Narrative Review: Effects of manipulation and mobilization techniques of cervical spine on pressure pain threshold in neck and shoulder muscles

Neck pain is one of the most common problems seen in medical practice. There are various factors that can cause or provoke neck pain. Myofascial trigger points in shoulder and neck regions are among the most effective factors that may provoke neck and head pain. Recently, it has been revealed that there is a clinical relationship between myofascial trigger points and joints dysfunction. Accordingly, different studies have been conducted in order to evaluate therapeutic effects of different manual approaches including mobilization and manipulation on improving Pressure Pain Threshold (PPT) as an indicator of changes in sensitivity of muscles. The aim of the present study was to conduct a narrative review to evaluate effects of manipulation and mobilization techniques of cervical spine on PPT in neck and shoulder muscles. From among different studies which have assessed the effectiveness of manual techniques directed on cervical spine, 10 most related studies were selected and the therapeutic approaches and results of these studies were studied. Review of these studies indicated that the application of manual techniques on cervical spine, such as manipulation and mobilization, could increase range of motion in cervical spine and even mouth opening according to relationship between cervical spine and tempromandibular joints. On the other hand, according to the relationship between joints and muscles, applying these techniques on cervical spines could improve PPT.