The Effect of Manipulation of the Cervical Spine on Pain Biomarkers (HVLAT)

Loma Linda University (LLU)

Status: Completed

Conditions: Neck Pain, Posterior

Treatments: Procedure: Sham HVLAT manipulation; Procedure: HVLAT manipulation

Study type: Interventional

Funder types: Other

Identifiers

NCT03176654

5160076

Details and patient eligibility

About

This study evaluates the effect of high-velocity low-amplitude thrust (HVLAT) manipulation to the cervical spine on neuropeptide expression as determined by the plasma concentration of oxytocin, neurotensin, orexin A and cortisol; and Examine the effect of HVLAT manipulation on pain perception in symptomatic females with non-specific mechanical cervical spine pain

Full description

A high-velocity low-amplitude thrust (HVLAT) manipulation or commonly known as a spinal manipulation, is an intervention frequently used by physical therapists and other healthcare practitioners as an alternative treatment to help relieve spinal pain The mechanism by which HVLAT manipulation modulates pain remains undefined, although this does not contradict the clinical effects from HVLAT manipulation. Furthermore, there is evidence that suggests analgesia after HVLAT manipulation. There is a variety of observed and proposed phenomena that can explain the mechanisms for the psychological, mechanical, or neurophysiological responses from a HVLAT manipulation associated with alterations in pain processing or sympathetic and motor systems' excitation.

Enrollment: 28 patients

Sex: Female

Ages: 20 to 45 years old

Volunteers: Accepts Healthy Volunteers

Inclusion criteria

• 20 - 45 years of age
• A score of 10 or more out of 50 on the Neck Disability Index (NDI) questionnaire
• Symptoms of pain present for 30 days or less and no pain symptoms below your shoulder

Exclusion criteria

• Serious condition (such as cancer, spondylolisthesis, rheumatoid arthritis, or ankylosing spondylitis)
• Cervical spinal stenosis signs (such as incoordination in hands, arms and legs, inability of walking at a brisk pace, or bowel and bladder incontinence)
• Nerve root compression (such as changes in sensation, muscle weakness, or decreased reflexes)
• Works the night shift
• Steroid medication within 3 months
• Pregnancy or postpartum
• Pending legal action regarding their neck pain
• History of whiplash associated disorder and/or cervical spine surgery

Trial design

Primary purpose: Basic Science

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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28 participants in 2 patient groups

HVLAT manipulation

Experimental group

Description:

An HVLAT manipulation is applied to the site of pain or restriction with the patient in supine. This technique uses both primary levers (pre-manipulation rotation - away (30 ° - 45 °) from the side of pain or limitation) and secondary levers (Side bending - towards coupled with lateral shift - away, and posterior-anterior (PA) shift (extension). This is a bimanual technique. For the applicator hand, the anterolateral portion of the first or second phalanx of the second ray was positioned on the superior joint partner of the target vertebrae using a cradle hold. The other hand is placed on the posterolateral aspect of the occiput (above the ear). While maintaining these positions the clinician performed the thrust with the arc of rotation dependent on the level of the target vertebrae.

Treatment:

Procedure: HVLAT manipulation

Sham HVLAT manipulation

Sham Comparator group

Description:

Subjects in the control group were instructed to lay on a table in the same position as the HVLAT manipulation group. The clinician went through the same basic steps as the HVLAT manipulation, localizing the appropriate vertebral landmarks but without carrying out the final HVLA thrust procedure.

Treatment:

Procedure: Sham HVLAT manipulation