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The Somatic Connection  |   October 2017
Posteroanterior Joint Mobilization for Cervical Somatic Dysfunction
Author Notes
  • Western University of Health Sciences, College of Osteopathic Medicine of the Pacific, Pomona, California 
Article Information
The Somatic Connection   |   October 2017
Posteroanterior Joint Mobilization for Cervical Somatic Dysfunction
The Journal of the American Osteopathic Association, October 2017, Vol. 117, 667-668. doi:10.7556/jaoa.2017.127
The Journal of the American Osteopathic Association, October 2017, Vol. 117, 667-668. doi:10.7556/jaoa.2017.127
Yung EY, Oh C, Wong MS, et al. The immediate cardiovascular response to joint mobilization of the neck - a randomized, placebo-controlled trial in pain-free adults. Musculoskelet Sci Pract. 2017;28:71-78. doi:10.1016/j.msksp.2017.01.013 
Osteopathic physicians manage cervical somatic dysfunction with a variety of osteopathic manipulative treatment (OMT) techniques. Neck pain is a frequently encountered condition in clinical practice worldwide.1,2 Physical therapists often use oscillatory posteroanterior joint mobilization (PAJM), which is similar to articulatory OMT taught in osteopathic medical schools, both of which are widely known as effective interventions. Studies3,4 have established that cervical JM has a sympathoexcitatory effect, resulting in an elevation in systolic blood pressure (BP). 
After power calculation for sample size, researchers enrolled 44 pain-free, normotensive, healthy volunteers (18 women; mean [SD] age, 23.8 [3.04] years) to assess BP and heart rate responses to unilateral PAJM vs touch placebo using a double blind, randomized controlled clinical trial design. Exclusion criteria were previous exposure to PAJM of the neck, history of syncope or cardiovascular disease, cervical-shoulder pain, or oral or hormonal contraceptive use. 
One doctor of physical therapy applied all interventions. He was randomly instructed which intervention to provide by turning over a card with the procedure written on it 30 seconds before applying either PAJM or placebo touch. Blood pressure and heart rate were measured before, during, and after the interventions. Statistical analysis used a mixed-effect model of repeated measures. 
A transient mid-treatment decrease in systolic BP with PAJM (P<.003) was measured, as well as significant group-time interaction for systolic BP (P<.01), but no change was found in diastolic BP or heart rate between groups. Contrary to prevailing theory, the authors interpreted these findings to indicate a possible sympathetic inhibitory response to specifically dosed cervical PAJM that needs further exploration with symptomatic participants, comparator groups with various manual therapy dosing, and larger sample sizes. Joint mobilization may activate a descending pain inhibitory system originating in the periaqueductal grey area. The periaqueductal grey area's effect on the peripheral vascular system may influence the mechanisms behind BP. The specific dosing of joint mobilization as used in this study should be considered for further research, as definite doses could be used in different potential clinical scenarios. 
Some limitations of this study include conjecture, since measuring BP is not the criterion standard for determining sympathetic activation. As osteopathic physicians, we do not perform OMT to activate the sympathetic nervous system—we typically seek to inhibit it. Additionally, the methods are simple compared with Brown et al,5 who directly measured the sympathetic nervous system activity at the peroneal nerve, for example. Future research should also assess the effects of various OMT procedures on cardiovascular parameters. 
References
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La Touche R, París-Alemany A, Mannheimer JS, et al Does mobilization of the upper cervical spine affect pain sensitivity and autonomic nervous system function in patients with cervico-craniofacial pain? a randomized-controlled trial. Clin J Pain. 2013;29(3):205-215. doi: 10.1097/AJP.0b013e318250f3cd [CrossRef] [PubMed]
Vicenzino B, Cartwright T, Collins D, Wright A. Cardiovascular and respiratory changes produced by lateral glide mobilization of the cervical spine. Man Ther. 1998;3(2):67-71. doi: 10.1016/S1356-689X(98)80020-9 [CrossRef]
Brown R, Kemp U, Macefield V. Increases in muscle sympathetic nerve activity, heart rate, respiration, and skin blood flow during passive viewing of exercise. Front Neurosci. 2013;7:102. doi: 10.3389/fnins.2013.00102 [CrossRef] [PubMed]