Bilateral Cervical Manipulation (C3/C4) on Thoracoabdominal Kinematics

Influence of Bilateral Cervical Manipulation (C3/C4) on Thoracoabdominal Kinematics on Healthy Young Adults: Randomized Controlled Trial (RCT)

There is evidence of the interdependence between the diaphragm and the C4 vertebral level with regard to nerve, fascial and muscular connections. The purpose of this study is to evaluate the influence of cervical bilateral manipulation (C3/C4) on the thoracoabdominal kinematics in healthy young adults.

Due to respiration the thoracoabdominal kinematics is considered a complex mechanism that evolves the movement of the ribs and fascia, the diaphragmatic function, the respiratory muscles and the mechanical properties of the airways that includes a coordinated reflex neural activity. The phrenic nerve (C3 to C5) is responsable for the motor and sensory innervation of the diaphragm.

The High Velocity Low Amplitude (HVLA) vertebral manipulation stimulates the corresponding spinal nerves. It is well known that when this manipulation is applied to cervical region induces vasomotor cutaneous and cardiorespiratory modifications in autonomic nervous system.

The sample composed of healthy young adults (aged 18-40 years) will be assigned randomly in three groups: experimental group (bilateral C3/C4 HVLA manipulation), sham manipulation group (passive cervical mobilization) and control group (no intervention). The thoracoabdominal kinematics measures will be assessed at baseline, right after the intervention and five minutes after the second measure using the Qualisys Motion Capture System.

Inclusion Criteria:

• Volunteers between 18 and 40 years of age.

Exclusion Criteria:

• Attending a degree in Osteopathy or being a health professional in this area;
• Apprehension to cervical manipulation;
• Be pregnant;
• Presenting cervical pain on the day of the study;
• Does not comply with the Australian Vertebral Artery Protocol guidelines;
• Having a clinical history of cervical and/or thoracoabdominal surgery;
• Having a clinical history of cervical trauma during the prior 12 months;
• Recurrent use of anti-coagulant and/or analgesic, muscle relaxant or anti-inflammatory therapeutics during the week before the study;
• Have been submitted to any manual intervention at cervical region during the week before the study;
• Having cardio-respiratory, neurological, rheumatic, oncologic and/or systemic diagnosed pathologies.