Effects of Jones’ Techniques on Joints Mobility, Back Pain and Cardiac Regulation

Abstract

Background: Jones’ techniques consist of the use of an analgesic position of correction to release guarding muscles and the kinetic dysfunction. For some authors, those techniques may have an impact on pain perception and sympathetic nervous system. The aim of this study is to find clinical evidences supporting a theoretical neurological model and to evaluate jones technique effectiveness on three different axes such as mobility (measured and experienced), pain and impact on sympathetic nervous system (here on cardiac issues). Methods: For this study 60 volunteers, 34 men and 26 women, with a mean age of 31.17 (± 9.88) were recruited. This study was a simple-blind randomised trial with an experimental group (N=30) in which a jones technique for the normalisation of the 4th thoracic vertebra in right rotation was performed and a control group (N=30) which stayed steadily for an equivalent duration. There were no significant differences of sex (17 men and 13 women in each) or age (F=1.76; NS) between the two groups. Results: Results show a significant effectiveness (p<0.05) of jones technique treating osteopathic dysfunctions with a resolution rate of 75% in experimental group against 11% for the control group. Tenderness of tender points has decreased significantly (p<0.05) of 65% in the experimental group against 5% in the control group. Mobility tests show a significate increase of flexion range of motion (p<0.05; +0.493cm between two groups in post-test and p<0.05; +0.527 for the before/after in experimental group). There is no significant difference in back pain, cardiac frequency or arterial pressure. Conclusion: These results shown effectiveness of Jones’ technique on mobility and presence of somatic dysfunctions. Those techniques had, however, no impacts on activity of vegetative nervous system. Introduction Jones’ techniques (aka strain-counter strain) were described by Lawrence Hugh Jones (American osteopath) in 1981, based on clinical experimentations for more than 40 years, to treat his patients. Those techniques are based on three main principles which are: use of Tender Points (TP) for diagnosis, analgesic position for correction and its effect on neuromuscular spindles allowing to relax tense muscle and therefore free from kinetic restriction [1]. In 1991, R.L. Van Buskirk has developed another approach which presumes that those techniques may have an impact on pain perception and Vegetative Nervous System (VNS) for stimulate an organ (heart for example) through Sympathetic Nervous System (SNS). He thus described a neurological model able to explain all the effects of Jones’ techniques. Nonetheless, this model is merely theoretical and has never been proven clinically [2]. In this latter, the author explains that the somatic dysfunction is not local musculoskeletal disruption, but rather a disorder binding those last disruptions with other phenomenon such as pain, vegetative arousal and visceral dysfunction. Nociceptor’s activation by a minor traumatism on a structure or an organ will cause pain whether it is perceived or not. At the medullary level, this activation will be able to stimulate, via synaptic loops, motor contingent of skeletal striated muscle leading to a muscular contraction shortening traumatized tissues and, thereby, be responsible of the lack of mobility experienced by the clinician (and sometimes the patient) on the somatic dysfunction level. Neural nociceptive loops can also stimulate sympathetic Citation: Midavaine V, Molinaro C, Lejeune L, Molinaro M (2018) Effects of Jones’ Techniques on Joints Mobility, Back Pain and Cardiac Regulation. Int J Musculoskelet Disord: IJMD-110. DOI: 10.29011/ IJMD-110. 000010 2 Volume 2018; Issue 02 pool on the involved medullar level which can result very variated answers depending on the organs linked to the activated location (vasomotor, Broncho-dilatator, positive chronotropic, ...) [2]. Associating musculoskeletal restriction, pain and effect on vegetative nervous system, this model better seems to explain the somatic dysfunction establishment in all its components [2]. In Jones’ techniques, tissues are shortened in order to supress intern stress without stimulating nociceptors from the antagonist region. The time passed in correction position (90 seconds) allows breaking activation loops of pain, muscular contraction and sympathetic arousal. The slow and passive return in neutral position avoids stimulating nociceptors and thus, preventing re-offending. It will be recalled that this model remains theoretical and has never been the object of a clinical study. Beside that theoretical description, there are some clinical studies of Jones’ techniques in literature which have contradictory results. 2 studies tried to compare effects of Jones’ techniques on masseters TP (to improve temporo-mandibular range of motion) to another technique and a control group (respectively with Chapman’s trigger points and Mitchell’s techniques). The first study outcomes are a significant improvement on temporo-mandibular range between techniques group and control group (no matter of the technique) without significant differences between the two techniques [3]. On the other hand, the 2nd study shows no significant differences between control group and Jones technique group [4]. In 2006, another study compared Jones technique on trapezius and a control group and found a significant improvement of the cervical range of mobility in agreement with the first study from Ibañez-Garcia [5]. In 2010, a 4th group has tried to study the effects of Jones’ techniques on low back comparing variation of pain pressure threshold at the TP, electrical detection threshold and electrical pain threshold on a group treated by Jones’ techniques, a second treated by a Sham technique (imitation-technique technically without effect). As a result, there are no significant differences between three groups [6]. Likewise, in 2013, a study compared effects of Jones’ techniques and Sham technique on the improvement of cervical range of motion without seeing any differences between two groups [7]. We would notice that there are relatively few studies on Jones’ techniques effect with conflicting results even if their protocols are very similar. This lack of results not allowing to understand how those techniques can act on the body, how well and for which use, brings into question the credit should be given to them treating patients in manual therapy. This being, from our literature analysis, we can point out that to proof Jones technique efficiency, authors have measured joints mobility and tenderness of tender points. To go even further and stick on osteopathic principles, we’ve decided to consider presence/absence of somatic dysfunction. Moreover, we’ve evaluated the subject feeling asking if he had a motion discomfort or any pain. Finally, we’ve chosen to evaluate impact on vegetative nervous system, to measure arterial blood pressure and instantaneous cardiac frequency. The choice of observed variables was guided by a study on high velocity osteopathic techniques [8]. The proposed study is suitable for testing clinically the theoretical neurological model and improves objectively osteopathic techniques efficiency which suffers their lack of credit at present. The aim of this study will be to assess part of this neurological model through an exploration of vegetative nervous response and estimate Jones technique efficiency on mobility (range of motion increase, reduce of the presence of dysfunction and experienced discomfort), pain (decline of spontaneous pain and TP tenderness) and sympathetic tonus (decrease of cardiac rhythm and arterial blood pressure). Methods Studied Population 60 subjects, 34 men and 26 women (31.17 years-old mean; ±9.88) signed the free and inform consent to enter this study. They had not any of those exclusion criteria: long-term disease, fracture, sprain, rheumatism, orthopaedic malformation, no surgery and no modification of dental, plantar or ophthalmic correction during the 3 previous months. This study is a randomized simple-blind trial with an experimental group on which have been tested Jones’ techniques and a control group which had a lying down rest period instead of the technique application. There were no significant differences of age between two groups (F=1.76; NS). The sex repartition between the groups was completely equal (17 men for 13 women in each group). Test Technique It was performed on experimental group subjects. Because it was the most recurrent dysfunction, only the correction of a posteriority to the right of the 4th thoracic level was performed. Moreover, it avoids bias of using multiple techniques depending on subjects. The subject is lengthened, head out of the table. Clinical practitioner set on the analgesic position of correction with a soft extension, right rotation and right side-bending by controlling tense on the corresponding TP. Rest period Subjects from the control group receive no treatment but a rest period with verbal exchange of 2 minutes 14 corresponding to time for achieving Jones’ technique (30” for setting parameters, 90” for technique realisation and 15” for the passive return to neutral position). Citation: Midavaine V, Molinaro C, Lejeune L, Molinaro M (2018) Effects of Jones’ Techniques on Joints Mobility, Back Pain and Cardiac Regulation. Int J Musculoskelet Disord: IJMD-110. DOI: 10.29011/ IJMD-110. 000010 3 Volume 2018; Issue 02 Instantaneous cardiac frequency Subjects had to wear the heart rate device (POLAR RX-800CX) in both two study groups before technique realisation or before the start of the rest period and remove it at the end. Instantaneous cardiac data have been identified and sequenced according to technique stages. Pre/Post-Test It is measurements and tests provided in both study groups before and after technique application or rest period (Figure 1). Figure 1: Experimental protocol. Evaluation of jo