EFFECTS OF MANIPULATION AND MOBILIZATION OF THE SPINE ON THE AUTONOMIC NERVOUS SYSTEM: A SYSTEMATIC REVIEW WITH META-ANALYSIS

Autores: Fellipe Amatuzzi1, Sérgio Thomaz2, Julio Zago2, Gerson Cipriano Jr.3
1D.O., PhD pela Universidade de Brasília, Brasília, DF, Brasil. Escuela de Osteopatia de Madrid
2 Doutourando em Ciências e Tecnologias em Saúde, Universidade de Brasília, Brasília, DF, Brasil.
3 Professor da Universidade de Brasília
E-mail: famatuzzi@gmail.com


Introdution

One of the main physiological foundations for methods involving spine manual therapy (SMT) is the secondary effects on autonomic modulation this type of treatment is able to cause, but the responses reported in the literature remain divergent 1-2.

Objective

The aim of the present systematic review and meta-analysis was to evaluate the influence of two different SMT techniques on the modulation of the autonomic nervous system (ANS).

Methods

For such, the MEDLINE (February 1965 to November 2015), Physiotherapy Evidence Database (PEDro) and Cochrane Library (2015) databases were searched for articles on this subject published through to April 2017.
The methodological quality of the studies was determined using the PEDro scale. Clinical trials that used the measurement of the ANS based on heart rate variability (HRV), heart rate and galvanic skin response and employed the high-velocity, low amplitude (HVLA) thrust method or joint mobilization as the SMT method were included in the study.
Two independent researchers selected six studies that had a score of 6 points or more on the PEDro scale for all HRV, heart rate and galvanic skin response variables studied.

Results

HVLA methods led to an increase in normalized low frequency (5.82 ms2; 95% CI: 2.26 to 9.38 ms2; I2 = 0%; p = 0.001) and the low frequency/high frequency ratio (0.38; 95% CI: 0.10 to 0.66; I2 = 0%; p = 0.008]), whereas joint mobilization led to an increase in galvanic skin response (6.66; 95% CI: 1.28 to 12.04; I2 = 0%; p = 0.02).

The administration site of the technique exerted no influence on the results. The present investigation found that HVLA methods did not alter the parasympathetic nervous system or heart rate. Surprisingly, galvanic skin response was also not altered following joint mobilization.
The meta-analysis indicated that SMT methods, especially HVLA thrust and joint mobilization, leads to the excitation of the sympathetic ANS in healthy individuals, independently of the region of the spinal column manipulated.
 However, the change caused by joint mobilization only occurs during the execution of the technique and does not seem to remain afterward.




Conclusion

The present review and meta-analysis indicates that SMT methods, especially, HVLA thrust and joint mobilization, lead to the excitation of the sympathetic ANS in healthy individuals, independent of the region of the spinal column.
However, the change caused by joint mobilization only occurs during the execution of the technique and does not seem to be maintained afterward.


References

1 Vieira-Pellenz F, Oliva-Pascual-Vaca A, Rodriguez-Blanco C, Heredia-Rizo AM, Ricard F, Almazán-Campos G. Short-term effect of spinal manipulation on pain perception, spinal mobility, and full height recovery in male subjects with degenerative disk disease: a randomized controlled trial. [Internet]. Archives of physical medicine and rehabilitation. 2014. p. 1613–9.

2   Wilder DG, Vining RD, Pohlman K a, Meeker WC, Xia T, Devocht JW, et al. Effect of spinal manipulation on sensorimotor functions in back pain patients: study protocol for a randomised controlled trial. Trials [Internet]. 2011;12:161.

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