Effect of Physiotherapy Treatment in the Autonomic Activation and Pain Perception in Male Patients with Non-Specific Subacute Low Back Pain

Abstract

Introduction: Physiotherapy treatment is a common intervention for low back pain (LBP) patients. These interventions have been related to physiological effects in the central nervous system. Thus, the aim of this study was to analyze the effect of physiotherapy treatment in patients with LBP in the autonomic nervous system activation and subjective pain perception of patients. Methods: A total of 30 male subjects diagnosed with non-specific subacute LBP received a 50 min session consisting of (a) a manual therapy based on joint mobilization and soft tissues techniques in the lumbo-pelvic area, (b) a stretching program, and (c) motor control exercises of the core muscles. The autonomic modification of participants was assessed prior to and after the physiotherapy treatment. Results: Heart rate variability (HRV) analysis reported a significant increase in average RR (p = 0.001), RMSSD (p = 0.008), LRMSSD (p = 0.001), SDNN (p = 0.005), and PNN50 (p = 0.024) after the session. Frequency-domain measures showed a significant increase in LF (p = 0.030) and HF (p = 0.014), and a decrease in LF/HF ratio (p = 0.046). A significant decrease was found in minimum HR values (p = 0.001) and average HR (p = 0.001). Moreover, maximal HR decreased its value from 116.7 ± 26.1 to 113.7 ± 40.8 after intervention. In addition, subjective pain perception (VAS scores) was significantly lower (p = 0.001) in the post-session assessment. Conclusions: Physiotherapy treatment produced an increase in parasympathetic nervous system activation and a decrease in subjective pain perception in non-specific subacute LBP patients.

Detection of Changes on Parameters Related to Heart Rate Variability after Applying Current Interferential Therapy in Subjects with Non-Specific Low Back Pain

“…The results showed statistically significant increases in rMSSD only in the EG. These results are consistent with the ones obtained by Abuín-Porras et al [ 48 ] after applying a session of manual therapy (36% of change), where the change percentage was lower than the one obtained in the present study (54% of change). According to Koening et al [ 12 ], changes in rMSSD in subjects with chronic pain are mainly due to pain perception.…”

“…In particular, ICT is an intervention method that combines the advantages of high permeability from middle frequency currents and efficient tissue stimulation from low frequency currents, delivering the maximum current with high tissue permeability. Therefore, changes observed on the deep back muscles could be due to the characteristics of the current used, being consistent with previous studies developed with LBP patients, in which effects on variables controlled by nociceptive pathways were associated (e.g., pain perceived with the Visual Analogue Scale, VAS) [ 26 ] with a decrease in variables regulated by the autonomic nervous system (e.g., heart rate) [ 47 , 48 ]. Wolff et al [ 47 ] explained this relationship by the interaction of the lower paraspinal muscle tension with central sensitization mechanisms.…”

“…On this matter, recent studies have associated the effects on perceived pain intensity with parameters related to HRV after using non-invasive physiotherapeutic treatments. Abuín-Porras et al [ 48 ] observed a decrease in perceived pain (dif vas: 1.8; change: 24.7%) and a significative increase in parasympathetic activity (rMSSD, min HR, mean HR) after a session of manual therapy in the lumbopelvic area of men with NSCLBP. In our study, the ICT led to a decrease in perceived pain (dif vas: 4.54; change: 60.5%).…”

“…Changes observed in both groups could be influenced by the differences of the subject position, who were sitting in the baseline state and in prone position during the intervention. The position’s influence on autonomic balance recordings has already been reported, where a sympathetic dominance exists in the sitting position here as, in young and healthy men, the dominance lies in the prone position [ 48 , 51 , 52 ]. These arguments could explain the lack of interaction between group and time in the analysis of the variance.…”

Effect of Combined Manual Therapy and Therapeutic Exercise Protocols on the Postural Stability of Patients with Non-Specific Chronic Neck Pain. A Secondary Analysis of Randomized Controlled Trial

“…Nonetheless, much remains unknown about why dizziness is present in the chronic neck population and, in general, about the etiology of chronic neck pain [ 24 ]. In addition, the implementation of physical therapy has shown important changes on the parasympathetic nervous system, which generates a decrease in the perception of pain, in sustained pain processes [ 25 , 26 ].…”