Short-Term Effects of Manual Therapy on Heart Rate Variability, Mood State, and Pressure Pain Sensitivity in Patients With Chronic Tension-Type Headache: A Pilot Study

Toro-Velasco, Cristina; Arroyo-Morales, Manuel; Fernández-de-las-Peñas, César; Cleland, Joshua A.; Barrero-Hernández, Francisco J.

doi:10.1016/j.jmpt.2009.08.011

« Previous Next »Journal of Manipulative and Physiological Therapeutics
Volume 32, Issue 7 , Pages 527-535, September 2009

Short-Term Effects of Manual Therapy on Heart Rate Variability, Mood State, and Pressure Pain Sensitivity in Patients With Chronic Tension-Type Headache: A Pilot Study

Cristina Toro-Velasco, PT
- Professor, Department of Physical Therapy, Health Sciences School, Universidad Granada, Spain
Manuel Arroyo-Morales, MD, PT, PhD
- Professor, Department of Physical Therapy, Health Sciences School, Universidad Granada, Spain
César Fernández-de-las-Peñas, PT, PhD
- Clinical Researcher, Esthesiology Laboratory of Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
- Professor, Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation of Universidad Rey Juan Carlos, Alcorcón, Spain
- Submit requests for reprints to: César Fernández de las Peñas, PT, PhD, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Avenida de Atenas s/n, 28922 Alcorcón, Madrid, Spain
Joshua A. Cleland, PT, PhD
- Professor, Department of Physical Therapy, Franklin Pierce University, Concord, NH
- Professor, Physical Therapist, Rehabilitation Services, Concord Hospital, NH
- Professor, Faculty, Manual Therapy Fellowship Program, Regis University, Denver, Col
Francisco J. Barrero-Hernández, MD
- Professor, University Hospital San Cecilio, Granada, Spain

Received 12 March 2009; received in revised form 29 April 2009; accepted 5 May 2009.

Abstract

Objective

The purpose of this study was to investigate the immediate effects of head-neck massage on heart rate variability (HRV), mood states, and pressure pain thresholds (PPTs) in patients with chronic tension-type headache (CTTH).

Methods

Eleven patients (8 females), between 20 and 68 years old, with CTTH participated in this crossover study. Patients received either the experimental treatment (massage protocol) or a placebo intervention (detuned ultrasound). Holter electrocardiogram recordings (standard deviation of the normal-to-normal interval, square root of mean squared differences of successive NN intervals, index HRV, low-frequency component, and high-frequency component), PPT over both temporalis muscles, and Profile of Mood States questionnaire (tension-anxiety, depression-dejection, anger-hostility, vigor, fatigue, confusion) were obtained preintervention, immediately after intervention, and 24 hours postintervention. Self-reported head pain was also collected preintervention and 24 hours postintervention. Separate analyses of covariance (ANCOVAs) were performed with each dependent variable. The hypothesis of interest was group × time interaction.

Results

The ANCOVA showed a significant group × time interaction for index HRV (F = 4.5, P = .04), but not for standard deviation of the normal-to-normal interval (F = 1.1, P = .3), square root of mean squared differences of successive NN intervals (F = 0.9, P = .3), low-frequency component (F = 0.03, P = .8), or high-frequency component (F = 0.4, P = .5) domains. Pairwise comparisons found that after the manual therapy intervention, patients showed an increase in the index HRV (P = .01) domain, whereas no changes were found after the placebo intervention (P = .7). The ANCOVA also found a significant group × time interaction for tension-anxiety (F = 5.3, P = .03) and anger-hostility (F = 4.6, P = .04) subscales. Pairwise comparisons found that after the manual therapy intervention, patients showed a decrease in tension-anxiety (P = .002) and anger-hostility (P = .04) subscales, whereas no changes were found after the placebo intervention (P > .5 both subscales). No significant changes were found in PPT levels (right F = 0.3, P = .6, left F = 0.4, P = .5). A significant group × time interaction for pain (F = 4.8, P = .04) was identified. No influence of sex was found (F = 1.5, P = .3). Pairwise comparisons showed that head pain (numerical pain rating scale) decreased 24 hours after manual therapy (P < .05) but not after the placebo intervention (P = .9).

Conclusions

The application of a single session of manual therapy program produces an immediate increase of index HRV and a decrease in tension, anger status, and perceived pain in patients with CTTH.

Key Indexing Terms: Tension-Type Headache, Heart Rate, Manual Therapy