Fernández-de-las-Peñas César, Pérez-de-Heredia Marta, Brea-Rivero Miguel, Miangolarra-Page Juan C
Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, Alcorcön, Spain.
J Orthop Sports Phys Ther. 2007 Jun;37(6):325-9. doi: 10.2519/jospt.2007.2542.
A placebo, control, repeated-measures, single-blinded randomized study.
To compare the immediate effects on pressure pain threshold (PPT) tested over the lateral elbow region following a single cervical high-velocity low-amplitude (HVLA) thrust manipulation, a sham-manual application (placebo), or a control condition; and to analyze if a different effect was evident on the side ipsilateral to, compared to the side contralateral to, the intervention.
Previous studies investigating the effects of spinal manual therapy used passive mobilization procedures. There is a lack of studies exploring the effect of cervical manipulative interventions.
Fifteen asymptomatic volunteers (7 male, 8 female; aged 19-25 years) participated in this study. Each subject attended 3 experimental sessions on 3 separate days, at least 48 hours apart. At each session, subjects received either the manipulation, placebo, or control intervention provided by an experienced therapist. The manipulative intervention was directed at the posterior joint of the C5-6 vertebral level. PPT over the lateral epicondyle of both elbows was assessed preintervention and 5 minutes postintervention by an examiner blinded to the treatment allocation of the subject. A 3-way analysis of covariance (ANCOVA) with intervention, side, and time as factors, and gender as covariate, was used to evaluate changes in PPT.
The analysis of variance detected a significant effect for intervention (F = 31.46, P < .001) and for time (F = 33.81, P < .001), but not for side (F = 0.303, P > .5). A significant interaction between intervention and time (F = 15.74, P < .001) was also found. Gender did not influence the comparative analysis (F = 0.252, P > .6). Post hoc analysis revealed that the application of a HVLA thrust manipulation produced a greater increase of PPT in both elbows, as compared to placebo or control interventions (P < .001). No significant changes in PPT levels were found after the placebo and control interventions (P > .6). Within-group effect sizes were large for PPT levels in both elbows after the manipulative procedure (d > 1.0), but small after placebo or control intervention (d < 0.1).
The application of a manipulative intervention directed at the posterior joint of the C5-6 vertebral level produced an immediate increase in PPT over the lateral epicondyle of both elbows in healthy subjects. Effect sizes for the HVLA thrust manipulation were large, suggesting a strong effect of unknown clinical importance at this stage, whereas effect sizes for both placebo and control procedures were small, suggesting no significant effect.
一项安慰剂对照、重复测量、单盲随机研究。
比较单次颈椎高速低幅（HVLA）推力手法、假手法应用（安慰剂）或对照条件对肘部外侧区域压力疼痛阈值（PPT）的即时影响；并分析干预同侧与对侧相比是否有不同的效果。
以往研究脊柱手法治疗效果时采用的是被动活动程序。缺乏探索颈椎手法干预效果的研究。
15名无症状志愿者（7名男性，8名女性；年龄19 - 25岁）参与本研究。每位受试者在3个不同日期参加3次实验，每次间隔至少48小时。在每次实验中，受试者接受由经验丰富的治疗师提供的手法、安慰剂或对照干预。手法干预针对C5 - 6椎体水平的后关节。由对受试者治疗分配不知情的检查者在干预前和干预后5分钟评估双侧肘部外侧上髁的PPT。采用以干预、侧别和时间为因素，性别为协变量的三因素协方差分析（ANCOVA）来评估PPT的变化。
方差分析发现干预（F = 31.46，P <.001）和时间（F = 33.81，P <.001）有显著影响，但侧别（F = 0.303，P >.5）无显著影响。还发现干预和时间之间存在显著交互作用（F = 15.74，P <.001）。性别不影响比较分析（F = 0.252，P >.6）。事后分析显示，与安慰剂或对照干预相比，HVLA推力手法在双侧肘部均使PPT有更大幅度升高（P <.001）。安慰剂和对照干预后PPT水平无显著变化（P >.6）。手法操作后双侧肘部PPT水平的组内效应量较大（d > 1.0），但安慰剂或对照干预后较小（d < 0.1）。
针对C5 - 6椎体水平后关节的手法干预使健康受试者双侧肘部外侧上髁的PPT即时升高。HVLA推力手法的效应量较大，表明现阶段有未知临床重要性的强烈效应，而安慰剂和对照程序的效应量较小，表明无显著效果。
