that the Polar wristwatch could not store all data of all volunteers and automatically saved only the 5 s R-R interval data instead of the needed 1 s R-R- data
Summary
Physiotherapists often use thoracic spine mobilization (TSM) to reduce pain in patients with back disorders via a reduction of sympathetic activity. In contrast to the PNS, the SNS increases HR, BP and causes a diversion of blood flow from the skin, the gut and splanchnic vessels to those supplying skeletal muscle during physical activity. Under normal condition (healthy state), a fine balance between PNS activity and SNS activity exists to maintain homeostasis. This sympathetic/parasympathetic balance (SPB) can be disturbed by PNS withdrawal and SNS overactivity due to a variety of factors such as changes in internal and external environment. Zegarra-Parodi et al [7] observed an increased peripheral skin blood flow, indicating a decreased SNS activity, after spine mobilization in 32 healthy volunteers. Sampath et al [10] found no short-term changes in SNS activity in 24 healthy men following thoracic spinal manipulation
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