Rehabilitation Science Postgraduation Progam, Augusto Motta University Centre (UNISUAM), Rio de Janeiro, Brazil.
Department of Physical Therapy, Federal Institute of Rio de Janeiro, Rio de Janeiro, Brazil.
Spine (Phila Pa 1976). 2021 Jul 15;46(14):915-922. doi: 10.1097/BRS.0000000000003962.
Three-arm, parallel, randomized, placebo-controlled, assessor-blinded trial.
To compare the immediate effect of manual therapy at the upper thoracic spine on the cardiovascular autonomic control of patients with musculoskeletal pain.
Musculoskeletal pain increases the risk of cardiovascular events. Thus, manual therapy applied to the upper thoracic region is likely efficient to improve the cardiac autonomic control.
The study included 59 patients with musculoskeletal pain enrolled at an outpatient clinic. Participants were randomly assigned to spinal manipulation (n = 19), myofascial manipulation (n = 20), or placebo (n = 20) administered to the upper thoracic region. Resting heart rate variability provided indexes of the cardiac autonomic control, and the blood pressure response to the cold pressor test as a proxy of the sympathetic responsiveness to a stressor stimulus.
Groups were similar for baseline variables except for blood pressure. Two-way repeated-measures one-way analysis of covariance (ANCOVA) revealed that only spinal manipulation induced immediate increase of the square root of the mean squared differences of successive RR intervals (RMSSD), absolute (ms2), and normalized units (n.u.) of the high-frequency power (HF) as compared with pre-intervention evaluation, indicating an improvement in the parasympathetic activity to the heart. Normalized units of low-frequency power (LF) and the LF/HF ratio reduced after the spinal manipulation solely, suggesting a reduction of the sympathetic activity to the heart. There were no significant differences in the blood pressure responsiveness among the three treatments. There were no adverse events.
In patients with musculoskeletal pain, spinal manipulation on the upper thoracic spine led to an immediate improvement in the resting cardiac autonomic control without an effect on the blood pressure responsiveness to a sympathoexcitatory stimulus. Myofascial manipulation or placebo did not change cardiovascular autonomic control.Level of Evidence: 2.
三臂、平行、随机、安慰剂对照、评估者盲法试验。
比较手法治疗对上胸段脊柱对肌肉骨骼疼痛患者心血管自主控制的即刻影响。
肌肉骨骼疼痛会增加心血管事件的风险。因此，在上胸段区域应用手法治疗可能有助于改善心脏自主控制。
本研究纳入了 59 名在门诊就诊的肌肉骨骼疼痛患者。参与者被随机分配到脊柱推拿组（n=19）、肌筋膜推拿组（n=20）或安慰剂组（n=20），在上胸段区域进行治疗。静息心率变异性提供了心脏自主控制的指标，血压对冷加压试验的反应作为对压力刺激的交感反应的替代指标。
除血压外，各组基线变量相似。双因素重复测量单向方差分析（ANCOVA）显示，只有脊柱推拿即刻引起连续 RR 间期均方根差（RMSSD）、绝对（ms2）和高频功率（HF）的归一化单位（n.u.）的均方根平方差的即刻增加，表明心脏副交感活动增强。低频功率（LF）的归一化单位和 LF/HF 比值仅在脊柱推拿后降低，提示心脏交感活动减弱。三种治疗方法之间的血压反应没有显著差异。无不良事件发生。
在上胸段脊柱进行脊柱推拿治疗可即刻改善肌肉骨骼疼痛患者的静息心脏自主控制，而对交感兴奋刺激的血压反应无影响。肌筋膜推拿或安慰剂治疗不能改变心血管自主控制。
2 级。
