No immediate changes on neural and muscular mechanosensitivity after first rib manipulation in subjects with cervical whiplash: A randomized controlled trial

Abstract

Background: Upper rib manipulative therapy appears to be effective on primary complaint of shoulder pain, but its efficacy has not been evaluated in subjects with whiplash-associated disorders.

Objective: To assess the immediate changes on neural and muscular mechanosensitivity after first-rib manipulation in patients with neck or cervicobrachial pain secondary to cervical whiplash (CW).

Methods: A single-blind (evaluators were blinded to subject allocation) randomized trial was conducted. Fifty-three (N = 53) subjects, 34.7 (SD 10.8 years; 56.6% females), with cervical or cervicobrachial pain following CW, were distributed into two groups. The experimental group (n = 27) underwent a single first-rib high-velocity low-amplitude manipulation technique, while the control group (n = 26) received a sham placebo intervention. Outcome measures were taken at baseline and immediately after intervention, of the pressure pain threshold over the trigeminal, median and ulnar nerves, and over the area described for the location of tense bands in the upper trapezius, masseter, biceps brachii and triceps brachii muscles.

Results: No significant differences in mechanosensitivity values were observed after intervention in the between-groups comparison (p > 0.05).

Conclusion: The use of a sole first-rib thrust technique has no immediate effect on neural or muscular mechanosensitivity, when compared to placebo, in subjects with cervical or cervicobrachial pain after CW.

Keywords: Brachial plexus; manual therapy; pain threshold; ribs; whiplash injuries.