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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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