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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