Sacred Heart University DigitalCommons@SHU All PTHMS Faculty Publications Physical erapy & Human Movement Science 4-2017 e Immediate Cardiovascular Response to Joint Mobilization of the Neck - A Randomized, Placebo-Controlled Trial in Pain-Free Adults Emmanuel Yung Sacred Heart University, [email protected]Cheongeun Oh New York University School of Medicine Michael Wong Azusa Pacific University Jason K. Grimes Sacred Heart University, [email protected]Erica M. Barton Azusa Pacific University See next page for additional authors Follow this and additional works at: hps://digitalcommons.sacredheart.edu/pthms_fac Part of the Musculoskeletal, Neural, and Ocular Physiology Commons , and the Physical erapy Commons is Peer-Reviewed Article is brought to you for free and open access by the Physical erapy & Human Movement Science at DigitalCommons@SHU. It has been accepted for inclusion in All PTHMS Faculty Publications by an authorized administrator of DigitalCommons@SHU. For more information, please contact [email protected], [email protected]. Recommended Citation Yung, Emmanuel; Oh, Cheongeun; Wong, Michael; Grimes, Jason K.; Barton, Erica M.; Ali, Muhammad I.; and Cameron, David A., "e Immediate Cardiovascular Response to Joint Mobilization of the Neck - A Randomized, Placebo-Controlled Trial in Pain-Free Adults" (2017). All PTHMS Faculty Publications. 259. hps://digitalcommons.sacredheart.edu/pthms_fac/259
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Sacred Heart UniversityDigitalCommons@SHU
All PTHMS Faculty Publications Physical Therapy & Human Movement Science
4-2017
The Immediate Cardiovascular Response to JointMobilization of the Neck - A Randomized,Placebo-Controlled Trial in Pain-Free AdultsEmmanuel YungSacred Heart University, [email protected]
Cheongeun OhNew York University School of Medicine
Follow this and additional works at: https://digitalcommons.sacredheart.edu/pthms_fac
Part of the Musculoskeletal, Neural, and Ocular Physiology Commons, and the Physical TherapyCommons
This Peer-Reviewed Article is brought to you for free and open access by the Physical Therapy & Human Movement Science atDigitalCommons@SHU. It has been accepted for inclusion in All PTHMS Faculty Publications by an authorized administrator ofDigitalCommons@SHU. For more information, please contact [email protected], [email protected].
Recommended CitationYung, Emmanuel; Oh, Cheongeun; Wong, Michael; Grimes, Jason K.; Barton, Erica M.; Ali, Muhammad I.; and Cameron, David A.,"The Immediate Cardiovascular Response to Joint Mobilization of the Neck - A Randomized, Placebo-Controlled Trial in Pain-FreeAdults" (2017). All PTHMS Faculty Publications. 259.https://digitalcommons.sacredheart.edu/pthms_fac/259
The immediate cardiovascular response to joint mobilization of the neck- Arandomized, placebo-controlled trial in pain-free adults
Emmanuel Y. Yung, Cheongeun Oh, Michael S. Wong, Jason Grimes, Erica M.Barton, Muhammad I. Ali, David Cameron
PII: S2468-7812(17)30031-0
DOI: 10.1016/j.msksp.2017.01.013
Reference: MSKSP 46
To appear in: Musculoskeletal Science and Practice
Received Date: 26 April 2016
Revised Date: 13 January 2017
Accepted Date: 30 January 2017
Please cite this article as: Yung, E.Y., Oh, C., Wong, M.S., Grimes, J., Barton, E.M., Ali, M.I., Cameron,D., The immediate cardiovascular response to joint mobilization of the neck- A randomized, placebo-controlled trial in pain-free adults, Musculoskeletal Science and Practice (2017), doi: 10.1016/j.msksp.2017.01.013.
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THE IMMEDIATE CARDIOVASCULAR RESPONSE TO JOINT MOBILIZATION OF
THE NECK- A RANDOMIZED, PLACEBO-CONTROLLED TRIAL IN PAIN-FREE
ADULTS
*Emmanuel Y. Yung1,2,4,5, Cheongeun Oh3, Michael S. Wong2, 6, 7, Jason Grimes1, Erica M. Barton8, Muhammad I. Ali1, 9, David Cameron1 1Doctor of Physical Therapy Program, Sacred Heart University, Fairfield, Connecticut 06825, United States ([email protected], [email protected], [email protected], [email protected])
2Doctor of Physical Therapy Program, Azusa Pacific University, 901 E. Alosta Avenue P. O. Box 7000 Azusa, California 91702, United States ([email protected])
3Divison of Biostatistics, Department of Population Health, New York University School of Medicine, 650 1st Avenue, #556 New York, New York 10016 United States ([email protected])
4PhD Program in Ergonomics and Biomechanics, Occupational and Industrial Orthopaedic Center, New York University Langone Medical Center, 63 Downing Street. New York, New York, 10014, United States ([email protected]) 5Elevating Practice in Orthopaedic Physical Therapy, MGH Institute of Health Professions, Boston, Massachusetts, United States 6Physical Therapy Spine Fellowship, University of Southern California, Los Angeles, California, United States 7Physical Therapy Spine Fellowship, Kaiser Permanente, Los Angeles, California, United States 8Orthopaedic Physical Therapy Residency Program, Kaiser Permanente Panorama City Medical Center, 8250 Woodman Ave. Building 2, Panorama City, California 91402, United States ([email protected]) 9United States Army Reserve, West Hartford, Connecticut, United States ([email protected]) *Corresponding Author: Emmanuel Y. Yung ([email protected]). Present Address: 5151 Park Avenue, Fairfield, Connecticut 06825, United States
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THE IMMEDIATE CARDIOVASCULAR RESPONSE TO JOINT MOBILIZATION OF THE
NECK- A RANDOMIZED, PLACEBO-CONTROLLED TRIAL IN PAIN-FREE ADULTS
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Abstract
Background: Some normotensive patients can have a spike in resting systolic blood pressure
(SBP) in response to acute neck pain. Applying the typical dosage of mobilization may
potentially result in a sympatho-excitatory response, further increasing resting SBP. Therefore,
there is a need to explore other dosage regimens that could result in a decrease in SBP.
Objectives: To compare the blood pressure (BP) and heart rate (HR) response of pain-free,
normotensive adults when receiving unilateral posterior-to-anterior mobilization (PA) applied to
the neck versus its corresponding placebo (PA-P).
Study Design: Double-Blind, Randomized Clinical Trial
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FIGURE 1: Flow Diagram
Assessed for eligibility (n= 46)
Excluded (n= 2)
♦ Not meeting inclusion criteria (n= 2)
♦ Declined to participate (n= 0)
Analysed (n= 22) ♦ Excluded from analysis (n=0)
Lost to follow-up (n= 0)
Adverse Reactions and/or Side effects
Allocated to PA-P (n= 22)
♦ Blood Pressure & Heart Rate at 5 & 7 minutes of rest
Received PA-P (n= 22)
Lost to follow-up (n= 0)
Adverse Reactions and/or Side effects
Allocated to PA group (n=22)
♦ Blood Pressure & Heart Rate at 5 & 7 minutes of rest
Received PA (n= 22)
Analysed (n= 22) ♦ Excluded from analysis (n= 0)
Allocation
Analysis
Follow-Up
Randomized (n= 44)
Enrollment
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TABLE 1. Descriptive comparisons between unilateral posterior-to-anterior (PA) glides and placebo (PA-P) PA Group (n=22) PA-P Group (n=22) P Value Gender n females (%) 9 (40.9%) 9 (40.9%) 1** Age, years 24.00 ± 3.66 23.63 ± 2.34 0.6972* BMI 23.55 ± 3.34 24.17 ± 2.79 0.5077*
Heart rate
Baseline 60.13 ±11.64 63.70 ±12.48 0.3326* During 58.88 ±11.07 62.14 ±11.62 0.3477* Post 60.23±10.87 64.07±12.39 0.2807*
SBP Baseline 110.61±10.61 111.43± 8.60 0.7802* During 107.65±11.31 112.15± 10.25 0.1743* Post 108.70±11.38 110.95±8.79 0.4675*
DBP Baseline 66.95± 7.84 66.36± 6.30 0.7845* During 66.20±7.88 65.63±5.51 0.7833* Post 67.00±7.52 66.45±5.91 0.7906*
Values expressed as mean ± SD, except where otherwise indicated. * t-tests ** chi-squared test
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TABLE 2. Changed heart rate, systolic blood pressure and diastolic blood pressure from baseline comparison between PA and PA-P groups
Outcomes Treatment Baseline to During
Baseline to Post
p-value by MEM ANOVA Between-Group
Time Group×Time Gender
Changed HR
PA 1.25±3.16 -0.09±3.55 0.2957 0.0043 0.8508 0.0643 PA-P 1.56±3.59 -0.36±4.15
Changed SBP
PA 2.95±3.11 1.90±4.76 0.3591 0.0895
0.0105 0.0027 PA-P -0.72±4.66 0.47±3.77
Changed DBP
PA 0.75±2.64 -0.04±3.15 0.7801
0.1143 0.9986 0.6665 PA-P 0.72±2.25 -0.09±3.03
Data displayed as mean±SD; Abbreviation: MEM mixed-effect model for repeated measured analysis adjusted for age, gender and BMI; ANOVA analysis of variance
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Figure 2. Mean heart rate at each time point.
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Figure 3. Mean systolic blood pressure at each time point. *Indicates a significant difference between groups followed by a post hoc Bonferroni’s multiple comparisons.
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Figure 4. Mean diastolic blood pressure at each time point.
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ACKNOWLEDGEMENT
Contributors
The authors wish to thank the following individuals for their assistance in: data collection
(Dr. Kyle Wikfors, Dr. Heather Powell, Dr. Janeil Stehr, Kelly Peterson, and Karen
Ching); data analysis (Dr. Tyler Smith, and Dr. Sigourney Schipper); and writing (Dr.
Andrew B. Sullivan).
Funding Sources
Funding: This work was supported by the American Academy of Orthopaedic and
Manual Physical Therapists (AAOMPT) Grant. Dr. Yung’s PhD studies at New York
University (NYU) were supported by the United States Government National Institute of
Occupational Safety and Health (NIOSH) Education and Research Center (ERC) Grant
through the NYU School of Medicine. Neither AAOMPT nor NYU has any role or
involvement in study design; in the collection, analysis and interpretation of data; in the
writing of the report; and in the decision to submit the article for publication.
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Highlights
• The neurophysiological system that alters pain overlap with blood pressure.
• Following acute pain, the resting SBP may increase in some normotensive adults.
• Sympatho-excitation from usual JM dosage increasing SBP may be deleterious.
• It is essential to explore other JM dosing regimen to possibly decrease SBP
• The alternative JM dosage resulted in decreased SBP in normotensive adults vs placebo.