Blood Pressure and Heart Rate Response to Posterior Pressures of the Cervical Spine in Young, Pain-free Volunteers- A Randomized, Repeated Measure...

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Study Design: Randomized Clinical Trial
Objectives: To compare the blood pressure (BP) and heart rate (HR) response of non-disabled volunteers to posteriorly directed pressure (AP) applied to the cervical spine versus placebo.
Background: Manual therapists employ cervical spine AP mobilizations for various cervical-shoulder pain conditions. However, there is a paucity of literature describing the procedure, cardiovascular response, and safety profile.
Methods: Thirty-nine (25 females) healthy participants (mean ± SD age, 24.7 ± 1.9 years) were randomly assigned to 1 of 2 groups. Group 1 received a placebo, where light touch was applied to the right C6 costal process. Group 2 received AP to the same location. BP and HR were measured prior, during, after the application of AP. One-Way analysis of variance (ANOVA) and paired-difference statistics were used for data analysis.
Results: There was no statistical difference between groups for mean systolic BP, mean diastolic BP, and mean HR (P > .05) for all time points. Within group comparisons indicated statistically significant differences for baseline HR minus post-AP HR (-2.8 bpm, 95%CI -4.6, -1.08) and for baseline systolic BP minus post-AP systolic BP (-2.4 mm Hg, 95%CI -3.68, -1.04) for the AP group and baseline systolic BP minus post-placebo systolic BP (-2.6 mm Hg, 95%CI -4.19, -1.04) for the placebo group. No participants reported any adverse reactions or side effects within 24 hours of the testing.
Conclusions: AP pressures caused a statistically significant physiologic response that resulted in a minor drop in HR (without causing asystole or vasodepression) after the procedure while this cardiovascular change did not occur for those in the placebo group. Within both grou...

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...duals may not be representative of the most common age group, middle age, with neck pain that may also have carotid sinus hypersensitivity. However, conducting this study on younger individuals does provide baseline information for future studies in middle-age groups. Third, we did not conduct a reliability testing of measuring asystole in our study. However, those monitoring asystole were all certified in cardiopulmonary resuscitation.

CONCLUSION

Cervical AP pressures caused a significant physiologic effect in young, pain free adults. Therefore, one may expect a cardiovascular response that could result in a safe and minimal reduction of heart rate without causing asystole or vasodepression. Testing was performed in young adults; therefore, it may not be generalizable to the older patient population who have neck pain and may have carotid sinus hypersensitivity.

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