Key result
Upper cervical spinal manipulative therapy enhanced parasympathetic activity and lower cervical therapy enhanced sympathetic activity in volunteers; both enhanced parasympathetic activity in patients.
Why the study?
Does upper or lower cervical spinal manipulative therapy alter heart rate variability and blood pressure in asymptomatic volunteers and patients with acute neck pain?
RCT (n=20)
Randomized
Does upper or lower cervical spinal manipulative therapy alter heart rate variability and blood pressure in asymptomatic volunteers and patients with acute neck pain?
Absolute Event Rate: 105.41% vs 83.54%
p-value: p=0.02
Cervical spinal manipulative therapy acutely enhances parasympathetic activity and reduces systolic blood pressure in patients with acute mechanical neck pain.
Acute cervical SMT may aid autonomic balance in neck pain; extends volunteer RCT data to symptomatic patients.
OBJECTIVE: The aims of this study were to examine autonomic nervous system responses by using heart rate variability analysis (HRV), hemodynamic parameters and numeric pain scale (NPS) when either upper (C1 and C2) or lower (C6 and C7) cervical segments were manipulated in volunteers, and whether such response would be altered in acute mechanical neck pain patients after spinal manipulative therapy (SMT). METHODS: A randomized controlled, cross-over, preliminary study was conducted on 10 asymptomatic normotensive volunteers and 10 normotensive patients complaining of acute neck pain. HRV, blood pressure (BP) and heart rate (HR), and NPS were recorded after upper cervical and lower cervical segments SMT in volunteer and patient groups. RESULTS: The standard deviation of average normal to normal R-R intervals (SDNN) increased (83.54 ± 22 vs. 105.41 ± 20; P = .02) after upper cervical SMT. The normalized unit of high frequency (nuHF), which shows parasympathetic activity, was predominant (40.18 ± 9 vs. 46.08 ± 14) after upper cervical SMT (P = .03) with a significant decrease (109 ± 10 vs. 98 ± 5) in systolic BP (P = .002). Low frequency to high frequency (LF/HF) ratio, which shows predominance of sympathetic activity increased (1.05 ± 0.7 vs. 1.51 ± 0.5; P = .02) after lower cervical SMT in the healthy volunteers group. However, there was an increase in SDNN (70.48 ± 18 vs. 90.23 ± 20; P = .02 and 75.19 ± 16 vs 97.52 ± 22; P = .01), a decrease in LF/HF ratio (1.33 ± 0.3 vs. 0.81 ± 0.2; P = .001 and 1.22 ± 0.4 vs. 0.86 ± 0.3; P = .02), which was associated with decreased systolic BP (105 ± 10 vs. 95 ± 9; P = .01 and 102 ± 9 vs. 91 ± 10; P = .02) and NPS scores (3 ± 1 vs. 0; P = .01 and 3 ± 1 vs. 1 ± 1; P = .03) following both upper and lower cervical SMT in the patient's group. The baseline HR was 67 ± 9 vs 64 ± 5 (upper cervical) and 65 ± 7 vs 69 ± 11 (lower cervical) in both the healthy volunteer' and patient' groups. CONCLUSION: Upper cervical SMT enhances dominance of parasympathetic and lower cervical SMT enhances dominance of sympathetic activity in this young volunteer group. However, dominance of parasympathetic activity was found in patients with neck pain that received both upper and lower cervical SMT.
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Win et al. (2015) conducted an RCT in Acute mechanical neck pain (n=20). Upper and lower cervical spinal manipulative therapy vs. Baseline / Cross-over (upper vs lower cervical segments) was evaluated on Standard deviation of average normal to normal R-R intervals (SDNN) after upper cervical SMT in volunteers (p=0.02). Upper cervical spinal manipulative therapy enhanced parasympathetic activity and lower cervical therapy enhanced sympathetic activity in volunteers; both enhanced parasympathetic activity in patients.
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