A systematic review and meta-analysis on effect of spinal mobilization and manipulation on cardiovascular responses

Abstract

Background: Spinal pain or misalignment is a very common disorder affecting a significant number of populations resulting in substantial disability and economic burden. Various manual therapeutic techniques such as spinal manipulations and mobilizations can be used to treat and manage pain and movement dysfunctions such as spinal mal-alignments and associated complications. These manual therapeutic techniques can affect the cardiovascular parameters.

Objective: The objective of this systematic review and meta-analysis is to assess the effect of spinal manipulation and mobilization on cardiovascular parameters.

Methods: We conducted a systematic review and meta-analysis to assess the effects of spinal mobilization and manipulation on cardiovascular responses. Mean changes in Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP) and Heart Rate (HR) were primary outcome measures. RevMan 5.3 software was used for the meta-analyses. Quality of the included studies was assessed by PEDro Rating scale. Risk of bias was assessed by Cochrane collaboration tool of risk of bias.

Results: Results of meta-analysis showed that there was statistically significant decrease in SBP ( $\text{MD}=-4.56$ , 95% $\text{CI}=-9.20$ , 0.08; $p\le 0.05$ ) with moderate heterogeneity ( $\text{I}2=75\%$ , $p<0.0002$ ) in experimental group as compared to control group. There was statistically non-significant decrease in DBP ( $\text{MD}=-1.96$ , 95% $\text{CI}=-4.60$ , 0.69; $p=0.15$ ) with high heterogeneity ( $\text{I}2=91\%$ , $p<0.00001$ ), Change HR was statistically non-significant ( $\text{MD}=-0.24$ , 95% $\text{CI}=-3.59$ , 3.11; $p=0.89$ ) with moderate heterogeneity ( $\text{I}2=60\%$ , $p=0.01$ ). Exclusion of short duration studies in sensitivity analysis revealed a statistically significant change in DBP ( $\text{MD}=-0.94$ , 95% $\text{CI}=-1.85$ , $-0.03$ ; $p=0.04$ ). However, the result was statistically non-significant for HR after sensitivity analysis.

Conclusion: Spinal manipulations and mobilizations may result in significant decrease of systolic as well as diastolic Blood Pressure.

Keywords: Spinal manipulations; blood pressure; cardiovascular responses; heart rate; spinal mobilizations.