Manual Therapy, Posturology & Rehabilitation Journal
Manual Therapy, Posturology & Rehabilitation Journal
Case Study

Spinal manipulation effect on pain and cardiac autonomic modulation in patients with rotator cuff tendinopathy: a pilot study

Alyssa Conte Silva; Juliana Falcão Padilha; Jefferson Luiz Brum Marques; Cláudia Mirian de Godoy Marques

Downloads: 1
Views: 358


Introduction: there are few studies that propose to identify the relationship of Vertebral Manipulation (VM) on pain and cardiac autonomic modulation, especially in subjects with rotator cuff injury. Objective: To analyze the effect of chest VM on the pain and cardiac autonomic modulation in patients with rotator cuff (RC). Method: quasi-experimental study with a quantitative approach. Sample of 6 subjects divided into two groups: Asymptomatic Group (AG, n = 3) not presenting shoulder injury and pain complaints and Symptomatic Group (SG, n = 3), with rotator cuff injury. Pain assessment was performed by Visual Analog Scale (VAS) before and after handling, as well as the assessment of Heart Rate Variability (HRV) using an electrocardiogram (ECG) with 8 minutes of duration. Chest VM was held on 4th and 5th thoracic vertebra. The analysis of HRV was performed in the Frequency Domain (VLF-very low frequency, LF-low frequency, HF-high frequency, LF/HF-ratio between low and high frequency). The statistical analysis used the Wilcoxon test for comparison in the same group and the Mann Whitney test for comparison between groups, adopting a 5% significance (p <0.05). Results: There was a reduction of post handling pain, but no statistically significant difference in SG (p=0.317). In HRV the AG showed a decrease VLF (p=0.83) and increased LF (p=0.51), HF (p=0.83) and LF/HF (p=0.51) variables. In the SG, there was an increase in VLF (p=0.83), LF (p=0.83), HF (p=0.51) variables and a decrease in LF/HF (p=0.51) variable. Conclusion: The upper thoracic VM had no effect on the pain and cardiac autonomic modulation in patients with rotator cuff (RC).


Rotator Cuff, Pain, Shoulder, Spinal Manipulation, Tendinopathy,


1. Saggini R, Cavezza T, Di Pancrazio L, Pisciella V, Saladino G, Zuccaro MC, et al. Treatment of lesions of the rotator cuff. J Biol Regul Homeost Agents. 2010;24(4):453-9.

2. Lasbleiz S, Quintero N, Ea K, Petrover D, Aout M, Laredo JD, et al. Diagnostic value of clinical tests for degenerative rotator cuff disease in medical practice. Ann Phys Rehabil Med. 2014;57(4):228-43.

3. Fukuda H. Partial-thickness rotator cuff tears: a modern view on Codmans classic. J. Shoulder Elbow Surg. 2000;9(2):163-168.

4. Shin KM. Partial-thickness rotator cuff tears. Korean J Pain. 2011;24(2):69-73.

5. Haik M, Sendín F, Silva C, Junior A, Ribeiro I, Camargo P. Scapular Kinematics pré-and post- thoracic thrust Manipulation in individuals with and without shoulder impingement symptoms: a randomized contolled study. J Orthop Sports Phys Ther. 2014;44(7):475-487.

6. Riley S, Bialosky J, Cote M, Swanson B, Tafuto V, Sizer P, et al. Thoracic spinal manipulation for musculoskeletal shoulder pain: Can an instructional set change patient expectation and outcome? Man. Ther. 2015;20(3):469-474.

7. Michener LA, Kardouni JR, Sousa CO, Ely JM. Validation of a sham comparator for thoracic spinal manipulation in patients with shoulder pain. Man Ther. 2015;20(1):171-175.

8. Ricard F, Sallé JL. Tratado de Osteopatía. 3º.ed. Madrid: Panamericana, 2010.

9. Welch A, Boone R. Sympathetic and parasympathetic responses to specific diversified adjustments to chiropractic vertebral subluxations of the cervical and thoracic spine. Journal of Chiropratic Medicine. 2008;7(3):86-93.

10. Shafiq H, Mcgregor C, Murphy B. The impact of cervical manipulation on heart rate variability.Engineering in Medicine and Biology Society. 2014;3406-3409.

11. Roy R, Bouche, J, Comtois A. Heart rate variability modulation after manipulation in pain-free patients vs patients in pain. Journal of Manipulative and Physiological Therapeutics. 2009;32(4):277-286.

12. Moss D, Shaffer F. Heart Rate Variability Training. [Internet]. [Acesso em: 6 de mai. 2016] Disponível em: .

13. Michener LA, Walsworth MK, Doukas WC, Murphy KP. Reliability and Diagnostic Accuracy of 5 Physical Examination Tests and Combination of Tests for Subacromial Impingement. Arch Phys Med Rehabil. 2009;90(11):1898-903.

14. Tashjian RZ, Deloach J, Porucznik CA, Powell AP. Minimal clinically important differences (MCID) and patient acceptable symptomatic state (PASS) for visual analog scales (VAS) measuring pain in patients treated for rotator cuff disease. J Shoulder Elbow Surg. 2009;18(6):927-932.

15. Task Force of the European Society of Cardiology. Heart rate variability: standards of measurement, physiological interpretation and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology.Circulation. 1996;93(5):1043-1065.

16. Maitland G, Hengeveld E, Banks K, English K. Maitland’s Vertebral Manipulation. 7º ed. Philadelphia: Elsevier Butterworth-Heinemann, 2007.

17. Muth S, Barbe M, Lauer R, Mcclure P. The effects of thoracic spine manipulation in subjects with signs of rotator cuff tendinopathy. J Orthop Sports Phys Ther. 2012;42(12):1005-1016.

18. Colloca L, Benedetti F. Placebos and painkillers: is mind as really as matter? Nature Rev Neurosci. 2005;6:545-552.

19. Benedetti F. Mechanisms of placebo and placebo-related effects across diseases and treatments. Annu Rev Pharmacol Toxicol. 2008;48:33-60.

20. Benedetti F. The Patient’s Brain: The Neuroscience Behind the DoctorePatient Relationship. Oxford: Oxford University Press, 2010.

21. Bakewell S. The autonomic nervous system. Update Anaesth. 1995;(5):6.

22. Budgell BS. Reflex effects of subluxation: the autonomic nervous system. J Manipulative Physiol Ther. 2000;23(2):104-106.

23. Budgell B, Polus B. The effects of thoracic manipulation on heart rate variability: a controlled crossover trial. Journal of Manipulative and Physiological Therapeutics. 2006;29(8):603-610.

24. Driscoll MD, Hall MJ. Effects of spinal manipulative therapy on autonomic activity and the cardiovascular system: a case study using the electrocardiogram and arterial tonometry. J Manipulative Physiol Ther. 2000;23(8):545-50.

58c6c8fd0e8825385d1d83a0 mtprehab Articles
Links & Downloads

Man. Ther., Posturology Rehabil. J.

Share this page
Page Sections