Physiotherapists often use thoracic spine mobilization (TSM) to reduce pain in patients with back disorders via a reduction of sympathetic activity. There is a “trade-off” in the activity of the sympathetic and parasympathetic nervous system activity. A sympathetic/parasympathetic balance (SPB) is needed to guarantee body homeostasis. However, body homeostasis is seldom considered as an aim of the treatment from the perspective of most physiotherapists. Strong empirical evidence for the effects of TSM on the SPB is still lacking. Some studies showed that spinal manipulation may yield beneficial effects on SPB. Therefore, it could be hypothesized that TSM is feasible and could influence SPB reactions. The primary aim was to describe the participants’ adherence to the intervention and to the measurement protocol, to identify unexpected adverse events (UAE) after TSM, to evaluate the best method to measure SPB parameters (heart rate variability (HRV), blood pressure (BP), heart rate (HR), skin perfusion and erythema) and to estimate the investigation procedure. The secondary aim was to assess the effects of TSM on SPB parameters in a small sample of healthy participants. This crossover pilot study investigated TSM using posterior-anterior mobilization (PAM) and anterior-posterior mobilization (APM) on segments T6 to T12 in twelve healthy participants during two consecutive days. To evaluate feasibility, the following outcomes were assessed: adherence, UAE, data collection and data analysis. To evaluate the effect of TSM on SPB, HRV, BP, HR, skin perfusion and erythema were measured. The adherence was 100%. No UAE were reported. PAM showed larger effect sizes compared to APM in many secondary variables. Although 100% maximal adherence was reached and no UAE were observed, data recording in future studies should be done during a second time interval while the data transfer from device to the computer software should occur immediately after completion of each participant’s measurement. The results of this pilot study suggest that PAM can reduce HRV HF and HRV ratio LF/HF and increase HR. ClinicalTrail.gov (NCT02832141).

/pdf/feasibility-and-effectiveness-of-thoracic-spine-mobilization-3gba8bm3j0.pdf

Feasibility and effectiveness of thoracic spine mobilization on sympathetic/parasympathetic balance in a healthy population - a randomized controlled double-blinded pilot study

Acute Effects on TH4 Thoracic Spine Mobilisation Techniques on the Sympathetic Nervous System - a Cross-Over Feasibility Study Abstract. Up to date, empiric evidence about effects of thoracic spine mobilisation (TH4) on the sympathetic nervous system is lacking. The primary goal of this feasibility study was to determine adherence rate, side effects and the protocol as well as the implementation of the study design. The secondary goal was to analyse and interpret acute effects on the sympathetic nervous system after thoracic mobilisation in anterior thrust and posterior thrust on six healthy participants on two following days. The feasibility of this study was adequate. The spine mobilisations did not produce any adverse effects. The anterior thrust spine mobilisations showed a tendency in reducing the heart rate activity.

[Acute Effects on TH4 Thoracic Spine Mobilisation Techniques on the Sympathetic Nervous System - a Cross-Over Feasibility Study].

Hintergrund: Manualtherapeutische Behandlungen werden oftmals auf der Hohe der thorakalen Wirbelsaule durchgefuhrt. Die segmentale Reaktion des sympathischen Nervensystems nach einer BWS-Mobilisation ist bislang unklar.

Ziel: Ziele dieser Pilotstudie sind (1) die Darstellung der Durchfuhrbarkeit sowie (2) die Untersuchung der akuten Effekte einer thorakalen manuellen Mobilisationstechnik auf das SNS in Bauchlage mit in anteriorer bzw. im Sitz mit in posteriorer Schubrichtung mobilisiertem Brustwirbel.

Methode: Fur diese Cross-Over-Pilotstudie sollen mindestens 10 gesunde Erwachsene rekrutiert und eingeschlossen werden. Cross-Over-Effekte werden mittels non-parametrischer L-Puri-Sen-Statistik berechnet. Um Unterschiede innerhalb bzw. der Gruppen untereinander zu ermitteln, werden der Friedman-Test bzw. der Mann-Whitney-U-Test angewendet.

Schlussfolgerung: Aufgrund der Wechselwirkung des Spinalnervs und des SNS kann durch manualtherapeutische Techniken im Bereich der BWS eine Veranderung von Herzratenvariabilitat, Blutdruck, Puls sowie Hautdurchblutung und Hautrotung im entsprechenden Segment angenommen werden.

Vergleich zwischen der Wirkung von BWS-Mobilisationstechniken in anteriore versus posteriore Schubrichtung auf das sympathische Nervensystem: Pilotstudie

BACKGROUND
Physical interventions or manual therapeutic techniques (MTTe) such as mobilisation, manipulation or soft tissue techniques not only have an influence on the target tissue with improvement of metabolism or reduction of hypertonic muscles. They are also used for balance regulation in central nervous changes of the autonomic nervous system (ANS). To date, there is a lack of empirical evidence on impact mechanisms and target locations of MTTe on the ANS. This scoping review aims to provide an overview of the evidence on the application of MTTe at diverse levels of the spine with a view to the ANS.


METHOD
A systematic literature search was conducted on CENTRAL, Google Scholar, Osteopathic Research Web, PEDro and PubMed. The scope and content of the literature were documented. The results of the included and referenced studies were summarised in a narrative approach with the focus being on the most significant clinical aspects.


RESULTS
MTTe was described as manipulations, mobilisations, myofascial techniques and cervical traction. In 27 out of 35 studies, therapeutic treatments were carried out on healthy volunteers. Ten studies analysed immediate effects in patients, while two studies were designed as longitudinal studies in patients with hypertension. Over a period of four to eight weeks, the frequency of intervention was between one and three MTTe sessions a week.


CONCLUSION
The study results proved to be heterogeneous. For this reason, it is not possible to draw definitive, explicit and generally valid statements regarding the type and intensity as well as the segmental level at which MTTe should be applied in order to trigger specific positive ANS response mechanisms. Consequently, longitudinal studies with follow-up are recommended for future studies. In addition, comprehensive effects of MTTe should be evaluated in groups of patients with different characteristics.

[Manual spinal therapy techniques to stimulate the autonomic nervous system: a scoping review].

Hintergrund: Physiotherapeutische Interventionen werden haufig auf Hohe der thorakalen Wirbelsaule angewendet. Die segmentale Wirkung auf das sympathische Nervensystem nach einer Reizung der Haut und Muskulatur ist bislang unklar. Ziel: Das Ziel war die Evaluation (1) der Machbarkeit und (2) der Effekte der segmentalen Perfusion und Erythembildung nach Massage, Mobilisation, Manipulation und Placebotherapie auf Hohe der thorakalen Wirbelsaule, um daraus Studiendesigns zu kreieren und erste mogliche Hypothesen uber Veranderungen der segmentalen Perfusion und Erythembildung aufzustellen. Methode: In dieser Einzelfallstudie erhielt ein beschwerdefreier Proband an 4 Tagen jeweils 4 unterschiedliche physiotherapeutische Behandlungsmasnahmen. Im Gebiet zwischen Th3 und Th6 wurden Massage, Mobilisation, Manipulation und zusatzlich eine Placebointervention appliziert und vor, wahrend und sowie nach der Intervention die Perfusion sowie die Erythembildung im zugehorigen Dermatom wahrend 55 Minuten im Intervall von 5 Minuten gemessen. Ergebnisse: Manipulation und Mobilisation fuhrten akut zu einer Steigerung der Sympathikotonus, wahrend Massage und Placebointervention aufgrund einer Veranderung der Perfusionsmikrozirkulation eine Senkung hervorriefen. Schlussfolgerung: Das Studiendesign muss fur zukunftige Studien hinsichtlich Verblindung der Therapeuten und Messzeitpunkte angepasst werden. Von einer Hypothesenbildung soll abgesehen werden, da das Messinstrument fur die Erythembildung keine aussagekraftigen Werte lieferte.

Segmentale Hautdurchblutungsreaktion während und nach Stimulation im Bereich der BWS

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Segmentale Hautdurchblutungsreaktion während und nach Stimulation im Bereich der BWS