JCPR Journal of Clinical Physiotherapy Research Review Article Journal of Clinical Physiotherapy Research. 2016;1(1): 1-5 Copyright © 2016 Shahid Beheshti University of Medical Sciences. All rights reserved. Downloaded from: http://journals.sbmu.ac.ir/physiotherapy/ Narrative Review: Effects of Manipulation and Mobilization Techniques of Cervical Spine on Pressure Pain Threshold in Neck and Shoulder Muscles Sahar Zamani a , Farshad Okhovatian b , Sedigheh Sadat Naimi b a Physiotherapy Research Centre, School of Rehabilitation, Student Research Office, Shahid Beheshti University of Medical Sciences, Tehran, Iran; b Physiotherapy Research Centre, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran *Corresponding Author: Farshad Okhovatian, Department of Physiotherapy, School of Rehabilitation Sciences, Shahid Beheshti Medical University, Damavand St, Imam Hossein SQ, Tehran, Iran. E-mail:farshadokhovatian1965@gmail.com Submitted: 2016-01-08; Accepted: 2016-05-29 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. Keywords: Manipulation, Mobilization, Pressure Pain Threshold, Cervical Spine Please cite this paper as: Zamani S, Okhovatian F, Naimi SS. Narrative Review: Effects of Manipulation and Mobilization Techniques of Cervical Spine on Pressure Pain Threshold in Neck and Shoulder Muscles. J Clin Physio Res. 2016; 1(1): 1-5. Introduction Neck pain is a common problem in the general population, which can provoke headache, tempromandibular pain, a limited range of motion in neck, and feeling of stiffness (1). The prognosis for chronic neck pain is poor. Chronic neck pain causes major financial loss due to the costs of diagnosis and treatment (2). A number of factors 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. The relationship between neck pain and myofascial trigger points (MTrPs) was previous revealed in the literature (3-7). Myofascial trigger points are defined as hypersensitive tender spots associated with a taut band of a skeletal muscle that is painful on compression or stretch and gives rise to a referred pain pattern distant from that spot, and if they are sensitive enough, they can cause referred pain and autonomic disorders (8). Several therapeutic approaches have been proposed for the treatment of MTrPs. Physical therapy techniques can be divided into three groups: 1. Manual therapies (including pressure release, muscle energy technique, strain counter strain, Spray and stretch, Massage, etc., 2. Needling therapies (dry needling and wet needling), and 3. Other techniques (laser therapy, thermotherapy, etc.) (9). It has been suggested that there is a clinical relationship between myofascial trigger points and joints dysfunction (8, 10). In the recent studies, it is revealed that the presence of MTrPs in the upper Trapezius muscle is associated with the cervical C3-C4 vertebrae dysfunctions, including hypomobility, abnormal end feel, increased stiffness, and a decreased joint mobility (11). On the other hand, it has been revealed that in peoples who suffer from migraine, the prevalence and the number of active MTrPs is high. Also, referred pain originating from different myofascial trigger points in the head, neck, or shoulder muscles could potentially cause or provoke symptoms in migraine sufferers. Moreover, it is suggested that common etiological factors in migraine and MTrPs, such as emotional or physical tension which can cause MTrPs in neck and shoulder muscles, also affect manifestation of migraine (12). Fernández‐de‐las‐Peñas et al. demonstrated further prevalence of active MTrPs in upper Trapezius, sternocleidomastoid, and temporalis muscles in cronic Tension‐Type Headache (CTTH) patients. Also, they suggested that severity of headache (intensity and duration) could be affected by existence of active MTrPs. In