THE IMPACT OF MANUAL THERAPY TECHNIQUES ON PAIN, DISABILITY AND IL-1B LEVELS IN PATIENTS WITH CHRONIC CERVICAL PAIN
DOI:
https://doi.org/10.15621/ijphy/2019/v6i6/190224Keywords:
manual therapy, chronic neck pain, cytokinesAbstract
Background: Chronic neck pain is a common musculoskeletal dysfunction, and Manual Therapy is one of the effective treatment modalities, but underlying mechanisms of action are unclear. The study's purpose was to investigate the short-term effect of mobilization-manipulations on patient’s symptoms and to detect changes in the concentration of inflammatory biomarker interleukin-1b.
Methods: Twenty-two patients aged 20-50 years with chronic neck pain, randomly assigned into two groups. The study group received nine sessions of a three-week Manual Therapy intervention. The control group received SHAM Manual Therapy of the same dosage. Pain and functionality measures conducted before and after the intervention via NPRS and NDI scales, respectively. Blood samples collected at baseline, after the first session and post-intervention, detecting IL-1β concentration, using the corresponding ELISA kit. Mixed ANOVA statistical analysis implemented for differences in the GROUP-TIME factors.
Results: There was a significant statistical interaction between factors and significant main effects on pain, functionality, and IL-1β (p <.05). IL-1β was statistically significant reduced (p <.05) at second measurement for the study group, but not significantly reduced (p> .05) between second and final measurement. No statistical significance was found for the control group on any of the dependent variables across measures.
Conclusion: Patients with chronic mechanical pain showed significant pain and functionality improvement after manual therapy application. The underlying mechanism of action seems to relate with a reduced IL-1b concentration of reinforcing future research at relevant pain biomarkers.
References
Cross M, Kuenze C, Grindstaff T, Hertel J. Thoracic spine thrust manipulation improves pain, range of motion, and self-reported function in patients with mechanical neck pain: a systematic review. J Orthop Sports Phys Ther. 2011; 41(9): 633-42.
Childs J, Cleland J. Neck Pain: Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability, and Health From the Orthopaedic Section of the American Physical Therapy Association J Orthop Sports 2009; 39(4):297.
Cleland J, Maj. John D. Immediate effects of thoracic manipulation in patients with neck pain: a randomized clinical trial. Manual Therapy. 2005; 10 127–135.
Hoy D, Protani M, De R, Buchbinder R. The epidemiology of neck pain. Best Pract Res Clin Rheumatol. 2010; 24(6):783-92
Strimpakos N. The assessment of the cervical spine. Part 2: strength and endurance/fatigue. J Body w Mov Ther. 2011; 15(4): 417-30.
Falco FJ, Berger J. Cross talk: a new method for peripheral nerve stimulation. An observational report with cadaveric verification. Pain Physician. 2009; 12(6): 965-83.
Vernon H, Humphreys B. Manual therapy for neck pain: an overview of randomized clinical trials and systematic reviews. Eura Medicophys. 2007; 43(1):91-118
Blanpied P, Gross A. Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability and Health From the Orthopaedic Section of the American Physical Therapy Association. J Orthop Sports Phys Ther. 2017; 47(7): A1-A83.
Tseng Y, Wendy T.J. Predictors for the immediate responders to cervical manipulation in patients with neck pain Manual Therapy. Manual Therapy. 2006; 11: 306–315.
Schmid A, Brunner F, Wright A, Bachmann LM. Paradigm shift in manual therapy? Evidence for a central nervous system component in the response to passive cervical joint mobilisation. Man Ther 2008; 13(5): 387-96.
Bialosky JE, Bishop MD, Price DD, Robinson ME, George SZ. The mechanisms of manual therapy in the treatment of musculoskeletal pain: a comprehensive model. Phys Ther 2009; 14(5): 531-8.
Haldeman S. Spinal manipulative therapy in sports medicine. Clinics in Sports Medicine. 1986; 5(2):277-293.
Woolf C. Central sensitization: implications for the diagnosis and treatment of pain. Pain. 2011; 152(3): 2-15.
Schäfer A, Joos L, Roggemann K. Pain experiences of patients with musculoskeletal pain and central sensitization: A comparative Group Delphi Study. Plos One. 2017; 12(8):182-207.
Bäckryd E. Pain in the Blood? Envisioning Mechanism-Based Diagnoses and Biomarkers in Clinical Pain Medicine. Diagnostics (Basel). 2015; 5(1):84-95.
Teodorczyk-Injeyan J, Injeyan H, Ruegg R. Spinal manipulative therapy reduces inflammatory cytokines but not substance P production in normal subjects. J Manipulative Physiol Ther. 2006; 29(1): 14-21.
Langevin HM, Bouffard NA, Fox JR. Fibroblast cytoskeletal remodeling contributes to connective tissue tension. J Cell Physiol. 2011; 226(5): 1166-75.
Bolton P. Reflex effects of vertebral subluxations: the peripheral nervous system. An update. J Manipulative Physiol Ther. 2000; 23(2): 101-3.
Ruiz-Sáez M1, Fernández-de-las-Peñas C. Changes in pressure pain sensitivity in latent myofascial trigger points in the upper trapezius muscle after a cervical spine manipulation in pain-free subjects. J Manipulative Physiol Ther. 2007;30( 8): 578-83.
Haldeman S, Johnson C. The Global Spine Care Initiative: classification system for spine-related concerns. Eur Spine J. 2018; 27(6):889-900.
Herzog W, Scheele D, Conway PJ. Electromyographic responses of back and limb muscles associated with spinal manipulative therapy. Spine. 1999; 24(2): 146-52.
Brennan P, Kokjohn K. Enhanced phagocytic cell respiratory burst induced by spinal manipulation: potential role of substance P. J Manipulative Physiol Ther. 1991; 14(7): 399-408.
Dinarello C. Overview of the IL-1 family in innate inflammation and acquired immunity. Immunol Rev. 2018; 281(1): 8–27.
Kovacic JC, Moreno P, Nabel EG, Hachinski V, Fuster V. Cellular senescence, vascular disease, and aging: part 2 of a 2-part review: clinical vascular disease in the elderly. Circulation. 2011; 123: 1900–10.
Attur, M, Belitskaya-Lévy I. Increased IL-1 beta gene expression in peripheral blood leukocytes is associated with increased pain and predicts risk for progression of symptomatic knee osteoarthritis. Arthritis Rheum. 2011; 63(7): 1908–1917.
Attur M, Krasnokutsky S, Statnikov A. Low-grade inflammation in symptomatic knee osteoarthritis: prognostic value of inflammatory plasma lipids and peripheral blood leukocyte biomarkers. Arthritis Rheumatol. 2015; 67(11): 2905-15.
Gonzalez-Iglesias J. Inclusion of thoracic spine thrust manipulation into an electro-therapy/thermal program for the management of patients with acute mechanical neck pain: A randomized clinical trial. Man Ther. 2009; 14: 306-313.
Baylis D, Bartlett DB, Patel HP, Roberts HC. Understanding how we age: insights into inflammaging. Longev Healthspan. 2013; 2(1): 8-18.
Suzuki A, Daubs MD, Hayashi T, Ruangchainikom M, Xiong C, Phan K, Scott TP, Wang JC. Patterns of Cervical Disc Degeneration: Analysis of Magnetic Resonance Imaging of Over 1000 Symptomatic Subjects. Global Spine J. 2018; 8(3): 254-259.
Kaltenborn KF. Prax Kinderpsychol Kinderpsychiatr. 2004; 53(3): 167-81.
Schomacher J, Learman K. Symptom localization tests in the cervical spine: a descriptive study using imaging verification. J Man Manip Ther. 2010; 18(2): 97-101.
Cho J, Lee E, Lee S. Upper thoracic spine mobilization and mobility exercise versus upper cervical spine mobilization and stabilization exercise in individuals with forward head posture: a randomized clinical trial. BMC Musculoskelet Disord. 2017; 18(1): 525.
Kessler TJ, Brunner F, Künzer S, Crippa M, Kissling R. Effects of Maitland's manual mobilization on the thoracic spine. Rehabilitation. 2005; 44(6): 361-6.
Fernández-de-las-Peñas C. Palomeque-del-Cerro L. Changes in neck pain and active range of motion after a single thoracic spine manipulation in subjects presenting with mechanical neck pain: a case series. J Manipulative Physiol Ther. 2007; 30(4): 312-20.
Flynn TW, Childs JD, Fritz JM. The audible pop from high-velocity thrust manipulation and outcome in individuals with low back pain. J Manipulative Physiol Ther. 2006; 29(1): 40-5.
Cleland JA, Glynn P, Whitman JM, Eberhart SL, MacDonald C, Childs JD. Short-term effects of thrust versus nonthrust mobilization/manipulation directed at the thoracic spine in patients with neck pain: a randomized clinical trial. Phys Ther. 2007; 87(4): 431-40.
Puentedura EJ, Landers MR, Cleland JA, Mintken PE, Huijbregts P, Fernández-de-Las-Peñas C. Thoracic spine thrust manipulation versus cervical spine thrust manipulation in patients with acute neck pain: a randomized clinical trial. J Orthop Sports Phys Ther. 2011; 41(4): 208-2.
Griswold D, Learman K, O'Halloran B1, Cleland J. A preliminary study comparing the use of cervical/upper thoracic mobilization and manipulation for individuals with mechanical neck pain. J Man Manip Ther. 2015; 23(2): 75-83.
Masaracchio M1, Cleland JA, Hellman M, Hagins M. Short-term combined effects of thoracic spine thrust manipulation and cervical spine nonthrust manipulation in individuals with mechanical neck pain: a randomized clinical trial. J Orthop Sports Phys Ther. 2013; 43(3): 118-27.
Dunning JR, Butts R, Mourad F, Young I, Fernandez-de-Las Peñas C, Hagins M, Stanislawski T. Upper cervical and upper thoracic manipulation versus mobilization and exercise in patients with cervicogenic headache: a multi-center randomized clinical trial. BMC Musculoskelet Disord. 2016; 17: 64.
Kanlayanaphotporn R. The Immediate Effects of Mobilization Technique on Pain and Range of Motion in Patients Presenting With Unilateral Neck Pain: A Randomized Controlled Trial. Archives of physical medicine and rehabilitation. 2008; 90(2): 187-92.
Slaven E, Goode A. The relative effectiveness of segment specific level and non-specific level spinal joint mobilization on pain and range of motion: results of a systematic review and meta-analysis. J Man Manip Ther. 2013; 21(1): 7–17.
Aquino R, Caires P. Applying Joint Mobilization at Different Cervical Vertebral Levels does not Influence Immediate Pain Reduction in Patients with Chronic Neck Pain: A Randomized Clinical Trial. Journal of Manual & Manipulative Therapy. 2009; 17(2): 211-219.
Vernon H, MacAdam K, Marshall V, Pion M, Sadowska M. Validation of a sham manipulative procedure for the cervical spine for use in clinical trials. J Manipulative Physiol Ther. 2005; 28(9): 662-6.
Young I, Dunning J, Butts R. Reliability, construct validity, and responsiveness of the neck disability index and numeric pain rating scale in patients with mechanical neck pain without upper extremity symptoms. Physiother Theory Pract. 2018 Jun 1:1-8.
Cleland JA, Childs JD, Whitman JM. Psychometric properties of the Neck Disability Index and Numeric Pain Rating Scale in patients with mechanical neck pain. Arch Phys Med Rehabil. 2008; 89(1): 69-74.
Curatolo M. Diagnosis of altered central pain processing. Spine 2011; 36(25): 200-4.
Wong J, Shearer H. Are manual therapies, passive physical modalities, or acupuncture effective for the management of patients with whiplash-associated disorders or neck pain and associated disorders? An update of the Bone and Joint Decade Task Force on Neck Pain and Its Associated Disorders by the OPTIMa collaboration. Spine J. 2016; 16(12): 1598-1630.
Coulter I, Crawford C, Vernon H, Hurwitz EL, Khorsan R, Booth MS. Manipulation and Mobilization for Treating Chronic Nonspecific Neck Pain: A Systematic Review and Meta-Analysis for an Appropriateness Panel. Pain Physician. 2019; 22(2): 55-70.
Indahl A, Kaigle AM, Reikeräs O, Holm SH. Interaction between the porcine lumbar intervertebral disc, zygapophysial joints, and paraspinal muscles. Spine. 1997; 22(24): 2834-40.
Sung Y, Lee J. Effects of Thoracic Mobilization and Manipulation on Function and Mental State in Chronic Lower Back Pain. J Phys Ther Sci. 2014; 26(11): 1711–1714.
Licciardone J, Kearns C. Associations of Cytokine Concentrations With Key Osteopathic Lesions and Clinical Outcomes in Patients With Nonspecific Chronic Low Back Pain: Results From the OSTEOPATHIC Trial. JAOA. 2016; 112(9): 596-605.
Igarashi A, Kikuchi S, Konno S, Olmarker K. Inflammatory cytokines released from the facet joint tissue in degenerative lumbar spinal disorders. Spine. 2004; 29(19): 2091-5.
Igarashi A1, Kikuchi S, Konno S. Correlation between inflammatory cytokines released from the lumbar facet joint tissue and symptoms in degenerative lumbar spinal disorders. J Orthop Sci. 2007; 12(2): 154-60.
Xu D, Sun Y, Bao G, Liu W, Zhu X. MMP-1 overexpression induced by IL-1β: possible mechanism for inflammation in degenerative lumbar facet joint. J Orthop Sci. 2013; 18(6): 1012-9.
Boyling 2004 Grieve's Modern Manual Therapy The Vertebral Column 3rd.
Eagan TS, Meltzer KR, Standley PR. Importance of strain direction in regulating human fibroblast proliferation and cytokine secretion: a useful in vitro model for soft tissue injury and manual medicine treatments. J Manipulative Physiol Ther. 2007; 30(8): 584-592.
Meltzer KR, Cao TV, Schad JF, King H, Stoll ST, Standley PR. In vitro modeling of repetitive motion injury and myofascial release. J Body w Mov Ther. 2010; 14(2): 162-171.
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