NONSPESİFİK BOYUN AĞRILI HASTALARDA SERVİKAL MOBİLİZASYONUN MOBİLİTE, AĞRI, BASINÇ AĞRI EŞİĞİ VE ÖZÜR ÜZERİNE ETKİSİ

Öz

Giriş: Boyun ağrısı sık rastlanılan omurga şikayetidir ve son dönemlerde manuel terapi tedavide sıklıkla kulanılmaktadır. Amaç: Nonspesifik boyun ağrılı hastalarda servikal omurgaya uygulanan manuel terapinin mobilite, ağrı, basınç ağrı eşiği ve dizabilite üzerine etkisini belirlemektir. Bireyler ve Yöntem: 95 hasta basit rastgele yöntemle üç gruba ayrıldı. Grup 1’e servikal bölgeye geleneksel fizyoterapi yaklaşımları (Transkutanöz elektrik stimülasyonu ile birlikte sıcak uygulama ve ev programı) uygulanırken, Grup 2’ye ek olarak servikal mobilizasyon ve Grup 3’e ise ek olarak plasebo mobilizasyon uygulandı. Üç haftalık tedavi proğramında manuel ve placebo uygulamalar haftada iki gün, aynı süre ve pozisyonda gerçekleştirildi. Tedavi öncesi ve sonrasında, mobilite, ağrı, basınç ağrı eşiği ve dizabilite; CROM Cihazı, Vizüel Analog Skala, J-tech dijital algometre cihazı ve Boyun Özürlülük Sorgulama Anketi ile değerlendirildi. Bulgular: Grup 2’de, tüm parametrelerde tedavi sonrası istatistiksel olarak anlamlı iyileşme olurken, bu iyileşme diğer iki gruba kıyasla daha fazla idi (p<0,05). İstatistiksel olarak, mobilite ve ağrının bazı parametrelerindeki azalma, Grup 3'te Grup 1’e kıyasla daha fazla saptandı (p<0,05). Sonuç: Nonspesifik boyun ağrılı hastalarda servikal bölgeye uygulanan manuel terapi, mobilite, ağrı, basınç ağrı eşiği ve dizabilite üzerinde daha belirgin ve anlamlı bir etkiye sahiptir. ABSTRACT Introduction: Neck pain is one of the common spine problems and manual therapy has been used frequently in its treatment recently. Objectives: To determine the effect of manual therapy applied as joint mobilization to the cervical spine on mobility, pain, pressure pain threshold and disability in patients with nonspecific neck pain. Subjects and Methods: Ninety-five study subjects were randomly assigned to three groups by simple random method. Traditional physiotherapy approaches (Transcutaneous Electrical Stimulation, hot pack, and home-based exercise program) were applied to the cervical region for Group 1, while both traditional physiotherapy approaches and cervical mobilization were applied for Group 2 and both traditional physiotherapy approaches and placebo joint mobilization were applied for Group 3. In the three-week treatment program, manual and placebo applications were executed two days in a week, for the same duration and position. Before and at the end of the treatment program, mobility, pain, pressure pain threshold and disability were evaluated with CROM device, Visual Analogue Scale, J-tech digital algometer device and Neck Disability Index. Results: While there was a statistically significant improvement after treatment in Group 2 in all parameters, this improvement was greater than the other two groups (p <0.05). The decrease in some parameters of mobility and pain was found more in Group 3 compared to Group 1, statistically (p <0.05). Conclusion: Manual therapy has a more pronounced and significant effect on mobility, pain, pressure pain threshold, and disability in patients with nonspecific neck pain. Key Words: Manuel therapy, mobility, pressure pain threshold, function.

Anahtar Kelimeler

• manuel terapi
• eklem hareket açıklığı
• basınç ağrı eşiği
• fonksiyon

Kaynakça

1. Referans1. Bogduk N. Prise en charge des cervicalgies aiguës et chroniques. First edition, Elsevier, Paris 2007.
2. Referans2. Binder A. The diagnosis and treatment of nonspecific neck pain and whiplash. Eura Medicophys. 2007; 43(1):79.
3. Referans3. Fejer R, Kyvik KO, Hartvigsen J. The prevalence of neck pain in the world population: a systematic critical review of the literature. Eur Spine J. 2006; 15(6):834-848.
4. Referans4. Haldeman S, Carroll L, Cassidy JD, Schubert J, Nygren Å. The bone and joint decade 2000–2010 task force on neck pain and its associated disorders: executive summary. Eur Spine J. 2008; 5(7): 5-7.
5. Referans5. Borghouts JA, Koes BW, Vondeling H, Bouter LM. Cost-of-illness of neck pain in The Netherlands in 1996. Pain. 1999; 80(3): 629-636.
6. Referans6. Hakgüder A, Kokino S. Manuel terapi. Trakya Üniversitesi Tıp Fakültesi Dergisi, 2002; 9(2):128-136.
7. Referans7. Kisner C, Colby L. Therapeutic exercise. foundations and techniques. Sixth edition, FA Davis Company, Philadelphia 2012 p:351-358.
8. Referans8. Farooq MN, Mohseni-Bandpei MA, Gilani SA, Ashfaq M, Mahmood Q. The effects of neck mobilization in patients with chronic neck pain: A randomized controlled trial. Journal of J Bodyw Mov Ther. 2018; 22(1):24-31.

9. Referans9. Fredin K, Lorås H. Manual therapy, exercise therapy or combined treatment in the management of adult neck pain–a systematic review and meta-analysis. Musculoskelet Sci Pract. 2017; 3162-71.
10. Referans10. Pérez HI, Perez JLA, Martinez AG, La Touche R, Lerma-Lara S, Gonzalez NC. et al. Is one better than another?: A randomized clinical trial of manual therapy for patients with chronic neck pain. Man Ther. 2014; 19(3):215-221.
11. Referans11. La Touche R, París-Alemany A, Mannheimer JS, Angulo-Díaz-Parreño S, Bishop MD, Lopéz-Valverde-Centeno A and et al. Does mobilization of the upper cervical spine affect pain sensitivity and autonomic nervous system function in patients with cervico-craniofacial pain?: A randomized-controlled trial. Clin J Pain. 2013; 29(3):205-215.
12. Referans12. Salom-Moreno J, Ortega-Santiago R, Cleland JA, Palacios-Ceña M, Truyols-Domínguez S, Fernández-de-las-Peñas C. Immediate changes in neck pain intensity and widespread pressure pain sensitivity in patients with bilateral chronic mechanical neck pain: a randomized controlled trial of thoracic thrust manipulation vs non–thrust mobilization. J Manipulative Physiol Ther. 2014; 37(5):312-319.
13. Referans13. Snodgrass SJ, Rivett DA, Sterling M, Vicenzino B. Dose optimization for spinal treatment effectiveness: a randomized controlled trial investigating the effects of high and low mobilization forces in patients with neck pain. J Orthop Sports Phys Ther. 2014; 44(3):141-152.
14. Referans14. Sterling M, Pedler A, Chan C, Puglisi M, Vuvan V, Vicenzino, B. 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. Man Ther. 2010; 5(2):149-153.
15. Referans15. Sterling M, Jull G, Wright A. Cervical mobilisation: concurrent effects on pain, sympathetic nervous system activity and motor activity. Man Ther. 2001; 6(2):72-81.
16. Referans16. Tuttle N, Barrett R, Laakso L. Relation between changes in posteroanterior stiffness and active range of movement of the cervical spine following manual therapy treatment. Spine, 2008; 33(19):673-679.
17. Referans17. Goodsell M, Lee M, Latimer J. Short-term effects of lumbar posteroanterior mobilization in individuals with low-back pain. J Manipulative Physiol Ther. 2000; 23 (5):332-342.
18. Referans18. Law EYH, Chiu TTW. Measurement of cervical range of motion (CROM) by electronic CROM goniometer: a test of reliability and validity. J Back Musculoskelet Rehabil. 2013; 26(2):141-148.
19. Referans19. Huskisson E, Jones J, Scott PJ. Application of visual-analogue scales to the measurement of functional capacity. Rheumatol Rehabil.1976;15(3):185-187.
20. Referans20. Vanderweeën L, Oostendorp RAB, Vaes P, Duquet W. Pressure algometry in manual therapy. Man Ther.1996; 1(5):258-265.
21. Referans21. Chesterton LS, Sim J, Wright CC, Foster NE. Interrater reliability of algometry in measuring pressure pain thresholds in healthy humans, using multiple raters. Clin J Pain. 2007; 23(9):760-766.
22. Referans22. de Camargo VM, Alburquerque-Sendín F, Bérzin F, Stefanelli VC, de Souza DPR, Fernández-de-las-Peñas C. Immediate effects on electromyographic activity and pressure pain thresholds after a cervical manipulation in mechanical neck pain: a randomized controlled trial. J Manipulative Physiol Ther. 2011; 34(4):211-220.
23. Referans23. Vernon H, Mior S. The Neck Disability Index: a study of reliability and validity. J Manipulative Physiol Ther. 1991; 14(7):409-415.
24. Referans24. Telci EA, Karaduman A, Yakut Y, Aras B, Simsek IE, Yagli, N. The cultural adaptation, reliability, and validity of neck disability index in patients with neck pain: a Turkish version study. Spine, 2009;34(16):1732-1735.
25. Referans25. Kaltenborn F. Manual Mobilization of the Joints, Volume 2: The Spine. Norlis Bokhandel, Oslo 2018 p:265-312.
26. Referans26. Millan M, Leboeuf-Yde C, Budgell B, Descarreaux M, Amorim M. The effect of spinal manipulative therapy on spinal range of motion: a systematic literature review. Chiropr Man Therap. 2012; 20: 23.
27. Referans27. Vincent K, Maigne J-Y, Fischhoff C, Lanlo O, Dagenais S. Systematic review of manual therapies for nonspecific neck pain. Joint Bone Spine. 2013; 80(5):508-515.
28. Referans28. Jun P, Pagé I, Vette A, Kawchuk G. Potential mechanisms for lumbar spinal stiffness change following spinal manipulative therapy: a scoping review. Chiropractic & Manual Therapies, 2020; 28(1): 1-13.
29. Referans29. Tecer D, Yaşar E, Adıgüzel E, Kesikburun S, Köroğlu Ö, Taşkaynatan MA. ve ark. Which treatment protocol is better in rehabilitation of joint contracture?. Gulhane Medical Journal, 2020; 62(1):14-20.
30. Referans30. Shamsi M, Vaisi-Raygani A, Rostami A, Mirzaei M. The effect of adding TENS to stretch on improvement of ankle range of motion in inactive patients in intensive care units: a pilot trial. BMC Sports Sci Med Rehabil. 2019;1(1):15.
31. Referans31. Carlino E, Piedimonte A, Frisaldi E. The effects of placebos and nocebos on physical performance. Handb Exp Pharmacol. 2014; 225:2149-2157.
32. Referans32. Fiorio M, Andani ME, Marotta A, Classen J, Tinazzi M. Placebo-induced changes in excitatory and inhibitory corticospinal circuits during motor performance. J Neuroscience, 2014; 34(11):3993-4005.
33. Referans33. Voogt L, de Vries J, Meeus M, Struyf F, Meuffels D, Nijs J. Analgesic effects of manual therapy in patients with musculoskeletal pain: a systematic review. Man Ther. 2015: 20(2):250-256.
34. Referans34. Clark BC, Thomas JS, Walkowski SA, Howell JN. The biology of manual therapies. J Am Osteopath Assoc. 2012; 112(9):617-629.
35. Referans35. Benedetti F, Amanzio M. Mechanisms of the placebo response. Pulm Pharmacol Ther. 2013; 26(5):520-523.
36. Referans36. Finniss DG, Benedetti F. Mechanisms of the placebo response and their impact on clinical trials and clinical practice. Pain. 2005; 114(1):3-6.
37. Referans37. Carlino E, Benedetti F. Different contexts, different pains, different experiences. Neuroscience. 2016; 338:19-26.
38. Referans38. Benedetti F, Carlino E, Pollo A. How placebos change the patient's brain. Neuropsychopharmacology. 2011; 36(1):339-354.
39. Referans39. Amanzio M, Benedetti F, Porro CA, Palermo S, Cauda F. Activation likelihood estimation meta‐analysis of brain correlates of placebo analgesia in human experimental pain. Hum Brain Mapp. 2013; 34(3):738-752.