Mansilla-Ferragut Pilar, Fernández-de-Las Peñas César, Alburquerque-Sendín Francisco, Cleland Joshua A, Boscá-Gandía Juan José
Professor, Escuela de Osteopatía de Madrid, Spain.
J Manipulative Physiol Ther. 2009 Feb;32(2):101-6. doi: 10.1016/j.jmpt.2008.12.003.
OBJECTIVE: The purpose of this study was to investigate the effects of a spinal thrust manipulation directed to the upper cervical segments (atlanto-occipital joint) on active mouth opening and pressure pain sensitivity in a trigeminal nerve innervated region (sphenoid bone) in women with mechanical neck pain. METHODS: Thirty-seven women, ages 21 to 50 years old (mean age, 35 +/- 8 years) with mechanical neck pain were recruited for this study. Participants were randomly assigned into 1 of 2 groups as follows: an experimental group that received a spinal manipulation of the atlanto-occipital joint and a control group that received a manual contact placebo intervention. Outcomes collected were assessed pretreatment and 5 minutes posttreatment by an assessor blinded to the treatment allocation and included active mouth opening and pressure pain thresholds (PPTs) over both sides of the sphenoid bone. A 2-way repeated measures analysis of variance (ANOVA) with time (pre-post) as the within subjects variable and group (control, experimental) as the between subjects variable was used to examine the effects of the intervention. The hypothesis of interest was group-time interaction. RESULTS: The ANOVA showed a significant effect for time (F = 23.1; P < .001) and an interaction between group and time (F = 37.7; P < .001) for active mouth opening as follows: the experimental group showed a greater improvement when compared to the control group. A large positive within-group effect size (d > 1.5) for the experimental group, whereas a negative medium within-group effect size (d = -0.5) for the control group were identified. The ANOVA showed a significant interaction between group and time (F = 14.4; P < .001) for PPT levels at the sphenoid bone as follows: the experimental group showed a greater improvement when compared to the control group. A medium positive within-group effect size (d = -0.5) for the experimental group, whereas a negative medium within-group effect size (d = -0.5) for the control group was found. CONCLUSIONS: Our findings suggest that the application of an atlantoaxial joint thrust manipulation resulted in an increase in active mouth opening and PPT over a trigeminal nerve distribution area (sphenoid bone) in women with mechanical neck pain.
目的：本研究旨在调查针对上颈椎节段（寰枕关节）的脊柱推力手法对机械性颈痛女性三叉神经支配区域（蝶骨）的主动张口度和压痛敏感性的影响。 方法：招募了37名年龄在21至50岁（平均年龄35±8岁）的机械性颈痛女性参与本研究。参与者被随机分为以下2组中的1组：接受寰枕关节脊柱手法治疗的实验组和接受手动接触安慰剂干预的对照组。收集的结果在治疗前和治疗后5分钟由对治疗分配不知情的评估者进行评估，包括蝶骨两侧的主动张口度和压痛阈值（PPTs）。采用以时间（治疗前后）作为组内变量、组（对照组、实验组）作为组间变量的双向重复测量方差分析（ANOVA）来检验干预效果。感兴趣的假设是组-时间交互作用。 结果：ANOVA显示，主动张口度方面，时间有显著影响（F = 23.1；P <.001），组和时间之间存在交互作用（F = 37.7；P <.001），具体如下：与对照组相比，实验组有更大改善。实验组组内效应量为大的正值（d > 1.5），而对照组组内效应量为中等的负值（d = -0.5）。ANOVA显示，蝶骨PPT水平方面，组和时间之间存在显著交互作用（F = 14.4；P <.001），具体如下：与对照组相比，实验组有更大改善。实验组组内效应量为中等的正值（d = -0.5），而对照组组内效应量为中等的负值（d = -0.5）。 结论：我们的研究结果表明，对机械性颈痛女性应用寰枢关节推力手法可使三叉神经分布区域（蝶骨）的主动张口度和PPT增加。
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