Effects of Cervical Manipulation and Mobilization on Salivary Cortisol Concentrations
Condition: Neck Pain
MeSH terms: Neck Pain
Study type: Interventional

Summary: 
      Currently, there are many studies about the effects of manual therapy on pain, but there are
      not enough studies to know what are the mechanisms that cause these effects.

      Although there is a research measuring neuromodulators substances after a cervical and dorsal
      manipulation, it has been done in healthy subjects and there is no information about
      mobilization. This work aims to select a sample with chronic neck pain, incorporating the
      cervical mobilization as a therapeutic approach to compare the effects of both techniques
      because not all patients accept the manipulation as a treatment technique (mobilization is
      much better tolerated) and to verify that the liberation of cortisol is not just caused by
      the stress on the joint manipulation and the psychological stress and expectation may be
      important.

      The hypothesis of this paper is that cervical manipulation and mobilization in subjects with
      chronic neck pain there will increase salivary cortisol levels.

      It is also expected a little increase in the expectation of being manipulated group because
      of the psychological stress.

      It is expected an improvement in the neck disability, pain and range of motion in the
      intervention groups immediately after and in the three groups the following week after the
      exercise.

      The main objective of the study is to measure and analyze changes in salivary cortisol
      concentrations after the intervention in the three groups. Secondary objectives is to analyze
      the changes in range of motion and disability caused by neck pain neck pain level
    

Detailed description: 
      STUDY DESIGN:

      Experimental study using a randomized controlled trial with blinded evaluator with three
      parallel groups, two experimental and one placebo.

      INTERVENTION

        1. Experimental group cervical manipulation:

           The patient is supine without a pillow and physiotherapist standing in the ipsilateral
           corner of the hand of the thrust. If the segment to manipulate is the upper cervical
           spine, the radial aspect of the distal phalanx of the index finger of the pulse is
           placed on the posterolateral aspect of the transverse process of the atlas (In medium or
           low segments of cervical spine on the vertebra on which we want to make the thrust). The
           thumb rests on the zygomatic arch and the other fingers rest on the back of the skull,
           leaving the forearm perpendicular to the neck. In middle or lower cervical spine, the
           thumb rests on the angle of the jaw and the other fingers on the back of the neck.

           The contralateral hand rests against the contralateral side of the patient's skull with
           the fingers facing caudally, so we left ear between the index and middle fingers.

           To take the patient to the end of range of motion will be added ipsilateral inclination
           and contralateral rotation without exceeding the 30-40 °.

           There will be a contralateral displacement of the head and a posteroanterior glide to
           take the patient to energizing. The impulse is made in pure contralateral rotation.

        2. Experimental Group of cervical posterior-anterior mobilization in the most painful
           segment:

           Maitland described by the patient is prone with his forehead in the palms. The thumb
           rests on the articular pillar (on the transverse blade) and the other fingers around the
           neck to stabilize the soft tissue.

           The limit pressure will be that cause pain to the patient. The oscillatory motion is
           produced by the arms and the body while the hands remain stable with a pressure
           distributed uniformly around the patient's neck. It is important that the neck and hands
           move as a unit. high-amplitude technique may be performed by raising the patient's neck
           with the pads of the fingers This technique was performed for 3 minutes remaining below
           the pain threshold of the patient.

        3. Placebo group:

      The subjects of this group will expect a cervical manipulation to check the psychological
      component has an effect on cortisol segregation. It will proceed with the same protocol as in
      the group of cervical manipulation, but without joint stress or thrust.

      Participants will receive a protocol of domiciliary cervical control exercises adapted to
      each subject for deep cervical muscles after taking the second salivary sample.

      Seasonal timing will be considered (evaluating the subjects in the same month), circadian
      rhythms (evaluating subjects mid-morning to avoid peak morning cortisol) and periods of the
      menstrual cycle as they are factors that can determine the results. In the case of the
      menstrual cycle they are cited the seventh day of the cycle.
    

Intervention name(s): cervical manipulation; cervical control exercises; Oscillatory mobilization technique
Intervention type(s): Procedure; Procedure; Procedure
Intervention description(s): cervical high-velocity low-amplitude thrust manipulation; Exercises of flexion, extension and rotation of the cervical spine; Joint mobilization technique type III according Maitland
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Investigator)
Primary purpose: Treatment
Keywords: Cervical pain, cervicalgia