title: Immediate effects of atlanto-occipital joint manipulation on active mouth opening and pressure pain sensitivity in women with mechanical neck pain.
abstract: OBJECTIVE
  The purpose of this study was to investigate the effects of a spinal thrust manipulation directed to the upper cervical segments (atlanto-occipital joint) on active mouth opening and pressure pain sensitivity in a trigeminal nerve innervated region (sphenoid bone) in women with mechanical neck pain.
  
  
  METHODS
  Thirty-seven women, ages 21 to 50 years old (mean age, 35 +/- 8 years) with mechanical neck pain were recruited for this study. Participants were randomly assigned into 1 of 2 groups as follows: an experimental group that received a spinal manipulation of the atlanto-occipital joint and a control group that received a manual contact placebo intervention. Outcomes collected were assessed pretreatment and 5 minutes posttreatment by an assessor blinded to the treatment allocation and included active mouth opening and pressure pain thresholds (PPTs) over both sides of the sphenoid bone. A 2-way repeated measures analysis of variance (ANOVA) with time (pre-post) as the within subjects variable and group (control, experimental) as the between subjects variable was used to examine the effects of the intervention. The hypothesis of interest was group-time interaction.
  
  
  RESULTS
  The ANOVA showed a significant effect for time (F = 23.1; P < .001) and an interaction between group and time (F = 37.7; P < .001) for active mouth opening as follows: the experimental group showed a greater improvement when compared to the control group. A large positive within-group effect size (d > 1.5) for the experimental group, whereas a negative medium within-group effect size (d = -0.5) for the control group were identified. The ANOVA showed a significant interaction between group and time (F = 14.4; P < .001) for PPT levels at the sphenoid bone as follows: the experimental group showed a greater improvement when compared to the control group. A medium positive within-group effect size (d = -0.5) for the experimental group, whereas a negative medium within-group effect size (d = -0.5) for the control group was found.
  
  
  CONCLUSIONS
  Our findings suggest that the application of an atlantoaxial joint thrust manipulation resulted in an increase in active mouth opening and PPT over a trigeminal nerve distribution area (sphenoid bone) in women with mechanical neck pain.
authors.affiliation: Professor, Escuela de Osteopatía de Madrid, Spain.
authors.forename: Pilar
authors.initials: P
authors.lastname: Mansilla-Ferragut
authors.forename: César
authors.initials: C
authors.lastname: Fernández-de-Las Peñas
authors.forename: Francisco
authors.initials: F
authors.lastname: Alburquerque-Sendín
authors.forename: Joshua A
authors.initials: JA
authors.lastname: Cleland
authors.forename: Juan José
authors.initials: JJ
authors.lastname: Boscá-Gandía
mesh_terms: D000328:Adult; D001269:Atlanto-Occipital Joint / Q000503:physiopathology*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D020393:Manipulation, Spinal / Q000379:methods*; D008875:Middle Aged; D009055:Mouth / Q000502:physiology; D019547:Neck Pain / Q000175:diagnosis / Q000534:rehabilitation*; D010147:Pain Measurement; D017288:Pain Threshold / Q000502:physiology; D017060:Patient Satisfaction; D011312:Pressure; D016059:Range of Motion, Articular / Q000502:physiology*; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult