Manuelle Therapietechniken an der Wirbelsäule zur Stimulation des autonomen Nervensystems - ein Scoping Review

Zusammenfassung

Hintergrund Physikalische Maßnahmen oder manualtherapeutische Techniken (MTTe) wie Mobilisationen, Manipulationen oder Weichteiltechniken führen zu einer Verbesserung des Metabolismus oder einer Senkung hypertoner Muskulatur und werden auch zur Balanceregulierung bei zentralnervösen Veränderungen des autonomen Nervensystems (ANS) eingesetzt. Bisher fehlen empirische Erkenntnisse über Wirkungsmechanismen und Reizorte von MTTe auf das ANS. Das Ziel dieses vorliegenden Scoping Reviews war es, einen Überblick zu geben über den Erkenntnisstand der Anwendung von MTTe auf diverse Niveaus der Wirbelsäule auf das ANS.

Methode Als Grundlage für die Durchführung des Scoping Reviews dienten die Datenbanken CENTRAL, Osteopathic Research Web, PEDro und PubMed. Umfang und Inhalte der Literatur wurden dokumentiert. Die Ergebnisse der einbezogenen und herangezogenen Studien wurden in narrativer Weise zusammengefasst, wobei der Fokus auf den signifikantesten klinischen Aspekten lag.

Ergebnisse Manipulationen, Mobilisationen, myofasziale Techniken und zervikale Traktionen wurden als MTTe definiert. In 27 von 35 Studien wurden gesunde Probanden therapeutisch behandelt. Zehn Studien analysierten unmittelbare Effekte an Patienten, während 2 Studien als Longitudinalstudie bei Bluthochdruckpatienten konzipiert waren. In einem Zeitraum von 4–8 Wochen betrug die Interventionshäufigkeit wöchentlich zwischen einer und 3 MTTe-Einheiten.

Schlussfolgerung Die Studienergebnisse erweisen sich als heterogen. Aus diesem Grund lassen sich keine verbindlichen, eindeutigen und allgemeingültigen Aussagen ableiten, in welcher Form, Intensität sowie in welchem Umfang MTTe angewendet werden sollen, um gezielt positive Wirkungsmechanismen am ANS in Gang zu setzen. Für zukünftige Studien sind demzufolge Longitudinalstudien mit Follow-up empfehlenswert. Darüber hinaus sollten umfassende Effekte von MTTe bei Patientengruppen mit unterschiedlichen Ausprägungen untersucht werden.

Abstract

Background Physical interventions or manual therapeutic techniques (MTTe) such as mobilisation, manipulation or soft tissue techniques not only have an influence on the target tissue with improvement of metabolism or reduction of hypertonic muscles. They are also used for balance regulation in central nervous changes of the autonomic nervous system (ANS). To date, there is a lack of empirical evidence on impact mechanisms and target locations of MTTe on the ANS. This scoping review aims to provide an overview of the evidence on the application of MTTe at diverse levels of the spine with a view to the ANS.

Method A systematic literature search was conducted on CENTRAL, Google Scholar, Osteopathic Research Web, PEDro and PubMed. The scope and content of the literature were documented. The results of the included and referenced studies were summarised in a narrative approach with the focus being on the most significant clinical aspects.

Results MTTe was described as manipulations, mobilisations, myofascial techniques and cervical traction. In 27 out of 35 studies, therapeutic treatments were carried out on healthy volunteers. Ten studies analysed immediate effects in patients, while two studies were designed as longitudinal studies in patients with hypertension. Over a period of four to eight weeks, the frequency of intervention was between one and three MTTe sessions a week.

Conclusion The study results proved to be heterogeneous. For this reason, it is not possible to draw definitive, explicit and generally valid statements regarding the type and intensity as well as the segmental level at which MTTe should be applied in order to trigger specific positive ANS response mechanisms. Consequently, longitudinal studies with follow-up are recommended for future studies. In addition, comprehensive effects of MTTe should be evaluated in groups of patients with different characteristics.

Schlüsselwörter

Manipulation - sympathisches Nervensystem - parasympathisches Nervensystem

Keywords

musculoskeletal manipulation - sympathetic nervous systems - parasympathetic nervous system

Publikationsverlauf

Eingereicht: 02. Juli 2020

Angenommen nach Revision: 09. Oktober 2022

Artikel online veröffentlicht:
22. Mai 2023

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