Técnicas manipulativas vertebrales como terapia osteopática en el dolor cervical / Vertebral manipulative techniques such as osteopathic therapy for neck pain

Introducción: Se considera a la cervicalgia como una de las patologías con mayor incidencia en la población. Las manipulaciones espinales utilizadas en Osteopatía, terapia manual y Quiropraxia parecen ofrecer buenos resultados restituyendo la fisiología cervical, por lo que consideramos necesario revisar la evidencia actualizada en esta área y resumir que técnicas arrojan mejores resultados a corto y largo plazo. Objetivo: Comparar el efecto de la manipulación de alta velocidad y corta amplitud (HVLA) dirigida tanto a la columna cervical como a la dorsal y de las técnicas de movilización solas y/o comparadas con otras técnicas en la recuperación de movilidad la disminución del dolor y la disminución de la discapacidad. Material y Métodos: Se realiza una búsqueda bibliográfica en PubMed (Medline), Scopus y PEDro. Encontramos 1.020 artículos relacionados, aunque se incluyeron 11 revisiones sistemáticas/metaanálisis y 18 ensayos controlados aleatorizados, de cohortes o serie de casos, por lo que han sido analizadas veintinueve publicaciones (n=29) en texto completo. Resultados: En el dolor agudo del cuello, en la primera hora después de la intervención, las técnicas de HVLA obtienen resultados superiores a los medicamentos recetados en urgencias y en el dolor crónico a corto, medio y largo plazo, son claramente superiores a la visita médica y medicamentos. También obtienen mejores resultados que las intervenciones electro/termales, que el Kinesiotaping(R), el ejercicio, el láser en disfunciones facetarías y otras terapia. Los efectos adversos, en su mayoría, son síntomas de leve duración en las primeras 24 horas, y raramente son intensos. Conclusiones: Las técnicas manipulativas producen efectos analgésicos, de aumento del rango articular, de la función, de la satisfacción del paciente y de la calidad de vida en el dolor del cuello, tanto agudo como crónico, con o sin dolores asociados, a corto, medio y largo plazo (AU)

Introduction: Neck pain is considered one of the most frequent pathologies in the population. Spinal manipulations used in osteopathy, manual therapy and chiropractics seem to offer good results in restoring cervical physiology. Therefore, we consider it necessary to review the updated evidence in this area and summarize which techniques show better results in the short and long term. Objective: To compare the effect of high speed manipulation and low amplitude (HVLA), targeting both the cervical and the dorsal spine and mobilization techniques alone and/or compared with other techniques in mobility recovery, pain reduction and disability reduction. Material and methods: A bibliographical search was conducted in PubMed (Medline), Scopus and PEDro. We found 1020 related articles, although 11 systematic reviews/metaanalysis were included and 18 randomized controlled trials, cohort trials or case series, twenty publications having been analyzed (n = 29) in full text. Results: In acute neck pain, in the first hour after intervention, HVLA techniques get superior results as compared to prescription drugs in emergencies and chronic pain in the short, medium and long term and are clearly superior to medical visits and medicines. They also perform better than electro thermal interventions, Kinesiotaping®, exercise, laser in faceting dysfunctions and other therapy. Adverse effects are mostly short duration symptoms in the first 24 hours, and are rarely severe. Conclusions: The manipulative techniques produce analgesic effects, an increase in joint range, range of function, patient satisfaction and the quality of life in neck pain, both acute and chronic, with or without associated pain, in the short, medium and long term (AU)

Comparative short-term effects of two thoracic spinal manipulation techniques in subjects with chronic mechanical neck pain: a randomized controlled trial.

Spinal Manipulation (SM) has been purported to decrease pain and improve function in subjects with non-specific neck pain. Previous research has investigated which individuals with non-specific neck pain will be more likely to benefit from SM. It has not yet been proven whether or not the effectiveness of thoracic SM depends on the specific technique being used. This double-blind randomized trial has compared the short-term effects of two thoracic SM maneuvers in subjects with chronic non-specific neck pain. Sixty participants were distributed randomly into two groups. One group received the Dog technique (n = 30), with the subject in supine position, and the other group underwent the Toggle-Recoil technique (n = 30), with the participant lying prone, T4 being the targeted area in both cases. Evaluations were made of self-reported neck pain (Visual Analogue Scale); neck mobility (Cervical Range of Motion); and pressure pain threshold at the cervical and thoracic levels (C4 and T4 spinous process) and over the site described for location of tense bands of the upper trapezius muscle. Measurements were taken before intervention, immediately afterward, and 20 min later. Both maneuvers improved neck mobility and mechanosensitivity and reduced pain in the short term. No major or clinical differences were found between the groups. In the between-groups comparison slightly better results were observed in the Toggle-Recoil group only for cervical extension (p = 0.009), right lateral flexion (p = 0.004) and left rotation (p < 0.05).

Efectos de las técnicas manipulativas de tratamiento comúnmente utilizadas en osteopatía para la cervicalgia / Effects of the manipulative treatment techniques commonly used in osteopathy for cervicalgias

Introducción: Diversas técnicas se han estudiado a lo largo de la historia para proponer tratamientos que optimicen la regeneración del tejido, la resolución de dolor o la limitación, en varias estructuras que podrían ser responsables de la cervicalgia mecánica, considerada de etiología idiopática. Dirigido a las articulaciones inter-apofisarias, con sus efectos neurofisiológicos asociados, encontramos técnicas de manipulación de alta velocidad y corta amplitud (HVLA) y técnicas de movilización descritas por quiroprácticos, osteópatas y terapeutas manuales, con la intención de generar un efecto general en todos los tejidos a través del sistema vascular y del sistema nervioso. En la bibliografía tienen respaldo científico sus efectos tanto en la recuperación de la movilidad, como en la disminución del dolor y la discapacidad. Objetivos: En este estudio la intención será comparar los distintos abordajes manipulativos para determinar cual podría ser más conveniente en el tratamiento de la cervicalgia mecánica. Material y Métodos: Se realizado un comentario crítico tras la revisión bibliográfica de estudios aleatorizados y controlados, analizando los posibles riesgos y beneficios asociados a la manipulación y la movilización en la zona cervical y dorsal. Resultados: Las técnicas de alta velocidad cuentan con mas evidencia científica que apoya su efectividad, tanto aplicadas a la región dorsal como a la cervical, aunque se asocian con riesgos neurovasculares poco frecuentes. Las movilizaciones también resultan efectivas para ese fin. Conclusiones: Tanto las manipulaciones (cervicales y dorsales) como las movilizaciones consiguen analgesia, y mejoran la movilidad de la columna cervical y la satisfacción del paciente, así como su discapacidad a corto, medio y largo plazo, comparado con el uso de medicamentos. Tiene un efecto mayor la manipulación, al menos a corto plazo, en la cervicalgia (AU)

Introduction: Different techniques were studied throughout the history, in order to propose treatments for optimizing tissue regeneration, pain resolution or limitation, in several structures that could responsible for mechanical cervicalgia, which has an idiopathic etiology. Aimed for the interapophyseal joints, with their corresponding neurophysiologic effects, we found high-velocity low-amplitude manipulation techniques (HVLA) and mobilisation techniques described by chiropractors, osteopaths and manual therapists, with the purpose of producing a general effect in all the tissues, through the vascular and nervous system. References reveal the scientific support of their effects for both recovering mobility and decreasing pain and disability. Objectives: In this study, the objective is to compare different manipulative approaches, to be able to choose the most convenient one for treating mechanical cervicalgia. Material and methods: A critical commentary was performed after the bibliographic review of the randomized and controlled trials, analysing the possible risks and benefits associated to manipulation and mobilisation in the cervical and thoracic area. Results: High-velocity techniques have more scientific evidences that support their effectiveness, no matter if they are applied in the cervical or thoracic area, although they are associated with rare neurovascular risks. Mobilisations are also effective for this purpose. Conclusions: Both manipulations (cervical and thoracic) obtain analgesia, like mobilisations, and improve cervical spinal ́s mobility and patient's satisfaction, as well as his/her disability in short, medial and long-term, compared to the use of drugs. Manipulation has a greater effect, at least in short-term, for cervicalgia (AU)