paradigm Shift in Manual Therapy Study Title: Paradigm shift in manual therapy? Evidence for a central nervous system component in the response to passive cervical joint mobilization Author(s): Schmid A, Brunner F, Wright A & Bachmann M Publication Information: Manual Therapy 2008; 13: 387-396. Recently, an increasing number of studies have suggested that passive spinal joint mobilization may activate various areas in the central nervous system (CNS), producing a “multisystem response that extends beyond the specific joints and spinal segments stimulated.” [p. 388] The goal of this systematic review was to evaluate the current evidence on the consis- I tency and nature of CNS responses to passive cervical joint mobilization (CJM). NOTE: This review did not include studies investigating high-velocity manipulation techniques. Dr. Shawn Thistle is the founder and president of Research Review Service Inc., an online, subscription- based service designed to help busy practitioners to integrate current, relevant scientific evidence into their practice. Shawn graduated from CMCC and holds an Hon- ours Degree in Kinesiology from McMaster University. He also holds a certificate in Contemporary Medi- cal Acupuncture from McMaster University, and is a Certified Active Release Techniques (ART®) Pro- vider. For more information about the Research Review Service, visit www.researchreviewservice.com. pERTINENT RESULTS: • the literature search yielded 15 studies that met inclusion criteria • the overall quality of the studies was consistently high (no studies meeting inclusion criteria were excluded due to methodological issues) • there were consistent results suggesting that CJM is associated with hypoalgesia, sympathetic nervous system excitement (skin conductance, blood pressure, heart rate and respiratory rate changes), and perhaps changes in motor function • all of the above suggest a role of the CNS in co-ordinating a response to manual therapy treatments Outcomes for three different parameters could be appropriately assessed: pAIN RELATEDMEASURES • various outcomes have been studied including Pain Pressure Threshold (PPT), Thermal Pain Threshold (TPT), and Visual Analogue Scale (VAS) ratings • there is consistent evidence that passive CJM increases PPT locally, and in a more widespread manner, including the upper quarter on the side of treatment • unlike PPT, no consistent effect on TPT has been noted in three separate studies • there is evidence for improvement in VAS at rest, and 24 hours after spinal manual therapy SyMpATHETIC NERVOUS SySTEM INDICATORS • there is high quality evidence that CJM increases skin conductance in a widespread manner in both upper limbs – this effect appears to last for several minutes • two studies have demonstrated that heart rate, respiratory rate, and diastolic blood pressure increase after CJM1,2 • there is conflicting evidence on the effect of CJM on skin temperature MOTOR fUNCTIONMEASURES • there is some evidence for CJM increasing pain-free grip strength • there is conflicting evidence around the effect of CJM on deep neck flexor activity • existing evidence suggests that in healthy people, CJM has little effect on motor function • in patients with existing impairments, there may be a role to play for CJM but data to date is insufficient to make recommendations 12 • CANADIAN CHIROPRACTOR | FEBRUARY 2009 Continued on page 16 www.canadianchiropractor.ca t has long been postulated that the benefit of cervical spine manipulation or mo- bilization is gleaned from a combination of local mechanical and segmental and/or suprasegmental neurological mechanisms. Shawn Thistle, BKin (Hons), DC, CSCS
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