Non-thrust cervical manipulations reduce short-term pain and decrease systolic blood pressure during intervention in mechanical neck pain: a randomized clinical trial

J Man Manip Ther. 2020 May;28(2):82-93. doi: 10.1080/10669817.2019.1646985. Epub 2019 Aug 4.


Objectives: To evaluate the association of resting blood pressure with pain response and evaluate the cardiovascular effects of anterior-to-posterior [AP] versus lateral [LAT] techniques of cervical spine non-thrust manipulation [NTM].Methods: Forty-three (23 females) participants with non-chronic neck pain (mean age 29.00 ± SD 9.09 years) randomly received AP or LAT NTM to the cervical spine. Blood pressure and heart rate were measured before, during, and after the intervention. Disability and pain were measured pre- and post-intervention.Results: Resting systolic blood pressure (SBP) was significantly associated with average pain reduction two days later on univariate and multivariate analyses (coefficients -0.029 ± SD 0.013, p = 0.036; -0.026 ± 0.012, p = 0.032).No significant differences existed between AP and LAT NTM groups in disability, pain reduction, and cardiovascular variables. The decrease in 'worst neck pain' rating 2-days post-intervention was clinically significant within the AP (mean -2.43 ± SD 2.66) group. Mixed-effect model ANOVA revealed a significant change in SBP over time (estimate -1.94 ± SD 0.70, p = 0.007).Discussion: This spinal NTM study was the first to relate resting SBP with short-term pain reduction, demonstrating SBP-related hypoalgesia. In normotensive individuals with unilateral non-chronic neck pain, each 10 mmHg higher resting SBP was associated with a 0.29-unit decrease in average pain at follow-up when holding baseline pain constant.AP and LAT NTM equally reduced short-term pain and decreased SBP during-intervention, suggesting SBP-sympathoinhibition. These techniques have previously been shown to be sympatho-excitatory when delivered under different dosage parameters. SBP's mediating and moderating role should be investigated."Level of Evidence: 1b."

Keywords: Mechanical neck pain; blood pressure; dosage; hypoalgesia; sympatho-inhibition.

Publication types

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

MeSH terms

  • Adult
  • Blood Pressure / physiology*
  • Disability Evaluation
  • Female
  • Heart Rate / physiology*
  • Humans
  • Male
  • Manipulation, Spinal / methods*
  • Middle Aged
  • Neck Pain / physiopathology*
  • Neck Pain / therapy*
  • Pain Management / methods*
  • Pain Measurement
  • Young Adult

Grants and funding

The American Academy of Orthopaedic and Manual Physical Therapists OPTP Grant provided funding for this study.The Ethics Committees of Sacred Heart University and Azusa Pacific University approved the protocol of this study. All participants provided their written informed consent after they were informed of their rights and the purpose and procedure of the study.