Neck Pain Clinical Trial
Official title:
Effects of Cervical Manipulation and Mobilization on Salivary Cortisol Concentrations
Currently, there are many studies about the effects of manual therapy on pain, but there are
not enough studies to know what are the mechanisms that cause these effects.
Although there is a research measuring neuromodulators substances after a cervical and
dorsal manipulation, it has been done in healthy subjects and there is no information about
mobilization. This work aims to select a sample with chronic neck pain, incorporating the
cervical mobilization as a therapeutic approach to compare the effects of both techniques
because not all patients accept the manipulation as a treatment technique (mobilization is
much better tolerated) and to verify that the liberation of cortisol is not just caused by
the stress on the joint manipulation and the psychological stress and expectation may be
important.
The hypothesis of this paper is that cervical manipulation and mobilization in subjects with
chronic neck pain there will increase salivary cortisol levels.
It is also expected a little increase in the expectation of being manipulated group because
of the psychological stress.
It is expected an improvement in the neck disability, pain and range of motion in the
intervention groups immediately after and in the three groups the following week after the
exercise.
The main objective of the study is to measure and analyze changes in salivary cortisol
concentrations after the intervention in the three groups. Secondary objectives is to
analyze the changes in range of motion and disability caused by neck pain neck pain level
STUDY DESIGN:
Experimental study using a randomized controlled trial with blinded evaluator with three
parallel groups, two experimental and one placebo.
INTERVENTION
1. Experimental group cervical manipulation:
The patient is supine without a pillow and physiotherapist standing in the ipsilateral
corner of the hand of the thrust. If the segment to manipulate is the upper cervical
spine, the radial aspect of the distal phalanx of the index finger of the pulse is
placed on the posterolateral aspect of the transverse process of the atlas (In medium
or low segments of cervical spine on the vertebra on which we want to make the thrust).
The thumb rests on the zygomatic arch and the other fingers rest on the back of the
skull, leaving the forearm perpendicular to the neck. In middle or lower cervical
spine, the thumb rests on the angle of the jaw and the other fingers on the back of the
neck.
The contralateral hand rests against the contralateral side of the patient's skull with
the fingers facing caudally, so we left ear between the index and middle fingers.
To take the patient to the end of range of motion will be added ipsilateral inclination
and contralateral rotation without exceeding the 30-40 °.
There will be a contralateral displacement of the head and a posteroanterior glide to
take the patient to energizing. The impulse is made in pure contralateral rotation.
2. Experimental Group of cervical posterior-anterior mobilization in the most painful
segment:
Maitland described by the patient is prone with his forehead in the palms. The thumb
rests on the articular pillar (on the transverse blade) and the other fingers around
the neck to stabilize the soft tissue.
The limit pressure will be that cause pain to the patient. The oscillatory motion is
produced by the arms and the body while the hands remain stable with a pressure
distributed uniformly around the patient's neck. It is important that the neck and
hands move as a unit. high-amplitude technique may be performed by raising the
patient's neck with the pads of the fingers This technique was performed for 3 minutes
remaining below the pain threshold of the patient.
3. Placebo group:
The subjects of this group will expect a cervical manipulation to check the psychological
component has an effect on cortisol segregation. It will proceed with the same protocol as
in the group of cervical manipulation, but without joint stress or thrust.
Participants will receive a protocol of domiciliary cervical control exercises adapted to
each subject for deep cervical muscles after taking the second salivary sample.
Seasonal timing will be considered (evaluating the subjects in the same month), circadian
rhythms (evaluating subjects mid-morning to avoid peak morning cortisol) and periods of the
menstrual cycle as they are factors that can determine the results. In the case of the
menstrual cycle they are cited the seventh day of the cycle.
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