Pain Med. 2014 Sep;15(9):1455-63. doi: 10.1111/pme.12404. Epub 2014 Mar 25.
Molins-Cubero S1, Rodríguez-Blanco C, Oliva-Pascual-Vaca A, Heredia-Rizo AM, Boscá-Gandía JJ, Ricard F.
Abstract
OBJECTIVE:
This study aims to evaluate the immediate effect of a global pelvic manipulation (GPM) technique, bilaterally applied, on low back pelvic pain in women with primary dysmenorrhea (PD).
DESIGN:
A prospective, randomized, double-blind, controlled trial.
SETTING:
Faculty of Nursing, Physiotherapy and Podiatry. University of Sevilla, Spain.
METHODS:
The sample group included 40 women (30 ± 6.10 years) that were divided into an experimental group (EG) (N = 20) who underwent a bilateral GPM technique and a control group (CG) (N = 20) who underwent a sham (placebo) intervention. Evaluations were made of self-reported low back pelvic pain (visual analog scale), pressure pain threshold (PPT) in sacroiliac joints (SIJs), and the endogenous response of the organism to pain following catecholamines and serotonin release in blood levels.
RESULTS:
The intragroup comparison showed a significant improvement in the EG in the self-perceived low back pelvic pain (P = 0.003) and in the mechanosensitivity in both SIJs (P = 0.001). In the between-group comparison, there was a decrease in pain perception (P = 0.004; F(1,38) = 9.62; R(2) = 0.20) and an increase in the PPT of both SIJs, in the right side (P = 0.001; F(1,38) = 21.29; R(2) = 0.35) and in the left side (P = 0.001; F(1,38) = 20.63; R(2) = 0.35). There were no intergroup differences for catecholamines plasma levels (adrenaline P = 0.123; noradrenaline P = 0.281; dopamine P = 0.173), but there were for serotonin levels (P = 0.045; F(1,38) = 4.296; R(2) = 0.10).
CONCLUSION:
The bilateral GPM technique improves in a short term the self-perceived low back pelvic pain, the PPT in both SIJs, and the serotonin levels in women with PD. It shows no significant differences with a sham intervention in catecholamines plasma levels.
Bilateral GPM Technique in the EG
The GPM technique was carried out by a therapist with more than 10 years of manual therapy experience. The GPM technique is a semi-direct high-velocity low amplitude (HVLA) thrust procedure that achieves a global opening of the SIJ and of the facet joint of the fifth lumbar vertebra (L5) over the first sacrum vertebrae (S1). The maneuver has been described as follows [38]. The subject is placed in lateral position. The lower limb remains extended and in contact with the treatment table, whereas the lumbar spine must be in neutral position. Then, the therapist adds a slight trunk rotation and the subject places her hands to the side.
After that, the therapist flexes the lower-top limb of the patient until perceiving some tension at the second sacral vertebra level. One therapist’s hand is placed on the pectoral region to exert a slight trunk rotation and to control the patient’s upper body. The caudal forearm contacts the SIJ and the iliac crest to bring tension to L5 and to the longer and lower arm of the SIJ. Then, the slack reduction is done in three stages: 1) for the lumbar-sacral facet, the therapist’s hand increases trunk rotation until perceiving tension in L5; 2) for the SIJ lower arm, the caudal forearm pushes toward the lower arm to form a fold in this side; and 3) for the SIJ longer arm, the forearm pushes the bottom part of the SIJ toward the therapist’s trunk. These three reductions are maintained while the therapist adds compression to open the SIJ. The therapist’s knee is placed over the subject’s flexed knee to achieve the “kick” contact. A thrust is performed increasing all parameters and compressing toward the ground (Figure 2).
