1. Investigación

Objective. The main objective of this trial was to assess whether action observation (AO) training and motor imagery (MI) produced changes in the cervical joint position sense (CJPS) both at the end of the intervention and 10 min postintervention compared with a placebo intervention in patients with nonspecific chronic neck pain (NSCNP). Methods. A single-blind placebo clinical trial was designed. A total of 30 patients with NSCNP were randomly assigned to the AO group, MI group or placebo observation (PO) group. CJPS in flexion, extension and rotation movements in both planes were the main variables. Results. The results obtained in the vertical plane showed that the AO group obtained greater impr ovements than the PO group in the CJPS in terms of cervical extension movement both at the end of the intervention and 10 min postintervention (p = .001, d = 1.81 and p = .004, d = 1.74, respectively), and also in cervical flexion movement, although only at 10 min after the intervention (p = .035, d = 0.72). In addition, the AO group obtained greater improvements than the MI group in the CJPS only at the end of the intervention in cervical extension movement (p = .041, d = 1.17). Regarding the left rotation cervical movement, both the MI and AO groups were superior to the PO group in both planes at the end of the intervention (p < .05, d > 0.80). Conclusions. Although both AO and MI could be a useful strategy for CJPS improvement, the AO group showed the strongest results. The therapeutic potential of the application of mental practice in a clinical context in the early stages of rehabilitation of NSCNP should be considered.

The aim of the present study was to explore the pain modulation effects of motor imagery(MI) and action observation (AO) of specific neck therapeutic exercises both locally, in the cervicalregion, and remotely. A single-blind, placebo clinical trial was designed. A total of 30 patients withchronic neck pain (CNP) were randomly assigned to an AO group, MI group, or placebo observation(PO) group. Pain pressure thresholds (PPTs) of C2/C3, trapezius muscles, and epicondyle werethe main outcome variables. Secondary outcomes included heart rate measurement. Statistically significant differences were observed in PPTs of the cervical region in the AO and MI groups betweenthe preintervention and first postintervention assessment. Significant differences were found inthe AO group in the epicondyle between the preintervention, first and second post-intervention assessments. Regarding heart rate response, differences were found in the AO and MI groups betweenthe preintervention and average intervention measurements. AO and MI induce immediate painmodulation in the cervical region and AO also induces remote hypoalgesia. OA appears to lead togreater pain modulation as well as a greater heart rate response, however, both should be clinicallyconsidered in patients with CNP.

Introducción. En la actualidad no existe suficiente evidencia científica acerca de los efectos de las manipulaciones osteopática vertebrales mediante thrust sobre el flujo de las arterias y venas. El conocimiento preciso de los posibles efectos post-manipulativos en los valores hemodinámicos locales y sistémicos es necesario para establecer indicaciones y contraindicaciones precisas, así como para desterrar miedos infundados al uso de la terapia osteopática. Objetivos. El conocimiento que pretende alcanzar este estudio es la relación causa efecto, entre la manipulación cervical, en este caso en rotación de C1, y su impacto sobre los valores hemodinámicos de las arterias carótidas internas, el umbral de dolor a la presión y la movilidad rotatoria suboccipital en sujetos con cervicalgia. Material y métodos. Estudiamos una muestra de 89 sujetos (n=89) mediante estudio aleatorizado a doble ciego. Aleatorizados 59 sujetos con cervicalgia y test de flexión rotación positivos, 30 sujetos en el grupo intervención y 29 sujetos en el grupo control . También se realizó un grupo de intervención en 30 sujetos asintomáticos y con test de flexión rotación negativo. Al G1 (grupo de Experimental con disfunción) se le aplica la técnica manipulativa y al G2( grupo de control con disfunción) un placebo. En ambos medimos los valores hemodinámicos de flujo, velocidad, pulsatilidad, resistividad, presión arterial y frecuencia cardiaca, así como valores algométricos y de rango de movilidad cervical superior, tras la intervención y 24 horas después y los comparamos con los valores basales previos. Al G3 ( grupo intervención en sujetos sanos) se les aplica la intervención manipulativa, en presencia de TFR neativo (Test flexión rotación). Resultados. Tras la intervención, observamos un aumento significativo en el G1 en la algometría post1, respecto de los valores basales. Una reducción significativa en el G1 respecto al G2 y G3 de los índices de resistividad en ambas arterias carótidas internas tras la intervención y a las 24 horas de la intervención. Un aumento significativo en el G1 respecto al G2 yG3 de los índices de pulsatilidad de ambas arterias carótidas internas post intervención y a las 24 horas de la intervención . En el grupo de sujetos asintomáticos no encontramos cambios significativos entre los valores basales previos y los valores post-manipulativos. Conclusiones. La técnica de thrust en rotación para C1 en sujeto con test de flexión-rotación (TFR) positivo parece aumentar la movilidad cervical, disminuir el umbral de dolor a la presión, reducir la resistividad y aumentar la pulsatilidad en ambas arterias carótidas internas. Así mismo aplicación de dicha técnica no genera cambios hemodinámicos potencialmente peligrosos en los sujetos del grupo experimental. / Introduction. There is currently not enough scientific evidence about the effects of osteopathic spinal manipulation with thrust on the flow of the arteries and veins. Precise knowledge of the possible post-manipulative effects on local and systemic hemodynamics is needed to establish precise indications and contraindications, as well as to banish unfounded fears about the use of osteopathic medicine Objectives. To know the cause and effect relationship between cervical manipulation, in this case rotation of Atlas, and its impact on the hemodynamics of internal carotid arteries, pain pressure threshold and suboccipital rotation in subjects with neck pain. Material and methods. We studied a sample of 89 subjects (n = 89), 30 in the group G1 ( intervention with positive test), 29 to the control group G2 ( placebo with positive test) and 30 subjects on group G3 ( intervention without positive test). The mean age was 31.76 ± 9.41 years. All subjects in G1 andG2 are diagnosed with cervical pain and have a positive flexión testd and rotation. Subjects in G3 has no positive test or neck pain. At G1 and G3 is applied manipulative technique and placebo at G2. In both hemodynamic values measured flow velocity, pulsatility, resistivity, high blood pressure and heart rate, as well as algometricos values and range of superior cervical mobility after surgery and 24 hours later and we compare with the previous baseline Results. After surgery, we observed a significant increase in G1 regarding pain threshold pressure (ALGO) Post 1 compared to baseline values. A significant reduction in G1 regarding resistivity indices in both internal carotid arteries, specially at 24 hours after the thrust . Immediate post reducing resistivity is significant too. A significant increase in GE1 compared to G2 and G3 pulsatility indices of both internal carotid arteries at 24 hours after surgery . Conclusions. The rotating thrust technique for C1 in subject with flexion-rotation test (TFR) positive appears to increase mobility, reduce pain pressure threshold, reduce the resistivity and makes pulsatility increase in both internal carotid arteries. Also application of this technique does not generate hazardous hemodynamic changes in experimental subjects.