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 Apr;15(2):149-53. doi: 10.1016/j.math.2009.09.004. Epub 2009 Nov 1.


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.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Female
  • Humans
  • Hyperesthesia / etiology
  • Hyperesthesia / rehabilitation*
  • Male
  • Manipulation, Spinal / methods*
  • Middle Aged
  • Neck Pain / etiology
  • Neck Pain / rehabilitation*
  • Pain Measurement / methods
  • Pilot Projects
  • Range of Motion, Articular
  • Single-Blind Method
  • Surveys and Questionnaires
  • Temperature
  • Treatment Outcome
  • Whiplash Injuries / complications
  • Whiplash Injuries / rehabilitation*
  • Young Adult