Effects of Suboccipital Release on Sensorial and Functional Parameters

Summary

Suboccipital release is a straightforward technique beneficial for addressing musculoskeletal complaints like neck pain and headaches. This versatile method aids the autonomic system by manipulating the occipital-atlanto region, specifically regulating the parasympathetic system rather than the sympathetic system targeted by most osteopathic treatments. Studies indicate this technique enhances range of motion and balance in the lower extremities of both healthy and pre-existing patients due to fascia connections throughout the body. Suboccipital muscle release increases cervical spine range of motion, facilitating physical therapy. Myofascial release significantly boosts joint flexibility and range of motion (ROM) without reducing strength or performance. The rectus capitus posterior minor (RCPM) muscle, dense with spindles, is crucial in the suboccipital region for balance and pain proprioception. Trauma-induced atrophy in this muscle is strongly linked to chronic neck pain and reduced standing balance. A case report showed that a patient undergoing a personalized balance program exhibited significant balance improvement, suggesting that balance training should be considered for cervicogenic pain intervention strategies. Neck muscle spasms or fatigue can impair proprioception and postural control, with prolonged unilateral cervical muscle contraction increasing neck proprioceptor sensitivity. Muscle fatigue-related interstitial inflammatory mediators can sensitize muscle spindles. This study will explore suboccipital relaxation's acute effects on pressure pain threshold, range of motion, balance, and joint position sense in healthy individuals based on existing literature.

Conditions

• Suboccipital Muscles

Interventions

DIAGNOSTIC_TEST

Pain Pressure Threshold

A hand-held pressure algometer will be used to record the pressure pain threshold (PPT), defined as the level at which gradually increasing pressure becomes painful. Pressure algometry has shown high intratest reliability in asymptomatic individuals over the suboccipital area and upper trapezius. PPT levels will be measured bilaterally over the neck angle over the middle of the anterior surface of the upper trapezius; and over the rectus capitis posterior major (RCPM) muscle. The physiotherapist will use an increasing pressure of approximately 1 kg/cm²/s. The average of three measurements with a 30-second rest period will be taken for analysis. Two measurements will be taken, before and after.

DIAGNOSTIC_TEST

Cervical Range of Motion

The degrees obtained as a result of the Range of Motion (ROM) measurements are made with a universal manual goniometer. Goniometer is still the most commonly used method for ROM measurements. For all ROM measurements to be performed, the necessary measurements can be taken based on the American Academy of Orthopaedic Surgeons (AAOS) guidelines . The flexion, extension, right and left rotation angles of the cervical region will be measured and recorded with the goniometer in the sitting position of the person. The measurement will be made twice, before and after the application.

DIAGNOSTIC_TEST

Balance Error Scoring

Balance performance will be assessed using the Balance Error Scoring System (BESS), known in Turkish as DHPS. Subjects must maintain test positions for 20 seconds under 6 conditions with eyes closed and no support: 2 surfaces (flat and foam) and 3 stance positions (double-foot, single-foot, tandem). A laboratory floor will serve as the flat surface, and an exercise mat will serve as the foam surface. All subjects will perform the conditions in this sequence: double-foot flat, single-foot flat, tandem flat, double-foot foam, single-foot foam, tandem foam, both pre-test and post-test. Each 20-second period will be timed with a stopwatch, and each error within this period will count as 1 point. Each test condition has a maximum error score of 10. Errors include: 1. Lifting hands above the iliac crest, 2. Opening eyes, 3. Taking a step,staggering, falling, 4. Flexing or abducting the hip joint beyond 30°, 5. Lifting the forefoot or heel off the ground, 6. Leaving the test position

DIAGNOSTIC_TEST

Cervical Joint Position Sense

The sense of joint position in the cervical region will be evaluated in four positions: flexion, extension, right rotation, and left rotation, using a goniometer. Participants will sit upright with arms at their sides, looking ahead. The physiotherapist will passively move the participant's head to 65% of the maximum joint range of motion, previously determined, minimizing vestibular function effects. After holding the head in position for three seconds, participants will be asked to remember the position. Subsequently, they will be instructed to return their head to the neutral position and then actively move it to the previously determined point. The degree of error between the target and achieved positions will be measured.

OTHER

Suboccipital manual therapy

The procedure will be conducted with the patient lying on their back. The practitioner will be seated on a stool at the top of the examination table, their forearm in contact with the surface. After locating the occipital condyles through palpation, the practitioner will position their fingers in the slightly concave region between the occiput and the second cervical vertebra's spinous process. The patient's head will be gently elevated by the practitioner flexing their metacarpophalangeal joints. With the patient's skull base resting in the practitioner's palm, pressure equivalent to the weight of the patient's head will be applied to the rectus capitis posterior and obliquus capitis superior muscles using the practitioner's second, third, and fourth fingers for a duration of 5 minutes. To prevent eye movements from influencing suboccipital muscle tone, patients will be instructed to keep their eyes closed during the procedure.

Sponsors & Collaborators

• Bezmialem Vakif University

  lead OTHER

Study Design

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

SINGLE

Model

PARALLEL

Eligibility

Min Age

18 Years

Max Age

55 Years

Sex

ALL

Healthy Volunteers

Yes

Timeline & Regulatory

Start

2024-06-02

Primary Completion

2024-10-02

Completion

2024-10-02

Countries

• Turkey (Türkiye)

Study Locations