title: The immediate cardiovascular response to joint mobilization of the neck - A randomized, placebo-controlled trial in pain-free adults.
abstract: Some normotensive patients can have a spike in resting systolic blood pressure (SBP) in response to acute neck pain. Applying the typical dosage of mobilization may potentially result in a sympatho-excitatory response, further increasing resting SBP. Therefore, there is a need to explore other dosage regimens that could result in a decrease in SBP.
  
  
  
  To compare the blood pressure (BP) and heart rate (HR) response of pain-free, normotensive adults when receiving unilateral posterior-to-anterior mobilization (PA) applied to the neck versus its corresponding placebo (PA-P).
  
  
  
  Double-Blind, Randomized Clinical Trial.
  
  
  
  44 (18 females) healthy, pain-free participants (mean age, 23.8 ± 3.04 years) were randomly allocated to 1 of 2 groups. Group 1 received a PA-P in which light touch was applied to the right 6th cervical vertebra. Group 2 received a PA to the same location. BP and HR were measured prior to, during, and after the application of PA or PA-P. A mixed-effect model of repeated measure analysis was used for statistical analysis.
  
  
  
  During-intervention, the PA group had a significant reduction in SBP, while the placebo group had an increase in SBP. The change in SBP during-intervention was significantly different between the PA and the placebo group (p-value = 0.003). There were no significant between-group differences found for HR and diastolic BP (DBP). The overall group-by-time interaction was statistically significant for SBP (p-value = 0.01).
  
  
  
  When compared to placebo, the dosage of applied PA resulted in a small, short-lived drop in SBP not exceeding the minimal detectable change. Trial registered at Germanctr.de (DRKS00005095).
authors.affiliation: Doctor of Physical Therapy Program, Sacred Heart University, Fairfield, CT, United States; Doctor of Physical Therapy Program, Azusa Pacific University, Azusa, CA, United States; PhD Program in Ergonomics and Biomechanics, OIOC Research & Education, New York University Langone Medical Center, New York, NY, United States; Elevating Practice in Orthopaedic Physical Therapy, MGH Institute of Health Professions, Boston, MA, United States. Electronic address: yunge@sacredheart.edu.
authors.forename: Emmanuel Y
authors.initials: EY
authors.lastname: Yung
authors.affiliation: Division of Biostatistics, Department of Population Health, New York University School of Medicine, New York, NY, United States. Electronic address: ohc03@nyumc.org.
authors.forename: Cheongeun
authors.initials: C
authors.lastname: Oh
authors.affiliation: Doctor of Physical Therapy Program, Azusa Pacific University, Azusa, CA, United States; Physical Therapy Spine Fellowship, University of Southern California, Los Angeles, CA, United States; Physical Therapy Spine Fellowship, Kaiser Permanente, Los Angeles, CA, United States. Electronic address: mswong@apu.edu.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Wong
authors.affiliation: Doctor of Physical Therapy Program, Sacred Heart University, Fairfield, CT, United States. Electronic address: grimesj@sacredheart.edu.
authors.forename: Jason K
authors.initials: JK
authors.lastname: Grimes
authors.affiliation: Orthopaedic Physical Therapy Residency Program, Kaiser Permanente Panorama City Medical Center, Panorama City, CA, United States. Electronic address: erica.jung.4@gmail.com.
authors.forename: Erica M
authors.initials: EM
authors.lastname: Barton
authors.affiliation: Doctor of Physical Therapy Program, Sacred Heart University, Fairfield, CT, United States; United States Army Reserve, West Hartford, CT, United States. Electronic address: iali4527@gmail.com.
authors.forename: Muhammad I
authors.initials: MI
authors.lastname: Ali
authors.affiliation: Doctor of Physical Therapy Program, Sacred Heart University, Fairfield, CT, United States. Electronic address: CameronD@sacredheart.edu.
authors.forename: David
authors.initials: D
authors.lastname: Cameron
mesh_terms: D000328:Adult; D001794:Blood Pressure / Q000502:physiology*; D004311:Double-Blind Method; D005260:Female; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D006973:Hypertension / Q000209:etiology* / Q000628:therapy*; D007103:Immobilization / Q000379:methods*; D008297:Male; D019547:Neck Pain / Q000150:complications* / Q000503:physiopathology / Q000628:therapy*; D026741:Physical Therapy Modalities; D055815:Young Adult
keywords: Blood pressure; Cervical spine; Clinical trials/intervention; Heart rate; Joint mobilization