Original Articles
Changes in Pressure Pain Thresholds Over C5-C6 Zygapophyseal Joint After a Cervicothoracic Junction Manipulation in Healthy Subjects

https://doi.org/10.1016/j.jmpt.2008.04.006Get rights and content

Abstract

Objective

This study examines if C7-T1 manipulation results in changes in pressure pain thresholds (PPT) over bilateral C5-C6 zygapophyseal joints in asymptomatic subjects.

Methods

Thirty subjects, 13 men and 17 women, without a current history of neck, shoulder, or upper extremity pain participated. Participants were randomly divided into 3 groups: experimental dominant group, subjects who received the manipulative thrust directed at the right side of the C7-T1 joint; experimental nondominant group, those who received the thrust on the left side of the C7-T1 joint; and a placebo group, those who received a sham-manual procedure. The outcome measure was the PPT on both right and left C5-C5 zygapophyseal joints, which was assessed at preintervention and 5 minutes postintervention by an assessor blinded to the treatment allocation of the subject. A 3-way repeated measures analysis of covariance was used to evaluate changes in PPT.

Results

The analysis of covariance revealed time × group (F = 32.3; P < .001), time × side (F = 4.9; P < .05), time × sex (F = 7.93; P < .01), and time × group × sex (F = 7.606; P < .001) interactions. Post hoc analyses found that (a) both experimental groups showed greater improvements in PPT than the placebo group (P < .05), without significant differences between them (P > .6); (b) the right side had greater increases in PPT in both experimental groups (P < .05), but not within the placebo group (P > .8); (c) men experienced greater increases in PPT levels than women, particularly in the experimental nondominant group (P < .01). Within-group effect sizes were large for both experimental groups (d > 1), but small for the placebo condition (d < 0.2).

Conclusions

These results suggest that a C7-T1 manipulation induced changes in PPT in both right and left C5-C6 zygapophyseal joints in healthy subjects.

Section snippets

Subjects

Thirty asymptomatic volunteers, 13 men and 17 women, aged 19 to 35 years (mean, 26 years; standard deviation [SD], 5 years) were recruited from the general population. All subjects were right-hand dominant. Volunteers were excluded if they exhibited any of the following: (1) any contraindication to manipulation; (2) aversion to manual contact assessed during physical examination; (3) symptoms in the cervical spine, head, or upper extremities; (4) previous history of whiplash injury or cervical

Results

The intraexaminer reliability [ICC1, 3] of PPT readings, which was determined from the 3 repeated measures collected before the intervention, was 0.97 (95% CI, 0.93-0.98) for the right C5-C5 zygapophyseal joint and 0.94 (95% CI, 0.9-0.97) for the left C5-C5 zygapophyseal joint, suggesting high repeatability of PPT testing. The standard error of measurement was 8.47 kPa for both sides.

A total of 4 men and 6 women aged 19 to 35 years (mean, 25; SD, 5) formed the experimental dominant group; 5 men

Discussion

The results of this clinical trial showed that cervicothoracic manipulation resulted in an increase in PPT in the cervical region, particularly C5-C6 zygapophyseal joints. These findings are similar to other studies that have shown that manual therapy techniques result in immediate improvements in PPT levels.13, 14, 15, 25 In addition, the effect size for the groups that received C7-T1 manipulation was large, suggesting a clinically important increase in PPT after intervention.

Previous studies

Conclusion

The application of a cervicothoracic junction manipulation induced changes in PPT in both right and left C5-C6 zygapophyseal joints in healthy subjects. In addition, the effect size for the groups that received C7-T1 manipulation was large, suggesting a clinically important increase in PPT after intervention. Different therapeutic mechanisms, either biomechanical or neurophysiologic, can be involved at the same time.

Practical Applications

  • The application of a cervicothoracic junction manipulation evokes bilateral

References (41)

  • SterlingM et al.

    Cervical mobilisation: concurrent effects on pain, sympathetic nervous system activity and motor activity

    Man Ther

    (2001)
  • SkybaDA et al.

    Joint manipulation reduces hyperalgesia by activation of monoamine receptors but not opioid or GABA receptors in the spinal cord

    Pain

    (2003)
  • LeeRY et al.

    Dynamic response of the cervical spine to postero-anterior mobilization

    Clin Biomech

    (2005)
  • PickarJ

    Neuro-physiological effects of spinal manipulation

    Spine J

    (2002)
  • YlinenJ et al.

    Evaluation of repeatability of pressure algometry on the neck muscles for clinical use

    Man Ther

    (2007)
  • BronfortG et al.

    A randomized clinical trial of exercise and spinal manipulation for patients with chronic neck pain

    Spine

    (2001)
  • EvansR et al.

    Two-year follow-up of a randomized clinical trial of spinal manipulation and two types of exercise for patients with chronic neck pain

    Spine

    (2002)
  • GrossAR et al.

    A Cochrane review of manipulation and mobilization for mechanical neck disorders

    Spine

    (2004)
  • Fernandez-de-las-PeñasC et al.

    Dorsal manipulation in whiplash injury treatment: a randomized controlled trial

    J Whiplash Relat Disord

    (2004)
  • ClelandJA et al.

    Short-term response of thoracic spine thrust versus non-thrust manipulation in patients with mechanical neck pain: a randomized clinical trial

    Phys Ther

    (2007)
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