One Session of Spinal Manipulation Improves the Cardiac Autonomic Control in Patients with Musculoskeletal Pain: A Randomized Placebo-Controlled Trial.

Autor:	Rodrigues PTV; Rehabilitation Science Postgraduation Progam, Augusto Motta University Centre (UNISUAM), Rio de Janeiro, Brazil., Corrêa LA; Rehabilitation Science Postgraduation Progam, Augusto Motta University Centre (UNISUAM), Rio de Janeiro, Brazil., Reis FJJ; Department of Physical Therapy, Federal Institute of Rio de Janeiro, Rio de Janeiro, Brazil., Meziat-Filho NA; Rehabilitation Science Postgraduation Progam, Augusto Motta University Centre (UNISUAM), Rio de Janeiro, Brazil., Silva BM; Department of Physiology, Federal University of São Paulo, São Paulo, Brazil., Nogueira LAC; Rehabilitation Science Postgraduation Progam, Augusto Motta University Centre (UNISUAM), Rio de Janeiro, Brazil.; Department of Physical Therapy, Federal Institute of Rio de Janeiro, Rio de Janeiro, Brazil.
Jazyk:	angličtina
Zdroj:	Spine [Spine (Phila Pa 1976)] 2021 Jul 15; Vol. 46 (14), pp. 915-922.
DOI:	10.1097/BRS.0000000000003962
Abstrakt:	Study Design: Three-arm, parallel, randomized, placebo-controlled, assessor-blinded trial. Objective: To compare the immediate effect of manual therapy at the upper thoracic spine on the cardiovascular autonomic control of patients with musculoskeletal pain. Summary of Background Data: Musculoskeletal pain increases the risk of cardiovascular events. Thus, manual therapy applied to the upper thoracic region is likely efficient to improve the cardiac autonomic control. Methods: The study included 59 patients with musculoskeletal pain enrolled at an outpatient clinic. Participants were randomly assigned to spinal manipulation (n = 19), myofascial manipulation (n = 20), or placebo (n = 20) administered to the upper thoracic region. Resting heart rate variability provided indexes of the cardiac autonomic control, and the blood pressure response to the cold pressor test as a proxy of the sympathetic responsiveness to a stressor stimulus. Results: Groups were similar for baseline variables except for blood pressure. Two-way repeated-measures one-way analysis of covariance (ANCOVA) revealed that only spinal manipulation induced immediate increase of the square root of the mean squared differences of successive RR intervals (RMSSD), absolute (ms2), and normalized units (n.u.) of the high-frequency power (HF) as compared with pre-intervention evaluation, indicating an improvement in the parasympathetic activity to the heart. Normalized units of low-frequency power (LF) and the LF/HF ratio reduced after the spinal manipulation solely, suggesting a reduction of the sympathetic activity to the heart. There were no significant differences in the blood pressure responsiveness among the three treatments. There were no adverse events. Conclusion: In patients with musculoskeletal pain, spinal manipulation on the upper thoracic spine led to an immediate improvement in the resting cardiac autonomic control without an effect on the blood pressure responsiveness to a sympathoexcitatory stimulus. Myofascial manipulation or placebo did not change cardiovascular autonomic control.Level of Evidence: 2. (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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