pp 1-13 | Cite as

Effects of Manual Somatic Stimulation on the Autonomic Nervous System and Posture

  • Giovanni Barassi
  • Rosa Grazia Bellomo
  • Camillo Di Giulio
  • Giuseppe Giannuzzo
  • Giuseppe Irace
  • Claudia Barbato
  • Raoul Saggini
Part of the Advances in Experimental Medicine and Biology book series


Low back pain frequently involves a multifactorial etiology and requires medical attention. The aim of the study was to assess the associations among pain, posture, and autonomic nervous system function in patients with low back pain, using neuromuscular manual therapy versus a generic peripheral manual stimulation (back massage therapy). Twenty young patients with low back pain were enrolled into the study. The patients were randomly divided into two groups: treated with neuromuscular manual therapy performed after a specific structural evaluation and treated with back massage therapy. Both groups performed eight sessions of 30 min each, once a week for two months. There were three main time points of the assessment: during the first, the fourth, and the last eighth session. In each of these three sessions, data were collected before onset of session (baseline), 5 min from onset, at end of session, and 5 min after the end. All patients were subjected to stabilometric evaluation and were assessed on a visual analogue scale to quantify postural and pain changes. Tabletop capnography and pulse oximetry were used to monitor autonomic changes. The findings were that the improvement in posture and pain reduction were appreciably better in patients subjected to neuromuscular manual therapy than in those subjected to back massage therapy, with a comparable autonomic response in both groups. In conclusion, the study demonstrates that posture modification was significantly more advantageous in patient treated with neuromuscular manual therapy.


Autonomic nervous system Low back Manual therapy Massage therapy Neuromuscular dysfunction Pain Posture Stabilometry Structural evaluation Trigger point 


Conflicts of Interest

The authors declare no conflicts of interest in relation to this article.


  1. American Osteopathic Association (2010) Guidelines for Osteopathic Manipulative Treatment (OMT) for patients with low back pain. Task Force on the low back pain clinical practice guidelines. J Am Osteopath Assoc 116(8):536–549Google Scholar
  2. Balagué F, Mannion AF, Pellisé F, Cedraschi C (2012) Non-specific low back pain. Lancet 379(9814):482–491CrossRefPubMedGoogle Scholar
  3. Benjamin PJ, Tappan FM (2005) Tappan’s handbook of healing massage techniques: classic, holistic and emerging methods, 4th edn. Pearson/Prentice-Hall, Saddle RiverGoogle Scholar
  4. Cervero F, Connell LA (1984) Distribution of somatic and visceral primary afferent fibers within the thoracic spinal cord of the cat. J Comp Neurol 230(1):88–98CrossRefPubMedGoogle Scholar
  5. Chiu TW, Wright A (1996) To compare the effects of different rates of application of a cervical mobilisation technique on sympathetic outflow to the upper limb in normal patients. Man Ther 1(4):198–203CrossRefPubMedGoogle Scholar
  6. Cholewicki J, McGill SM (1996) Mechanical stability of the in vivo lumbar spine: implications for injury and chronic low back pain. Clin Biomech (Bristol, Avon) 11(1):1–15CrossRefGoogle Scholar
  7. Fryer G, Morris T, Gibbons P (2004) The relationship between palpation of thoracic paraspinal tissues and pressure sensitivity measured by a digital algometer. J Osteopath Med 7:64CrossRefGoogle Scholar
  8. Gori L, Firenzuoli F (2005) Posturology. Methodological problems and scientific evidence. Recenti Prog Med 96(2):89–91. (Article in Italian)PubMedGoogle Scholar
  9. Granger J (2011) Neuromuscular therapy manual. Wolters Kluver/Lippincott Williams & Wilkins, BaltimoreGoogle Scholar
  10. Henatsch HD (1976) Bauplan der peripheren und zentralen sensomotorischen Kontrollen. In Gauer OH, Kramer K, Jung R (eds) Physiologie des Mensche. Bd XIV: Sensomotorik. Urban & Schwarzenberg, München (Article in German)Google Scholar
  11. Jänig W (1996) Neurobiology of visceral afferent neurons: neuroanatomy, functions, organ regulations and sensations. Biol Psychol 42(1–2):29–51CrossRefPubMedGoogle Scholar
  12. Johansson B (1962) Circulatory responses to stimulation of somatic afferents with special reference to depressor effects from muscle nerves. Acta Physiol Scand Suppl 198:1–91PubMedGoogle Scholar
  13. Kapteyn TS, Bles W, Njiokiktjien CJ, Kodde L, Massen CH, Mol JM (1983) Standardization in platform stabilometry being a part of posturography. Agressologie 24(7):321–326PubMedGoogle Scholar
  14. Katz JN (2006) Lumbar disc disorders and low-back pain: socioeconomic factors and consequences. J Bone Joint Surg Am 88(2):21–24PubMedGoogle Scholar
  15. Kimura A, Sato A, Sato Y, Suzuki A (1996) Single electrical shock of a somatic afferent nerve elicits A- and C-reflex discharges in gastric vagal efferent nerves in anesthetized rats. Neurosci Lett 210(1):53–56CrossRefPubMedGoogle Scholar
  16. Koes BW, Van Tulder MW, Thomas S (2006) Diagnosis and treatment of low back pain. BMJ 332(7555):1430–1434CrossRefPubMedPubMedCentralGoogle Scholar
  17. Korr IM (1978) Sustained sympathicotonia as a factor in disease. In: Korr IM (ed) The neurobiologic mechanisms in manipulative therapy. Springer, BostonCrossRefGoogle Scholar
  18. Korr IM, Wright HM, Thomas PE (1962) Effects of experimental myofascial insults on cutaneous patterns of sympathetic activity in man. Acta Neuroveg 23:329–355CrossRefGoogle Scholar
  19. Kozin F, McCarty DJ, Sims J, Genant H (1976) The reflex sympathetic dystrophy syndrome: I. Clinical and histologic studies: evidence for bilaterality, response to corticosteroids and articular involvement. Am J Med 60(3):321–331CrossRefPubMedGoogle Scholar
  20. Levine JD, Dardick SJ, Roizen MF, Clyde H, Allan I (1986) Basbaum contribution of sensory afferents and sympathetic efferents to joint injury in experimental arthritis. J Neurosci 6(12):3423–3429PubMedGoogle Scholar
  21. Licciardone JC (2008) The epidemiology and medical management of low back pain during ambulatory medical care visits in the United States. Osteopath Med Prim Care 2(1):11CrossRefPubMedPubMedCentralGoogle Scholar
  22. McCabe CS, Haigh RC, Halligan PW, Blake DR (2005) Simulating sensory–motor incongruence in healthy volunteers: implications for a cortical model of pain. Rheumatology 44(4):509–516CrossRefPubMedGoogle Scholar
  23. McCabe CS, Cohen H, Blake DR (2007) Somaesthetic disturbances in fibromyalgia are exaggerated by sensory–motor conflict: implications for chronicity of the disease? Rheumatology 46(10):1587–1592CrossRefPubMedGoogle Scholar
  24. McCracken LM, Turk DC (2002) Behavioural and cognitive-behavioural treatment for chronic pain. Outcome, predictors of outcome, and treatment process. Spine 27(22):2564–2525CrossRefPubMedGoogle Scholar
  25. Melzack R (1999) From the gate to the neuromatrix. Pain 6:121–126CrossRefGoogle Scholar
  26. Mendell LM (2014) Constructing and deconstructing the gate theory of pain. Pain 15(2):210–216CrossRefGoogle Scholar
  27. Miao FJ, Jänig W, Green PG, Levine JD (1996) Inhibition of bradykinin-induced synovial plasma extravasation produced by intrathecal nicotine is mediated by the hypothalamopituitary adrenal axis. J Neurophysiol 76(5):2813–2821CrossRefPubMedGoogle Scholar
  28. Michaelis M, Liu X, Jänig W (2000) Axotomized and intact muscle afferents but no skin afferents develop ongoing discharges of dorsal root ganglion origin after peripheral nerve lesion. J Neurosci 20(7):2742–2748PubMedGoogle Scholar
  29. Nijs J, Meeus M, De Meirleir K (2006) Chronic musculoskeletal pain in chronic fatigue syndrome: recent developments and therapeutic implications. Man Ther 11(3):187–191CrossRefPubMedGoogle Scholar
  30. O’Sullivan PB, Twomey L, Allison GT (1997) Dysfunction of the neuro-muscular system in the presence of low back pain – implications for physical therapy management. J Man Manip Ther 5(1):20–26CrossRefGoogle Scholar
  31. Patterson MM, Wurster RD (2011) Somatic dysfunction, spinal facilitation, and viscerosomatic integration. In: Chila AG (ed) Foundations of osteopathic medicine, 3rd edn. Lippincott William & Wilkins, PhiladelphiaGoogle Scholar
  32. Pengel L, Herbert R, Maher CG, Refshauge K (2003) Acute low back pain: systematic review of its prognosis. BMJ 327:323–327CrossRefPubMedPubMedCentralGoogle Scholar
  33. Pettman E (2007) A history of manipulative therapy. J Man Manip Ther 15(3):165–174CrossRefPubMedPubMedCentralGoogle Scholar
  34. Price DD, McGrath PA, Rafii A, Buckingham B (1983) The validation of visual analogue scales as ratio scale measures for chronic and experimental pain. Pain 17(1):45–56CrossRefPubMedGoogle Scholar
  35. Saggini R, Ridi R (2002) Equilibrio corporeo. Martina Editore, BolognaGoogle Scholar
  36. Saggini R, Giamberadino MA, Gatteschi L, Vecchiet L (1996) Myofascial pain syndrome of the peroneus longus: biomechanical approach. Clin J Pain 12:30–37CrossRefPubMedGoogle Scholar
  37. Sakai S, Hori E, Umeno K, Kitabayashi N, Ono T, Nishijo H (2007) Specific acupuncture sensation correlates with EEGs and autonomic changes in human subjects. Auton Neurosci 133(2):158–169CrossRefPubMedGoogle Scholar
  38. Sato A, Schmidt RF (1971) Spinal and supraspinal components of the reflex discharges into lumbar and thoracic white rami. J Physiol 212(3):839–850CrossRefPubMedPubMedCentralGoogle Scholar
  39. Sato A, Sato Y, Schmidt RF (1986) Catecholamine secretion and adrenal nerve activity in response to movements of normal and inflamed knee joints in cats. J Physiol 375:611–624CrossRefPubMedPubMedCentralGoogle Scholar
  40. Schleip R (2003) Fascial plasticity: a new neurobiological explanation: Part 1. J Bodyw Mov Ther 7(1):11–19CrossRefGoogle Scholar
  41. Schleip W, Klingler F, Horn L (2005) Active fascial contractility: fascia may be able to contract in a smooth muscle-like manner and thereby influence musculoskeletal dynamics. Med Hypotheses 65:273–277CrossRefPubMedGoogle Scholar
  42. Sterling M, Jull G, Wright A (2001) Cervical mobilisation: concurrent effects on pain, sympathetic nervous system activity and motor activity. Man Ther 6(2):72–81CrossRefPubMedGoogle Scholar
  43. Travell JG, Simons DG (1992) Myofascial pain and dysfunction: the trigger point manual, 2nd edn. Simons DG, Travell JG, Lois LS (eds). Williams & Wilkins, BaltimoreGoogle Scholar
  44. Vecchiet L, Giamberardino MA, Saggini R (1991) Myofascial pain syndromes: clinical and pathophysiological aspects. Clin J Pain Suppl 7:S16–S22CrossRefGoogle Scholar
  45. Vecchiet L, Vecchiet J, Giamberardino MA (1999) Referred muscle pain: clinical and pathophysiologics aspects. Curr Rev Pain 3:489–498CrossRefPubMedGoogle Scholar
  46. Vicenzino B, Collins D, Wright T (1994) Sudomotor changes induced by neural mobilisation techniques in asymptomatic patients. J Man Manip Ther 2(2):66–74CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG  2018

Authors and Affiliations

  • Giovanni Barassi
    • 1
  • Rosa Grazia Bellomo
    • 2
  • Camillo Di Giulio
    • 3
  • Giuseppe Giannuzzo
    • 1
  • Giuseppe Irace
    • 1
  • Claudia Barbato
    • 1
  • Raoul Saggini
    • 1
  1. 1.Department of Medical Oral and Biotechnological Science“Gabriele d’Annunzio” UniversityChieti-PescaraItaly
  2. 2.‘Carlo Bo’-UniversityUrbinoItaly
  3. 3.Department of Neuroscience and Imaging“Gabriele D’Annunzio” UniversityChieti-PescaraItaly

Personalised recommendations