The sympathetic nervous system effects of spinal mobilisations in those with and without chronic low back pain

Almuslem, Wafa Hashem (2018) The sympathetic nervous system effects of spinal mobilisations in those with and without chronic low back pain. Doctoral thesis (PhD), Manchester Metropolitan University.

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Abstract

Low back pain (LBP) is one of the most common musculoskeletal conditions encountered in clinical practice. Physiotherapists as well as other professionals in healthcare use manual spinal mobilisations to treat patients with LBP with the aim of reducing pain or/and stiffness and improving the range of motion. Although spinal mobilisations are widely used in the clinical sitting, the underlying mechanisms regarding its effectiveness remain largely unknown. The purpose of the current study was to examine the physiological responses of spinal mobilisations in terms of the hypoalgesic and SNS responses in those with and without LBP. Phase 1 examined the test-re-test reliability of sympathetic and hypoalgesic measurements (n = 15). Phase 2 was a pre-clinical study (single arm trial, n = 14) that investigated the hypoalgesic and sympathetic effects of thoracic mobilisation treatment in asymptomatic participants over a course of three sessions of mobilisation. Phase 3 investigated the hypoalgesic and sympathetic effects of thoracic mobilisation treatment in patients with nonspecific chronic low back pain (NSCLBP) (n = 36) over a course of three sessions of mobilisation. Phase 1 demonstrated that the within-day test-retest reliability of skin conductance, skin temperature, heart rate, respiratory rate, systolic blood pressure and PPT measurements were excellent (ICCs of 0.77 to 0.99). On the other hand, the reliability of diastolic blood pressure and salivary alpha-amylase measurements were demonstrated to be fair to good (ICCs of 0.55 and 0.7, respectively). Phase 2 revealed significant sympathoexitatory effects in terms of diastolic blood pressure (p=0.026), heart rate (p=0.005) and respiratory rate (p= 0.001) where there were insignificant results with regard to peripheral sympathetic measures (skin conductance and skin temperature). Significant hypoalgesic effects were evident in some locations, including distal areas, but not at all visits. Phase 3 showed significant peripheral detectable sympathoexcitatory effects in the lower limbs in terms of increased skin conductance (p= 0.001) and decreased skin temperature (p= 0.001) following thoracic mobilisation that were not detected in asymptomatic participants. This study demonstrated that patients with nonspecific low back pain are more peripheral sympathetic responsive to thoracic mobilisations than asymptomatic population suggesting that adaptive neuroplasticity, as well as dorsal horn and central processing, in the LBP patients, may be a feasible explanation of the results.