Access to this full-text is provided by Wiley.
Content available from Evidence-based Complementary and Alternative Medicine
This content is subject to copyright. Terms and conditions apply.
Research Article
Effect of Osteopathic Visceral Manipulation on Pain,
Cervical Range of Motion, and Upper Trapezius Muscle Activity
in Patients with Chronic Nonspecific Neck Pain and Functional
Dyspepsia: A Randomized, Double-Blind, Placebo-Controlled
Pilot Study
Andréia Cristina de Oliveira Silva,1Daniela Aparecida Biasotto-Gonzalez,1
Fábio Henrique Monteiro Oliveira ,2Adriano Oliveira Andrade,2
Cid André Fidelis de Paula Gomes,2Fernanda de Córdoba Lanza,1
César Ferreira Amorim,3and Fabiano Politti 1
1Postgraduate Program in Rehabilitation Sciences, Physical erapy Departament, Universidade Nove de Julho, UNINOVE, Brazil
2Faculty of Electrical Engineering, Postgraduate Program in Electrical and Biomedical Engineering, Centre for Innovation and
Technology Assessment in Health, Federal University of Uberlˆ
andia, (UFU), Brazil
3Physical erapy Program, Universidade Cidade de S˜
ao Paulo (UNICID), S˜
ao Paulo-SP, Brazil
Correspondence should be addressed to Fabiano Politti; fpolitti@ig.com.br
Received 30 June 2018; Accepted 23 October 2018; Published 11 November 2018
Academic Editor: Andreas Sandner-Kiesling
Copyright © Andr´eia Cristina de Oliveira Silva et al. is is an open access article distributed under the Creative Commons
Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is
properly cited.
Previous studies have reported that visceral disturbances can lead to increased musculoskeletal tension and pain in structures
innervated from the corresponding spinal level through viscerosomatic reexes. We designed a pilot randomised placebo-
controlled study using placebo visceral manipulation as the control to evaluate the eect of osteopathic visceral manipulation
(OVM) of the stomach and liver on pain, cervical mobility, and electromyographic activity of the upper trapezius (UT) muscle in
individuals with nonspecic neck pain (NS-NP) and functional dyspepsia. Twenty-eight NS-NP patients were randomly assigned
into two groups: treated with OVM (OVMG; n= ) and treated with placebo visceral manipulation (PVMG; n=).eeects
were evaluated immediately and days aer treatment through pain, cervical range, and electromyographic activity of the UT
muscle. Signicant eects were conrmed immediately aer treatment (OVMG and PVMG) for numeric rating scale scores (p<
.) and pain area (p<.). Signicant increases in EMG amplitude were identied immediately and days aer treatment for
the OVMG (p<.). No dierences were identied between the OVMG and the PVMG for cervical range of motion (p>.).
is study demonstrated that a single visceral mobilisation session for the stomach and liver reduces cervical pain and increases
the amplitude of the EMG signal of the UT muscle immediately and days aer treatment in patients with nonspecic neck pain
and functional dyspepsia.
1. Introduction
Nonspecic neck pain (NS-NP) is a musculoskeletal disorder
characterised by pain in the structures located between the
superior nuchal line and the spinous process of the rst
thoracic vertebra [], which is not associated with a particular
disease or modication of anatomical structures []. is
little-known dysfunction is thought to have a multifactorial
cause [] and contributes to substantial health care costs,
work absenteeism and loss of productivity at all levels [–].
e specic diagnosis of NS-NP is not clear in the liter-
ature or in clinical practice, as several dierent therapeutic
Hindawi
Evidence-Based Complementary and Alternative Medicine
Volume 2018, Article ID 4929271, 9 pages
https://doi.org/10.1155/2018/4929271
Evidence-Based Complementary and Alternative Medicine
modalities (manual therapy [], therapeutic exercise [],
auricular acupuncture [], and acupotomy therapy []) have
been described as a form of treatment for NS-NP. Fur-
thermore, as the clinical responses from these therapeutic
approaches vary in the literature, a specic intervention
cannot be identied as a more eective treatment for NS-
NP patients. Diculties in diagnosis and the need to nd
a specic treatment for this disorder reinforce the need to
investigate the possible mechanisms that give rise to cervical
pain [].
One mechanism that remains poorly understood is
related to the possibility that visceral disturbances can lead
to increased muscle tension and decreased pain threshold
in structures innervated at the corresponding spinal level
through viscerosomatic reexes []. Sensory nerves enter
the spinal cord, and those destined to terminate locally end
in the grey matter of the spinal cord where they produce
localsegmentalresponsessuchasexcitation,facilitationand
reex actions. In this way, a sensory stimulus may directly
aect a motor or sympathetic nerve, or do so through
an intermediary interneuron. ese interneurons may be
either excitatory or inhibitory [–]. erefore, the ongoing
aerent stimulation produced from restriction of the mobility
of tissues innervated by the phrenic nerve (subdiaphragmatic
peritoneum, liver capsule, coronary, and falsiform ligaments)
[, ] could promote facilitation (irritability) of the inter-
nuncial neurons at the levels at which their neural roots are
found (between C and C []). is results in increased
trapezius muscle tension, as this muscle is innervated by
nerve bres originating from the same medullary segment
(C and C).
Another possible visceral inuence in the cervical region
is the anatomical relationship between the accessory nerve,
which innervates the sternocleidomastoid and trapezius
bres, and the vagus nerve, responsible for the parasympa-
thetic control of most abdominal viscera []. e accessory
nerve has a medullary origin, and arises from neurones of the
upper spinal cord, specically C-C/C. is nerve traverses
the posterior cranial fossa to reach the jugular foramen to
anastomose with the vagus nerve in its superior ganglion [].
If nociceptive excitations caused by changes in the
functioning and/or visceral mobility also contribute to the
emergence of NS-NP, inhibition of the aerent input provided
by these alterations could be associated with clinical improve-
ment in individuals with this dysfunction. is inhibition
or nociceptive stimulation of visceral origin can potentially
be produced by external mechanical action on the viscera
through manual manipulation of these structures [, ].
e rationale for the use of osteopathic visceral manipu-
lation (OVM) techniques is to improve the mobility [] and
function [, ] of the viscera by altering their movement,
thereby reducing the excessive aerent input at the spinal
level. is could theoretically contribute to normalisation of
the excitability state of the aerent neurons of the central
nervous system [].
ese neurofunctional relationships and the eects of
OVM are currently unclear. erefore, considering the
possibility that viscerosomatic reexes may be found in
patients with NS-NP who exhibit dyspepsia (chronic stomach
pain or discomfort with no gastric alteration to explain
the symptoms) [], we tested the hypothesis that possible
nociceptive inhibition provided by OVM (stomach and liver)
may improve the clinical condition of patients with NS-NP
associated with functional dyspepsia.
is pilot randomised placebo-controlled study was
designed to evaluate the eect of OVM (stomach and liver)
on pain, cervical mobility, and electromyographic activity of
the upper trapezius (UT) muscle in individuals with NS-NP
and dyspepsia.
2. Methods
e present study was a double-blind, placebo-controlled
trial with balanced randomization (:), approved by the
Ethics Committee of the University Nove de Julho (process
n∘: ...) and registered in Clinical Trials
(NCT). All subjects were informed about the pro-
cedures of the study and signed a consent form before any
procedure.
2.1. Subjects. A convenience sample of patients with NS-
NP and dyspepsia participated in the study. Criteria for inclu-
sion were neck pain for at least three months, Numeric Pain
Rating Scale (NPRS) [] between and , Neck Disability
Index (NDI) [] between and , and the presence of
symptoms related to functional dyspepsia, according to the
diagnostic criteria of Rome III []. e exclusion criteria
were presence of structural alterations or cervical abnor-
malities, history of cervical whip-lash type injury; surgery
on the neck, shoulders, chest, or abdomen; reporting of
structural changes or any disease in the gastrointestinal tract;
treatment for neck pain two weeks prior to the study; the use
of analgesics, muscle relaxants, and psychotropic and anti-
inammatory drugs in the days prior to intervention.
2.2. Randomization and Blinding. Individuals were allocated
to dierent groups based on numbers randomly generated
by a randomization site []. Numbers were put into opaque
envelopes. e treatment group received osteopathic visceral
manipulation group (OVMG) and the control group received
placebo visceral manipulation (PVMG). Both the investi-
gators and the participants were unaware of the treatment
allocation.
Independent evaluators performed the following proce-
dures: Evaluator : triage, random draw of treatments to be
performed; Evaluator : treatment application; Evaluator :
EMG data collection; Evaluator : EMG signal processing and
statistical analysis. Evaluators and were blinded in relation
to the groups.
2.3. Outcome Assessment. NRS scores for pain and pain area
aer a single session of OVM were considered the primary
outcome and cervical range of movement (ROM) and surface
electromyographic (sEMG) activity of the upper trapezius
muscle as the secondary outcomes of the study.
2.4. Sensory Assessment. e NPRS, translated and cross-
culturally adapted for the Brazilian population, was used to
Evidence-Based Complementary and Alternative Medicine
(a) (b) (c)
F : Visceral manipulation techniques for stomach (a), liver (b), and placebo technique (c).
assess pain intensity (-point scale; : no pain, : the worst
possible pain imaginable) [, ]. Pain area was documented
on a body chart. e drawings were subsequently digitized
and pain areas were measured using open-source soware
ImageJ (Version ., National Institutes of Health, Bethesda,
Maryland). e reproducibility of the measurements has
been veried in a previous study and was considered accept-
able as a pain measurement tool in clinical practice and
research [].
2.5. Cervical Range of Motion. Cervical ROM (degree) was
measured using a eximeter (Sanny,S
˜
ao Paulo, Brazil, L-
), in a standardized sitting position, to remove errors
and movement compensation, except for the movements of
rotation, in which they had to stay in the supine position. e
equipment was xed by means of a Velcro strap around the
head, with the gauge positioned on the lateral side of the head
for the exion-extension movements, in the frontal region of
the head for the right and le lateral inclination movements
and at the top for the right and le lateral rotation move-
ments. e reproducibility of the measurements has been
veried in a previous study that had intra- and interexaminer
reliabilities that ranged from moderate to excellent, which
proved its potential for use in clinical practice [].
2.6. Electromyography. e sEMG signals were recorded by
an acquisition system with channels (Band pass lter: -
Hz, amplier gain of time, CRMR <dB, EMG
System do Brasil Ltda. ). Two channels were set for the use
of the force transducer. e data were recorded with a sample
frequency of Hz and digitalized using analog-digital
(A/D) conversion plates, with a -bit resolution.
A linear electrode array composed of silver bar
electrodes distributed in two columns ( mm long, mm
diameter, and mm interelectrode distance in both direc-
tions) was positioned on the UT muscle, cm lateral to the
medium point of the line traced between the posterior edge
of the acromion and the seventh cervical vertebra []. A
gel conductor was used to decrease the impedance of the
skin. For sEMG signal capture, the skin on the belly of the
UT muscle was previously prepared with % alcohol to
eliminate fatty residues. A ground electrode was placed at the
wrist.
2.7. Osteopathic Visceral Manipulation. Subjects in the osteo-
pathic visceral manipulation group (OVMG) were submitted
to treatment with a single intervention, which involved appli-
cation of a manipulation technique to the stomach followed
by the liver. Aer an initial evaluation, each participant was
instructed to lie down comfortably on an examination table
in the supine position, with their lower limbs exed and
abdomen exposed. e therapist was positioned to the right
side of the patient. e therapeutic intervention began with
the therapist’s le hand in contact with the lower region of the
stomach. e therapist applied force to this region to move
the organ in an upper and lateral le direction while their
right hand controlled and directed the subject’s knees to the
right side, until the therapist noticed an increase in tension
in the stomach region (Figure (a)). e same procedure was
followed for the liver manipulation, but the hand position of
the therapist was reversed, with contact in the right epigastric
region and the patient’s knees directed to the le side. e
position was maintained for each organ until the therapist
felt a decrease in the tension of the viscera (Figure (b)). e
mean treatment time was minutes.
Subjects in the placebo visceral manipulation group
(PVMG) were treated with a single intervention involv-
ing a placebo mobilisation technique, as described by
McSweeney []. Aer an initial evaluation, each participant
was instructed to lie down comfortably on an examination
table in the supine position with their lower limbs extended.
e therapist placed their hands over the umbilical region for
minute, with no tissue movement (Figure (c)).
2.8. Procedure. e sequence of experimental events is
summarized in Figure . e sEMG signal collections were
performed in a chair previously instrumented with two force
transducers, positioned on the acromion region and adjusted
according to the height of each volunteer. e force signals
obtained by the transducers were collected, together with
the sEMG signal, by the same signal acquisition system. For
data collection, volunteers were instructed to sit in the chair
with the shoulder and upper limb bare, spine erect, knees at
∘exion, and feet slightly apart. Aer the patients were
positioned, measurements of pain (NPRS and pain area) and
cervical ROM were collected at baseline (E).
Aer electrode xation in the UT muscle that presented
greater area of pain, the subjects were instructed to perform
Evidence-Based Complementary and Alternative Medicine
E1
Pain
C-ROM C-ROM C-ROM
OVM 10 minutes
Pain
EMG-1
MIVC
E2 E3
Pain
Aer 7 days
E4
Pain
EMG-3
MIVC
E5
EMG-2
E5
Pain Pain
(a)
10
% MVC (N)
20
0
30
40
Time (S)
10 20 30 40 50 600
Force
transducer
Force line
EMG signal
V
(b)
F : (a) Flow sequence diagram of data recording. (b) Force levels in percentage of the maximum voluntary contraction (MVC). E:
evaluation. C-ROM: cer vical range of motion. EMG: electromyography. OVM: osteopathic visceral manipulation.
three shoulder elevations in maximal isometric voluntary
contraction (MIVC) against the resistance of the force trans-
ducers for s during verbal encouragement, with an interval
of minute between collections. e maximum peak force
between force collections (Newtons) was considered as %
of MIVC. A % MIVC training line was established as feed-
back on the computer screen and subjects were instructed
to maintain shoulder elevation over this training line for s
(EMG-). Aer minute rest interval, data on pain was col-
lected (E). Subsequently, treatment with visceral mobiliza-
tion or placebo was started. Aer a ten minute rest interval,
new evaluations of NPRS and cervical ROM were performed
(E), followed by a new sEMG signal collection (EMG-) in
the same manner as performed during EMG- and data col-
lected on pain aer minute rest interval (E). Aer a period
of days, a further evaluation of pain and cervical ROM
(E) was performed, followed by sEMG signal collection as
performed during EMG- ( MIVC initially and shoulder ele-
vation over the training line with % MVIC for s) (EMG-
). Aer minute rest interval, data on pain was collected
(E). All participants received training prior to shoulder
elevations based on the previously determined force levels.
2.9. EMG Signal Processing. e data were analyzed oine
using specic routines carried out in the Mathlab program
(version Ra; the MathWorks Inc., Natick, MA, USA).
e amplitude of sEMG was dened as the RMS (root
mean square) value of the sig-placebo manipulation on UT
muscle activity was veried by the overall RMS value (gRMS)
obtained from the mean RMS of the eight channels, since
averaging across multiple electrodes increases the stability of
the RMS estimates [].
Muscle ber conduction velocity (MFCV) was calculated
for each force level, using a cross-correlation based algorithm
that calculated the time delay corresponding to the maximum
of the cross-correlation function, using its time derivative
[].
2.10. Data Analysis. e Shapiro-Wilk test was used to test
the normality of the data distribution. Data in relation to
pain area were log-transformed prior to analyses to negate the
eects of heteroscedasticity. Mean age, body mass index and
height were compared between groups using independent-
sample ttests.
e two-way repeated-measures analysis of variance
(ANOVA) design was used to analyze the inuence of OVM
treatment on the pain considering with factors: treatment
(OVM vs. PVM) and intervention (pre- vs. immediate post-
treatment vs. days aer termination of OVM). Specic
dierences were determined based on post hoc analysis, using
Bonferroni correction. e signicance level was p<..
e data were analyzed using the StatSo soware SPSS .
(SPSS Inc., Chicago, USA).
3. Results
Anthropometric data (age, weight, and height) and clinical
characteristics assessed by NDI did not dier between the
Evidence-Based Complementary and Alternative Medicine
T1 T2 T3
PVMG
OVMG
3.0
3.5
4.0
4.5
5.0
5.5
MFCV (ms)
T1 T2 T3
PVMG
OVMG
#
0.0
30.0
60.0
90.0
120.0
gRMS (V)
∗
∗
F : Mean and standard deviation of the muscle ber conduction velocity (MFCV) and electromyographic amplitude (RMSg) of the
upper trapezius muscle recorded pretreatment (T) immediate posttreatment (T) and days aer treatment (T) with osteopathic visceral
manipulation (OVMG) or placebo visceral manipulation (PVMG). e data were obtained with % of the maximum voluntary contraction
from the shoulder elevation.∗Signicant dierence in relation to T. Signicant dierence between group.
T : Mean and standard deviation of demographic and clinical
data.
OVMG PMG pVa l ue∗
Age (years) .±. .±. .
Weight(Kgf).±. .±. .
Hight(cm) .±. .±. .
NDI.±. .±. .
OVMG:osteopathic visceral manipulation group. PMG:placebo manipula-
tion group. NDI:Neck D es.
∗Independent-sample tests.
groups treated with visceral manipulation (OVMG) and
placebo manipulation (PVMG) (Table ).
Table shows the results obtained in the evaluations per-
formed preintervention (T), immediately postintervention
(T) and aer days (T) for individuals treated with visceral
manipulation and placebo manipulation.
3.1. Pain Analysis. For NPRS, we considered the mean of the
data obtained in the evaluations in E and E as pretreatment
values, the mean values of the E and E evaluations as
immediate posttreatment, and the mean E and E values as
post- days values.
Signicant interaction (treatment vs. groups: ANOVA
test) was identied between groups aer the treatment for
NPRS scores (F = .; p<., p2= .) and the pain area
(F= .; p>., p2= .) (Table ).
In intra group analysis (post hoc test), signicant eects
were conrmed for the data collected immediately aer
treatment in both groups to NPRS (OVMG: p<.; PVMG:
p<.) and pain area (OVMG: p<.; PVMG: p<.)
(Table ). For the data collected aer days of treatment,
only OVMG presented statistically signicant dierences for
NPRS (p<.) and pain area (p<.) in relation to data
collected preintervention (baseline).
3.2. Cervical Range of Motion. No signicant interaction
(treatment vs. groups: ANOVA test) was identied between
groups aer the treatment for cervical ROM. In intra-group
analysis, only OVMG presented a signicant increase of the
cervical ROM for extension and right side exion movements
aer immediate treatment (p<.) and le side exion aer
daysoftreatment(p<.) (Table ).
3.3. Electromyography. Figure shows the mean values (SD)
of muscle ber conduction velocity (MFCV) and electromyo-
graphic amplitude (gRMS), before, immediately aer, and
days aer treatment, for VMG and PMG. e analysis of the
inuence of the treatment with visceral manipulation in the
MFVC revealed no signicant dierences for the treatment
interactions (F=., p=.; p2=.) and treatment vs.
group (F=., p=.; p2=.). However, signicant dif-
ferences were observed in the EMG signal amplitude analysis
for treatment interactions (F=., p<.; p2=.) and
treatment vs. group (F=., p=.; p2=.).
4. Discussion
e results of this study veried our hypothesis that possible
nociceptive inhibition provided by OVM of the stomach
and liver reects an improvement in the clinical status of
patients with NS-NP associated with dyspepsia. e signif-
icant decrease in pain, measured by NPRS and the area of
pain, together with a signicant increase in the amplitude of
the EMG signal of the UT muscle in the OVMG immediately
aer the intervention and aer days suggests that vis-
cerosomatic reexes may be present in NS-NP patients with
dyspepsia. e mechanisms underlying this reex are not yet
understood and require further investigation; however, these
results strengthen the possibility that OVM of the stomach
and liver could contribute to the treatment of these patients.
ere was a signicant decrease in pain symptoms imme-
diately aer the intervention for the groups treated with
Evidence-Based Complementary and Alternative Medicine
T : Mean and standard deviation (SD) and interactions(ANOVA) of the values of cervical ROM and pain, obtained pretreatment (T), immediately posttreatment (T), and days aer
treatment (T).
Osteopathic Visceral Manipulation Group
(Mean±SD)
PlaceboManipulation Group
(mean±SD)Anovatestinterations
TTTTTTTre a tme n t Tre a tme n t vsgroups
pvalue Eect sizepvalue Eect size
Cervical ROM
(∘)
Extension .±. .±.∗.±. .±. .±. . ±. . . . .
Flexion .±. .±. .±. . ±. .±. .±. . . . .
Right Side
Bending .±. .±.∗.±. . ±. .±. .±. . . . .
Le Side
Bending .±. .±. .±.∗.±. .±. .±. . . . .
Right Rotation .±. .±. .±. .±. .±. .±. . . . .
Le Rotation .±. .±. .±. .±. .±. .±. . <. . .
Pain Analysis
NPRS .±. .±.∗† .±.∗.±. .±.∗.±.∗<. . . .
Area ‡.±. .±.∗† .±.∗.±. .±.∗.±. <. . . .
‡Log-transformed values (arbitrary units).
∗Signicantly dierent from T (p <.).
†Signicantly dierent from T (p <.).
Evidence-Based Complementary and Alternative Medicine
OVM and the placebo. Similar results have been reported for
patients with NS-NP who were treated with acupuncture for
pain control [], as well as in those with musculoskeletal
disorders such as bromyalgia [] and acute and chronic
lower back pain []. One possible explanation for these
results is that sensory stimulation by touching the skin
activates mechanoreceptors in the skin that convey light
touch and activate Aaerents bres, thereby inhibiting
pain []. In addition, nonspecic factors such as contact
time, expectation and the ritual related to the therapeutic
approach may have also led to the observed reduction in pain
immediately aer performing interventions with OVM and
the placebo [].
In relation to EMG of UT muscle activity, previous studies
have found that pain promotes a decrease in the electromyo-
graphic activity of this muscle during isometric contraction
[, ]. us, the increase in signal amplitude (RMSg) found
only for the OVMG in this study suggests a possible eect
on contraction of this muscle promoted by OVM of the
liver and stomach. e fact that no changes were found in
the MFCV for both groups could be related to the level of
force needed during the evaluation, as the MFCV appears
to remain constant during sustained isometric exercises at
relatively low contraction levels (–% MVC) [, , ].
e results observed for the cervical ROM in this study
did not contribute to a better understanding of the phys-
iological mechanisms of OVM. e dierences observed
in the OVMG post-intervention were heterogeneous, with
signicant dierences in the movements of extension and
right-side exion immediately aer OVM and for le-side
exion days aer the intervention. ere was no signicant
improvement in the PVMG, so we are unable to conclude that
these dierences are related to treatment with OVM. us,
these results must be interpreted with caution.
Although explanation of these ndings is not straightfor-
ward, the responses observed for pain and EMG activity of
the UT muscle aer OVM indicate that the visceral stimulus
provided by the manipulation techniques applied in this
study may be related to some physiological mechanism (not
yet reported clearly in the literature) that inhibited pain and
muscle activity. is physiological eect could be due to
muscle relaxation and a consequent clinical improvement,
evidenced by the decrease in pain reported by individuals
in the OVMG days aer treatment. ese observations
reinforce our initial hypothesis that visceral changes can
produce a nociceptive input that can promote alterations in
the muscular activation threshold at the spinal level and,
consequently, changes in the activation pattern of the muscles
corresponding to the aected spinal level as previously
suggested [, , ].
e results of this study reinforce the possibility that
spinal facilitation of the internuncial neurons occurred in the
OVMG at the level of the neural roots of the phrenic nerve
(C-C) that innervates the diaphragm muscle, the sub-
diaphragmatic peritoneum [], coronary ligaments, sickle
cell, and liver capsule []. is is supported by previous
studies which reported the presence of trophic changes in
the supercial and deep paraspinal muscles in patients with
gallbladder dysfunction [], an increase in the pressure pain
threshold of the paraspinal muscles of L aer manipulation
of the sigmoid colon [], and decreased mobility of the right
kidney and bladder in patients with nonspecic lower back
pain [].
e results of this study can be considered promising
for a better understanding of mechanisms involving vis-
cerosomatic reexes; however, they should be interpreted
with caution given the important methodological limitations
of the current study. ese include the lack of calculation
of sample size ratio (although mitigated by the eect size
calculation), presentation of the eects observed aer only a
single treatment session, and absence of prior evaluation of
visceral mobility, which is usually performed subjectively by
the therapist, which makes scientic reproduction dicult.
Another limitation was that we did not assess clinical vari-
ables related to bromyalgia (visceral pain, headache, sleep,
and mood disorders), which is a common comorbidity in
thesepatients[].ishasimportantimplicationsregarding
the clinical management of patients with overlapping chronic
pain [], and our focus on only two pain condition (NS-
NP and dyspepsia), both in the context of diagnosis and
treatment, may be an important limiting factor in relation to
our understanding of the results observed aer OVM.
To our knowledge, there has been no randomised
controlled trial assessing the eectiveness of OVM as a
complementary therapy for the relief of acute pain or for
improving cervical function in NS-NP patients. erefore,
the present study provides the basis for future studies to assess
the eciency of treating NS-NP with OVM, as previously
suggested [, ].
5. Conclusions
e results of this pilot study indicate that a single session
of osteopathic visceral manipulation for the stomach and
liver reduces cervical pain and increases the amplitude of
the upper trapezius muscle EMG signal immediately and
days aer treatment in patients with nonspecic neck
pain and functional dyspepsia. Patients treated with placebo
visceral mobilisation reported a signicant decrease in pain
immediately aer treatment. e eect of this intervention
on the cervical range of motion was inconclusive. e results
of this study suggest that further investigation is necessary.
Data Availability
e datasets generated during and/or analyzed during the
current study are available from the corresponding author on
reasonable request.
Conflicts of Interest
e authors declare that there are no conicts of interest
regarding the publication of this paper.
Acknowledgments
is study is supported by the Universidade Nove de Julho
(UNINOVE, Brazil) and the Brazilian fostering agency
Evidence-Based Complementary and Alternative Medicine
Fundac¸˜
ao de Amparo a Pesquisa (FAPESP: Process n∘./
-) and Coordination for the Improvement of Higher
Education Personnel (CAPES: Process n∘).
References
[] H. Merskey and N. Bogduk, “Classication of chronic
pain—descriptions of chronic pain syndromes and denitions
of pain terms,” e Clinical Journal of Pain,vol.,no.,p.,
.
[] A. Binder, “e diagnosis and treatment of nonspecic neck
pain and whiplash,” European Journal of Physical and Rehabil-
itation Medicine,vol.,no.,pp.–,.
[] P. C ˆot´e, J. D. Cassidy, and L. Carroll, “e epidemiology of neck
pain: what we have learned from our population-based studies,”
e Journal of the Canadian Chiropractic Association,vol.,no.
, pp. –, .
[] J.A.J.Borghouts,B.W.Koes,H.Vondeling,andL.M.Bouter,
“Cost-of-illness of neck pain in e Netherlands in ,” PAIN,
vol.,no.,pp.–,.
[]B.Hidalgo,T.Hall,J.Bossert,A.Dugeny,B.Cagnie,and
L. Pitance, “e ecacy of manual therapy and exercise for
treating non-specic neck pain: A systematic review,” Journal of
Back and Musculoskeletal Rehabilitation,vol.,no.,pp.–
, .
[] L.Bertozzi,I.Gardenghi,F.Turonietal.,“Eectoftherapeutic
exercise on pain and disability in the management of chronic
nonspecic neck pain: Systematic review and meta-analysis of
randomized trials,” Physical erapy in Sport,vol.,no.,pp.
–, .
[] A.C.D.O.Silva,D.A.Biasotto-Gonzalez,D.M.D.Santoset
al., “Evaluat ion of the immediate eec t of auricular acupu ncture
on pain and electromyographic activity of the upper trapezius
muscle in patients with nonspecic neck pain: a randomized,
single-blinded, sham-controlled, crossover study,” Evidence-
Based Complementary and Alternative Medicine,vol.,
pages, .
[] F.Liu,F.Zhou,M.Zhao,T.Fang,M.Chen,andX.Yan,“Acupo-
tomy therapy for chronic nonspecic neck pain: a systematic
review and meta-analysis,” Evidence-Based Complementary and
Alternative Medicine, vol. , Article ID , pages,
.
[] G. Tsakitzidis, R. Remmen, W. Dankaerts, and P. V. Royen,
“Non-specic neck pain and evidence-based practice,” Euro-
pean Scientific Journal, ESJ,vol.,no.,.
[] E. L. DiGiovanna, S. Schiowitz, and D. J. Dowling, An
Osteopathic Approach to Diagnosis and Treatment, Lippincott
Williams & Wilkins, Philadelphia, PA, USA, rd edition, .
[] I. M. Korr, “e neural basis of the osteopathic lesion,” e
Journal of the American Osteopathic Association,vol.,no.,
pp. –, .
[] A. Chila, Foundations of Osteopathic Medicine, Lippincott
Williams & Wilkins, Philadelphia, PA, USA, .
[] S. Standring, Grays Anatomy: e Anatomical Basis of Clinical
Practice,Elsevier,NewYork,NY,USA,stedition,.
[ ] J . P. B ar r a l an d P. J . M e rc i e r, Visceral Ma nipu lati on ,Eastland
Press, Seattle, USA, .
[] M. M. Shoja, N. M. Oyesiku, G. Shokouhi et al., “A compre-
hensive review with potentialsignicance during skull base and
neck operations, Part II: Glossopharyngeal, vagus, accessory,
and hypoglossal nerves and cervical spinal nerves -,” Clinical
Anatomy,vol.,no.,pp.–,.
[]T.P.McSweeney,O.P.omson,andR.Johnston,“e
immediate eects of sigmoid colon manipulation on pressure
pain thresholds in the lumbar spine,” Journal of Bodywork and
Movement erapies,vol.,no.,pp.–,.
[] P. Tozzi, D. Bongiorno, and C. Vitturini, “Low back pain
and kidney mobility: Local osteopathic fascial manipulation
decreases pain perception and improves renal mobility,” Journal
of Bodywork and Movement erapies,vol.,no.,pp.–,
.
[] T.-V. Attali, M. Bouchoucha, and R. Benamouzig, “Treatment
of refractory irritable bowel syndrome with visceral osteopathy:
Short-term and long-term results of a randomized trial,” Journal
of Digestive Diseases,v
ol.,no.,pp.–,.
[] A. Belvaux, M. Bouchoucha, and R. Benamouzig, “Osteo-
pathic management of chronic constipation in women patients.
Results of a pilot study,” Clinics and Research in Hepatolog y and
Gastroenterology, vol. , no. , pp. –, .
[] R. Mostafa, “Rome III: e functional gastrointestinal disor-
ders,third edition,,” World Journal of G astroenterology ,vol.
,no.,p.,.
[] M. A. Ferreira-Valente, J. L. Pais-Ribeiro, and M. P. Jensen,
“Validity of four pain intensity rating scales,” PAIN ,vol.,no.
, pp. –, .
[]C.Cook,J.K.Richardson,andL.Braga,“Cross-cultural
adaptation and validation of the Brazilian Portuguese version
of the neck disability index and neck pain and disability scale,”
e Spine Journal,vol.,no.,pp.–,.
[ ] “ran domizati on.c om. [O nline ],” htt p://www.randomization.com/,
.
[] L. O. P. Costa, C. G. Maher, J. Latimer et al., “Clinimetric testing
of three sel f-report outcom e measures for low back pain p atients
in Brazil: which one is the best?” e Spine Journal,vol.,no.
, pp. –, .
[] F. J. J. dos Reis, V. de Barros e Silva, R. N. de Lucena, B. A.
M.Cardoso,andL.C.Nogueira,“Measuringthepainarea:
an intra- and inter-rater reliability study using image analysis
soware,” Pain Practice,vol.,no.,pp.–,.
[] L. L. Florˆencio, P. A. Pereira, E. R. T. Silva, and L. L. Florˆencio,
“Agreement and reliability of two non-invasive methods for
assessing cervical range of motion among young adults,” Brazil-
ian Journal of Physical erapy, vol. , no. , pp. –, .
[] L. McLean, M. Chislett, M. Keith, M. Murphy, and P. Walton,
“e eect of head position, electrode site, movement and
smoothing window in the determination of a reliable maximum
voluntary activation of the upper trapezius muscle,” Journal of
Electromyography& Kinesiology,vol.,no.,pp.–,.
[] F. S. Mendonc¸a,P.T.C.Carvalho,andD.A.Biasotto-Gonzalez,
“Muscle ber conduction velocity and EMG amplitude of the
upper trapezius muscle in healthy subjects aer low-level laser
irradiation: a randomized, double-blind, placebo-controlled,
crossover study,” Lasers in Medical Science,vol.,no.,pp.
–, .
[] D. Farina and R. Merletti, “Methods for estimating muscle bre
conduction velocity from surface electromyographic signals,”
Medical & Biological Engineering & Computing,vol.,no.,
pp. –, .
[]S.A.P.Calamita,D.A.Biasotto-Gonzalez,N.C.DeMelo
et al., “Immediate eect of acupuncture on electromyographic
activity of the upper trapezius muscle and pain in patients
Evidence-Based Complementary and Alternative Medicine
with nonspecic neck pain: a randomized, single-blinded,
sham-controlled, crossover study,” Journal of Manipulative and
Physiological erapeutics, vol. , no. , pp. –, .
[] J. C. Deare, Z. Zheng, and C. C. Xue, “Acupuncture for treating
bromyalgia,” Cochrane Database of Systematic Reviews,vol.,
Article ID CD, .
[] J. Vas, E. Perea-Milla, C. M´endez et al., “Ecacy and safety
of acupuncture for chronic uncomplicated neck pain: A ran-
domised controlled study,” PAIN,vol.,no.-,pp.–,
.
[] J. E. Hall, Guyton and Hall Textbook of Medical Physiology,
Elsevier Health Sciences, .
[] H.M.Langevin,P.M.Wayne,HughMacPhersonetal.,“Para-
doxes in acupuncture research: strategies for moving forward,”
Evidence-Based Complementary and Alternative Medicine,vol.
, Article ID , pages, .
[] H.-Y. Ge, L. Arendt-Nielsen, D. Farina, and P. Madeleine,
“Gender-specic dierences in electromyographic changes and
perceived pain induced by experimental muscle pain during
sustained contractions of the upper trapezius muscle,” Muscle
&Nerve,vol.,no.,pp.–,.
[] P. Madeleine, F. Leclerc, L. Arendt-Nielsen, P. Ravier, and
D. Farina, “Experimental muscle pain changes the spatial
distribution of upper trapezius muscle activity during sustained
contraction,” Clinical Neurophysiology,vol.,no.,pp.–
, .
[]C.Krogh-LundandK.Jørgensen,“Changesinconduction
velocity, median frequency, and root mean square-amplitude
of the electromyogram during % maximal voluntary con-
traction of the triceps brachii muscle, to limit of endurance,”
European Journal of Applied Physiology,vol.,no.,pp.–,
.
[] L. A. C. Kallenberg and H. J. Hermens, “Behaviour of a surface
EMG based measure for motor control: Motor unit action
potential rate in relation to force and muscle fatigue,” Journal
of Electromyography & Kinesiology, vol. , no. , pp. –,
.
[] M. A. Giamberardino, G. Aaitati, R. Lerza, D. Lapenna, R.
Costantini, and L. Vecchiet, “Relationship between pain symp-
toms and referred sensory and trophic changes in patients with
gallbladder pathology,” PAIN ,vol.,no.-,pp.–,
.
[] F. Wolfe, D. J. Clauw, M. Fitzcharles et al., “e American
College of Rheumatology preliminary diagnostic criteria for
bromyalgia and measurement of symptom severity,” Arthritis
Care & Research,vol.,no.,pp.–,.
[] R. Costantini, G. Aaitati, U. Wesselmann, P. Czakanski, and
M. A. Giamberardino, “Visceral pain as a triggering factor for
bromyalgia symptoms in comorbid patients,” PAI N,vol.,
no.,pp.–,.
Available via license: CC BY
Content may be subject to copyright.
Content uploaded by Fábio Henrique Monteiro Oliveira
Author content
All content in this area was uploaded by Fábio Henrique Monteiro Oliveira on Nov 13, 2018
Content may be subject to copyright.
