The effect of force direction on hypoalgesia locally, segmentally and non-segmentally: an investigation into AP & PA mobilisation at C4/5

Day, Alison and Coales, Philippa J. 2015. The effect of force direction on hypoalgesia locally, segmentally and non-segmentally: an investigation into AP & PA mobilisation at C4/5. Presented at: Physiotherapy UK 2015: Your Profession, Your CPD, Liverpool, UK, 16-17 October 2015.

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Abstract

Title: The effect of force direction on hypoalgesia locally, segmentally and non-segmentally: an investigation into AP and PA mobilisation at C4/5. Author(s): Day A and Coales P Background: Mechanisms of hypoalgesia following spinal mobilisation are not fully understood. Various treatment dose parameters are considered by Physiotherapists with little empirical evidence guiding decisions. Researchers have investigated some treatment parameters yet none have investigated the effect of force direction on resultant hypoalgesia with regards size of effect and distribution (locally, segmentally and non-segmentally). The hypoalgesic effect of an intervention can be determined in healthy subjects through pre and post measures of pressure pain threshold (PPT) algometry. Purpose: To determine whether cervical mobilisations applied in different directions (AP and PA) significantly change the PPT in the upper limb. Stability of the baseline PPT measurements was established through intra and intersession reliability analysis. Methods: A double blind, within-subject, repeated measures design was employed. A convenience sample (n=25) of asymptomatic, manual therapy naïve subjects was recruited. Subjects attended three, randomly allocated experimental conditions: i) unilateral PA Gr III C4/5 ii) unilateral AP Gr III C4/5 iii) control. A blinded assessor measured mean PPT pre and post condition over three sites in the right upper quadrant (local right C4/5, ipsilateral segmental C5 dermatome, ipsilateral non-segmental C8 dermatome). Data were analysed for differences between the magnitude and the extent of hypoalgesia induced by the three conditions using Two-Way ANOVA with post-hoc analysis. Stability of baseline PPT measurements (intra and intersession reliability) was calculated using ANOVA and Intraclass Correlation Coefficients (ICC). Results: Baseline PPT readings were found to be highly reliable at each site (ICC local 0.936, segmental 0.955 and non-segmental 0.932) with no significant difference intersession (p= 0.946, 0.745, 0.722 for each site respectively). AP mobilisations demonstrated a statistically significant difference against control (p=0.007) and clinically valuable changes (reduction of ≥15%) in PPT of the right upper quadrant locally (15.7%) and segmentally (16.6%), but not non-segmentally (4.56%). AP mobilisations resulted in an overall moderate effect size (f=0.26). PA mobilisations demonstrated no statistically significant difference against control (p=0.061) and clinically valuable changes only within the segment (17.4%). PA mobilisations resulted in a small effect size (f=0.18). No significant difference occurred at any site under the control condition. The results demonstrated a statistically significant local (p=0.023) and segmental (p<0.001) effect with either an AP or PA mobilisation, but failed to identify a non-segmental effect. Conclusion: The direction of force appears to be important in the overall hypoalgesic effect with statistically significant results only after the AP mobilisation. Within each site, no difference between the two mobilisations was demonstrated, with both producing a significant effect locally and segmentally, but not non-segmentally. Further research into the possible reasons for this difference such as extent of movement generated, proximity of mechanoreceptors/access to joint capsule and depth of overlying tissues would be beneficial. Investigations with a larger and/or symptomatic sample would add clinical value. Implications: Enhanced understanding of treatment parameters and mechanisms of hypoalgesia will allow more informed treatment selection, by current and future Physiotherapists, for improved patient outcome. This study creates a platform from which future investigations into the mechanisms of hypoalgesia and treatment parameters can be developed. Keywords: 1. spinal mobilisation 2. hypoalgesic effect 3. cervical spine

Item Type:	Conference or Workshop Item (Poster)
Date Type:	Completion
Status:	Unpublished
Schools:	Healthcare Sciences
Subjects:	R Medicine > R Medicine (General)
Related URLs:	Organisation
Last Modified:	20 Mar 2021 02:35
URI:	https://orca.cardiff.ac.uk/id/eprint/74322

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