Aim of investigation: This study investigated the antinociceptive and anti-inflammatory effects of different grades of joint mobilization (JM) at different periods of time after induction of inflammation. Methods: Seventy five male Wistar rats were induced with joint inflammation through an injection volume with 0.1 mL of 3% carrageenan and kaolin at the left knee. Later, they were divided into groups of joint mobilization grade 1, grade 3 and control. Animals were assessed at different periods as 5 days before induction, 07 hours after induction, and 03, 10 and 20 days after induction of inflammation. Joint mobilizations were held for grades 1 and 3 differentiated by the degree of range performed and where clinically indicated for pain reduction and improved mobility. The protocol of JM was performed by using three sets of three minutes with one minute of interval between each series. Control animals were maintained in a glove for the duration of therapeutic intervention. All tests were performed with the investigator blinded to treatment. Mechanical hyperalgesia, and motor performance were assessed through digital analgesimeter and grip strength meter, respectively. Anti-inflammatory action was assessed by the total cell counting. Results: All experimental groups became hyperalgesic, through a significant reduction in mechanical withdrawal threshold (p<0.001) 24 hours after the inflammation was induced. There was no change in the mechanical withdrawal threshold in the experiment where the JM was done before induction. There were antinociceptive effects in the other groups, when compared with control (p<0.05). There was a significant reduction of the total cells counting only in the group treated with grade 1 JM when compared to the group treated with grade 3 and to the control group (p<0.0001). There was no difference for the withdrawal threshold between grades 1 and 3 JM related to the experiments assessed 03, 10 and 20 days after induction of inflammation, and for the 7-hour after induction group, only grade 1 mobilization showed antinociceptive effect (p<0.001). There was no difference between groups related to motor performance. Conclusions: Both grade 1 and grade 3 JM were effective in reducing secondary hyperalgesia after joint inflammation, and grade 1 was more effective in suggesting anti-inflammatory effect in joint inflammation. / Introdução: Dor músculo-esquelética é uma condição altamente prevalente, com influência econômica relevante para a sociedade e repercussões na funcionalidade dos indivíduos. A mobilização articular (MA) é um método terapêutico que promove alívio de dor e melhora da amplitude de movimento funcional. Este estudo é justificado pela necessidade de maior aprofundamento nos efeitos da MA na dor articular aguda e crônica, envolvendo os seus diversos períodos, desde a instalação aguda da inflamação, até a cronificação da dor articular. Objetivo: O presente estudo investigou os efeitos dos graus 1 e 3 de MA bem como o efeito antihiperalgésico das MAs efetuadas durante diferentes períodos após a indução da inflamação articular. Método: 75 ratos Wistar foram induzidos com inflamação articular através de uma injeção com o volume de 0,1 mL de solução de carragenina e caolina (3%) no joelho esquerdo. Posteriormente, a formação dos grupos deu-se de acordo com os graus de MA clinicamente indicados para redução da dor e melhora da mobilidade: grau 1, grau 3 e controle, com 25 animais em cada grupo. As intervenções foram realizadas em diferentes fases: 05 dias antes da indução, 07 horas após a indução, e 03, 10 e 20 dias após a indução de inflamação articular. Os animais do grupo controle foram mantidos dentro da luva durante o tempo do procedimento de intervenção terapêutica. Todos os testes foram feitos com experimentador cego para o tratamento. Foram mensurados os efeitos antinociceptivos, a partir da hiperalgesia mecânica secundária, e os efeitos anti-inflamatórios, a partir da contagem total de células inflamatórias, além disso, foi mensurado o desempenho motor, a partir do Grip Strength Meter. Resultados: Em todos os grupos experimentais, houve redução significativa do limiar mecânico da pata 24 horas após instalado o processo infamatório em todos os grupos, indicando hiperalgesia (p<0,001). Não houve efeitos antinociceptivos quando a MA foi administrada antes de induzir a inflamação articular pré-indução. Ambos os graus de MA (1 e 3) promoveram redução significativa do limiar mecânico de retirada da pata em relação ao controle quando aplicada 3, 10 e 20 dias após indução da inflamação (p<0,05). Às 7 horas pós-indução apenas o grau I apresentou redução significativa do limiar mecânico de pata (p<0,001). Não houve repercussão no desempenho motor após tratamento com MA em nenhum dos períodos de intervenção. Houve diminuição significativa do número total de leucócitos nos grupos que sofreram intervenção com o grau 1 (p<0,0001). Conclusões: Mobilização articular grau 1 e grau 3 foram eficientes na redução da hiperalgesia mecânica em todos os momentos da inflamação articular, sendo que o grau 1 apresentou efeito antinociceptivo no momento mais precoce estudado em modelo experimental de dor inflamatória. A mobilização articular de pequena amplitude apresentou repercussão sobre a contagem de leucócitos, sugerindo um efeito anti-inflamatório da mobilização articular.

Depuis la dernière décennie, un nombre croissant de parents consultent divers praticiens en médecine complémentaire et alternative pour des troubles reliés à la santé de leurs bébés ou enfants. Les thérapies manuelles, incluant les mobilisations et manipulations vertébrales, sont des modalités thérapeutiques couramment utilisées dans ce domaine alternatif et malgré la popularité de ces thérapies, peu de littérature existe quant à la sécurité de celles-ci. La majorité des effets secondaires rapportés dans la littérature suite aux thérapies manuelles sont légers et transitoires (ex. : pleurs et raideur), mais certains plus graves (ex. : décès) ont déjà été rapportés. L’objectif de l’article présenté dans ce mémoire était d’évaluer les effets secondaires immédiats et différés (48h) associés aux thérapies manuelles chez les enfants de 5 ans et moins et de présenter des données préliminaires. L’obtention des données chez 73 participants-enfants fut réalisée par l’entremise d’un questionnaire en ligne complété par le tuteur légal. Les résultats de cette étude clinique pragmatique démontrent des effets secondaires bénins et transitoires (ex : irritabilité/pleurs, fatigue/somnolence) chez 30% des enfants ayant reçu des thérapies manuelles. La réalisation de ce projet a permis de confirmer la portion faisabilité auprès de chiropraticiens-participants dans leurs pratiques privées respectives. La limite principale de cette étude est la taille de l’échantillon, qui fut trop petite pour obtenir une puissance statistique permettant de tirer des conclusions sur la fréquence et la nature des effets secondaires. Les retombées de ce projet de recherche incluent un apport quant aux connaissances concernant les effets secondaires suite aux thérapies manuelles pédiatriques et surtout permettent de démontrer qu’il est faisable de réaliser un tel projet au sein des diverses professions pratiquant les thérapies manuelles comme la physiothérapie ou la chiropratique. / Over the past decade, a growing number of parents have been consulting various complementary and alternative medicine practitioners for health-related problems concerning their babies or children. Manual therapies, including spinal mobilizations and spinal manipulation, are one of the therapeutic modalities commonly used in this alternative field and despite the popularity of these therapies, little literature exists on their safety. The majority of adverse events reported in the literature following manual therapies are mild and transient (e.g. crying and stiffness), but some more serious (e.g. death) have already been reported. The objective of the article presented in this thesis was to evaluate immediate and delayed side effects associated with manual therapies in children 5 years of age and under and to present preliminary data. Those data was obtained from 73 child participant through an online questionnaire completed by the legal guardian. The results of this pragmatic clinical study demonstrate mild and transient adverse events (e.g. irritability/crying, fatigue/drowsiness) in 30% of children who received manual therapies. The realization of this project made it possible to confirm the feasibility portion with participating chiropractors in their private practices and the main limitation of it was the sample size, too small to obtain a statistical power allowing to draw conclusions on the frequency and nature of side effects. The benefits of this research project include a contribution to knowledge concerning adverse events following pediatric manual therapies and above all make it possible to demonstrate that it is feasible to carry out such a project within the various professions practicing manual therapies such as physiotherapy or chiropractic.

La mobilisation vertébrale est fréquemment utilisée pour traiter les troubles neuromusculosquelettiques chez les enfants. Cependant, il existe peu d’études ayant mesurées les caractéristiques force-temps de la mobilisation pédiatrique. Cette étude visait à évaluer la faisabilité de l'utilisation d'un capteur de force au bout des doigts pour mesurer les caractéristiques force-temps de la mobilisation vertébrale administrée par des chiropraticiens à des enfants âgés de cinq ans et moins. Des chiropraticiens traitant couramment de jeunes enfants ont été recrutés. Un capteur (Tekscan®, USA) a été placé sur le bout du doigt des chiropraticiens lors de l’exécution des mobilisations vertébrales chez un patient de cinq ans et moins. Avant la collecte de données, le capteur a été calibré à l'aide d'un capteur précalibré (Large Loadpad®, Novel®) positionné sur la cuisse du chercheur. Les courbes force-temps des mobilisations ont été analysées visuellement pour identifier des patrons de mobilisations. Au total, cinq patrons de mobilisations vertébrales ont été identifiés. Cette étude a permis d’identifier des défis limitant la faisabilité à mesurer les caractéristiques force-temps des mobilisations vertébrales pédiatriques en clinique privée. Le positionnement adéquat du capteur lors des mobilisations cervicales explique la perte importante des données limitant la compréhension de sa sécurité et de son efficacité. Bien que l’algorithme de calibration ait démontré une concordance parfaite entre la force et le voltage, la calibration effectuée sur la cuisse du chercheur peut expliquer en partie un manque d’exactitude observé. Néanmoins, les résultats ont démontré que les mobilisations pédiatriques peuvent être effectuées de différentes façons, cependant qu’un patron prédomine auprès d’un même chiropraticien. Cette étude soulève le besoin d’établir des standards pour guider la mesure des caractéristiques force-temps des thérapies manuelles en pédiatrie considérant les défis particuliers associés à ce type de population. / Spinal mobilization is frequently used to treat neuromusculoskeletal disorders in children. However, there are few studies that have measured the force-time characteristics of pediatric mobilization. This study aimed to assess the feasibility of using a fingertip force sensor to measure the force-time characteristics of spinal mobilization administered by chiropractors to children aged five years and younger. Chiropractors who commonly treat young children were recruited. A sensor (Tekscan®, USA) was placed on the chiropractors' fingertip during the execution of spinal mobilizations in a patient aged five years and younger. Before data collection, the sensor was calibrated using a precalibrated sensor (Large Loadpad®, Novel®) positioned on the researcher's thigh. The force-time curves of mobilizations were visually analyzed to identify mobilization patterns graphically. In total, five patterns of vertebral mobilizations were been determined.. This study identified challenges that limit the feasibility of measuring the force-time characteristics of pediatric spinal mobilizations in private practice. The proper positioning of the sensor during cervical mobilizations explains the significant loss of data limiting the understanding of its safety and effectiveness. Although the calibration algorithm showed a perfect match between force and voltage, calibrating on the researcher's thigh may point out a lack of accuracy shown. Nevertheless, the results demonstrate that pediatric mobilizations can be performed in different ways, but a predominant pattern existed for the same chiropractor. This study highlights the need to establish standards to guide the measurement of forcetime characteristics of manual therapies in pediatrics, considering the specific challenges associated with this type of population.