Cervical lateral glide increases nociceptive flexion reflex threshold but not pressure or thermal pain thresholds in chronic whiplash associated disorders: A pilot randomised controlled trial

Sterling, Michele; Pedler, Ashley; Chan, Cliffton; Puglisi, Madonna; Vuvan, Viana; Vicenzino, Bill

doi:10.1016/j.math.2009.09.004

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Volume 15, Issue 2 , Pages 149-153, April 2010

Cervical lateral glide increases nociceptive flexion reflex threshold but not pressure or thermal pain thresholds in chronic whiplash associated disorders: A pilot randomised controlled trial☆

Michele Sterling
- Centre for National Research on Disability and Rehabilitation Medicine (CONROD), The University of Queensland, Herston Rd, Herston, Brisbane 4006, Queensland, Australia
- Division of Physiotherapy and National Health and Medical Research Council Centre for Clinical Research Excellence in Spinal Pain, Injury and Health (CCRE Spine), School of Health and Rehabilitation Sciences, The University of Queensland, Australia
- Corresponding author at: Centre for National Research on Disability and Rehabilitation Medicine (CONROD), The University of Queensland, Herston Rd, Herston, Brisbane, Queensland, Australia. Tel.: +61 (07) 33655344.
Ashley Pedler
- Division of Physiotherapy and National Health and Medical Research Council Centre for Clinical Research Excellence in Spinal Pain, Injury and Health (CCRE Spine), School of Health and Rehabilitation Sciences, The University of Queensland, Australia
Cliffton Chan
- Division of Physiotherapy and National Health and Medical Research Council Centre for Clinical Research Excellence in Spinal Pain, Injury and Health (CCRE Spine), School of Health and Rehabilitation Sciences, The University of Queensland, Australia
Madonna Puglisi
- Division of Physiotherapy and National Health and Medical Research Council Centre for Clinical Research Excellence in Spinal Pain, Injury and Health (CCRE Spine), School of Health and Rehabilitation Sciences, The University of Queensland, Australia
Viana Vuvan
- Division of Physiotherapy and National Health and Medical Research Council Centre for Clinical Research Excellence in Spinal Pain, Injury and Health (CCRE Spine), School of Health and Rehabilitation Sciences, The University of Queensland, Australia
Bill Vicenzino
- Division of Physiotherapy and National Health and Medical Research Council Centre for Clinical Research Excellence in Spinal Pain, Injury and Health (CCRE Spine), School of Health and Rehabilitation Sciences, The University of Queensland, Australia

Received 9 December 2008; received in revised form 5 September 2009; accepted 30 September 2009. published online 02 November 2009.

Abstract

Sensory hypersensitivity indicative of augmented central pain processing is a feature of chronic whiplash associated disorders (WAD). This study investigated the immediate effects of a cervical spine manual therapy (SMT) technique on measures of central hyperexcitability. In a randomised, single blind, clinical trial, 39 participants with chronic WAD were randomly assigned to a cervical SMT (lateral glide) or manual contact intervention. The Neck Disability Index (NDI) and GHQ-28 were administered at baseline. Pressure pain thresholds (PPTs), thermal pain thresholds (TPTs) and Nociceptive Flexion Reflex (NFR) responses (threshold and VAS of pain) were measured pre and post intervention. There was a significantly greater increase in NFR threshold following SMT compared to the manual contact intervention (p = 0.04). PPTs at the cervical spine increased following both SMT (mean ± SE: 24.1 ± 7.3%) and manual contact (21 ± 8.4%) with no difference between interventions. There was no difference between interventions for pain ratings with the NFR test, PPTs at the Median Nerve or Tibialis Anterior, heat or cold TPT. SMT may be effective in reducing spinal hyperexcitability in chronic WAD.

Keywords: Whiplash, Spinal manual therapy, Central hyperexcitability, Nociceptive flexion reflex