Muscular ischemic compression vs. cervical spine manipulation techniques: effects on pressure pain threshold in the trapezius muscle

M. Gazin DO MROF

R. Zegarra-Parodi DO MROF

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Introduction Myofascial trigger point (MTP): a clinical entity

55% of neck pain and headaches More frequently women, patients from 30 to 49 years

old

Treating MTP

Iatrogenic effects of cervical spine HVLANeurovascular accidents (1/200,000 to 1/1 Million)Side-effets (7%)

Local and distant manual techniques based on different theoretical physiological mechanisms

Simons et al., 1999Fernández de las Peñas et al, 2005Gun, 1997

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Purpose

Compare short-term pain effects of two manual techniques, each with differing benefits and risks

C3/C4 HVLA technique vs. ischemic compression technique on the trapezius muscle MTP

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Study designClinical study, approved by CEESO Ethics

CommitteeOctober 2008 to January 200981 subjects included

Criteria for inclusionCriteria for non-inclusion Criteria for exclusion

Randomisation

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Diagnostic criteria

Trapezius muscle MTP, Simons et al, 1999Palpable taut band Hypersensitive tender spot Local twitch responseReferred pain pattern

Somatic dysfunction C3/C4Restriction of passive mobilityPain spontaneous or induced by palpationBone asymmetry Soft tissue changes

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MethodsPressure pain threshold assessment, Fischer, 1990

DefinitionAlgometer

Two trained students as practitioners In 5th year of osteopathy With two years of experience in the clinical

department

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MethodsTechniques

HVLA Ischemic compression Sham

Statistical analysisDistribution: Agostino and Pearson TestFor each group: ANOVA Test / Bonferroni Post

TestComparison of groups: Kruskal Wallis Test

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Results

Values expressed as mean ± SD (kg/cm²)ns = not significant, * for p≤0.05, ** for p≤0.001, *** for p≤0.0001

o Pressure pain threshold in the upper trapezius muscle during the study in both groups

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Results

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Results

Values expressed as mean ± SD (kg/cm²)

o Average of the variations of the pressure pain threshold before and after technique at different time

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Discussion First study comparing these two techniques

Influence of techniques on pressure pain threshold

HVLA technique: Ruiz-Sáez et al, 2007 Ischemic compression technique:

Fernández de las Peñas et al, 2006

Dearing et al, 2006Hodgson et al, 2006

Gemmell et al, 2008

Latency of action:Ischemic compression vs. HVLA technique

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Discussion

Distant nervous system disturbance; effects of manual technique on central and peripheral nervous systemMcPartland, 2004Graff, 2004Butler, 2000Quintner et al, 1994

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Discussion

Risk/ benefit ratio for MTP treatment is in favour of ischemic compression

Ethical: contraindication

Legal: France’s case

Practitioner skills

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Discussion

Limitations of this studySource of subjectsSham group

Future studySubjects from general publicSymptomatic subjectsLong-term evaluation of pain threshold, Rickards,

2006

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ConclusionResults of these two techniques vs. sham not

significant

Cervical HVLA technique equally effective as ischemic compression for MTP pain threshold, but risk / benefit ratio in favour of ischemic compression technique

Significant pain threshold improvement from manual techniques with differing physiological mechanisms

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Acknowledgements

The CEESO Paris clinic and students

Rafael Zegarra-Parodi and the CEESO Research Department for their support with my current research

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Thank you for your attention

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