Does Mobilization of the Upper Cervical Spine Affect Pain Sensitivity and Autonomic Nervous System Function in Patients With Cervico-craniofacial Pain?

Abstract

This study provided preliminary evidence of a short-term hypoalgesic effect of APUCM on craniofacial and cervical regions of patients with cervico-craniofacial pain of myofascial origin, suggesting that APUCM may cause an immediate nociceptive modulation in the trigeminocervical complex. We also observed a sympathoexcitatory response, which could be related to the hypoalgesic effect induced by the technique, but this aspect should be confirmed in future studies.

Mechanism of Action of Spinal Mobilizations

“…42,43 Fifteen studies 20,21,26,28,30,[32][33][34][35][36]38,[40][41][42][43] measured immediate effects of mobilizations; others measured after different periods of time: 24 hours afterward, 22,37 4 days 31 and 1 week, 27 and 2 to 18 weeks (Table 3). [23][24][25]29,39 Mobilizations used were the cervical lateral glide, 20,21,32,34,37,38 central 22,26,28,30,31,33,40-43 or unilateral 35,36 posteroanterior (PA) mobilizations, central anteroposterior mobilizations, 24,39 a cervical sustained natural apophyseal glide, 29 and a combination of passive physiological (e.g., flexion, extension, or retraction) and accessory mobilizations (PA and anteroposterior). 23,25,27 In 10 studies, effects were compared with sham; either maintenance of therapist's hand position without oscillation 24,32,34,35,37,38 Measures that may explain the mechanism of action of mobilizations or the application of detuned laser 29,31 or ultrasound.…”

“…[23][24][25]29,39 Mobilizations used were the cervical lateral glide, 20,21,32,34,37,38 central 22,26,28,30,31,33,40-43 or unilateral 35,36 posteroanterior (PA) mobilizations, central anteroposterior mobilizations, 24,39 a cervical sustained natural apophyseal glide, 29 and a combination of passive physiological (e.g., flexion, extension, or retraction) and accessory mobilizations (PA and anteroposterior). 23,25,27 In 10 studies, effects were compared with sham; either maintenance of therapist's hand position without oscillation 24,32,34,35,37,38 Measures that may explain the mechanism of action of mobilizations or the application of detuned laser 29,31 or ultrasound. 20,21 Others compared effects of mobilizations with self-stretching, 23 peripheral neurodynamic sliders (upper limb passive movements aimed at mobilizing the nerves), 27 thoracic spinal mobilizations, 25 a high-velocity thrust, 30 Thai massage, 26 prone lumbar extension, 28 spinal mobilizations to an asymptomatic location, 36 or supplementary to craniocervical flexor muscle exercises.…”

“…22,26,28,33,40,43 Three studies' participants had cervicobrachial neurogenic pain. 20,21,27 The remainder had shoulder, 34 elbow 37,38 or craniofacial pain, 24 cervicogenic dizziness, 29 or neck or shoulder symptoms originating from the neck. 39 Symptom duration varied from more than 48 hours 22 to 3 years.…”

“…37 Outcomes associated with mechanisms of action were surface electromyography (SEMG), 35 25 substance P concentration, 26 and nociceptive flexion reflex. 32 Studies also assessed outcome measures associated with symptoms; pain at rest, 22,24,26,27,30,31,35,37,39,43 during movement, 22,28,[33][34][35] during the previous 24 hours, 37 during PA force application, 33,43 and during activities of daily living, 22,29 dizziness, 29 range of movement (ROM), 27,29,31,33,34,36,43 disability, 39 global perceived effect, 29 and upper limb function. 37 Methodological Quality Table 4 summarizes methodological quality assessment.…”

Spinal high-velocity low-amplitude manipulation with exercise in women with chronic temporomandibular disorders

“…This is probably due to the interruption of nociceptive stimulus from the upper cervical area. Another study by La Touche et al [23] suggested greater effectiveness of anterior-posterior upper cervical mobilization in improving pain intensity (visual analog scale [VAS] score) and PPT of masticatory muscles after the second and third sessions of treatment in patients with temporomandibular and neck pain when compared to the control group. In this study, VAS and PPT values were gradual and consistent, improving after treatment sessions, but long-term effects were not achieved.…”