Manuelle Therapie und Sensomotorisches System – Teil 2

Zusammenfassung

In der frühen Lebenszeit sind reversible Funktionsstörungen bereits verbreitet. Die gestörte Biomechanik ist untrennbar mit einem veränderten afferenten Muster der sensorischen Informationen verbunden, die zu sensomotorischen Fehlfunktionen führen. Diese Kombination führt zu konditionellen Nachteilen und degenerativen Entwicklungen bis hin zur Schmerzerkrankung. Die Qualität der Sensorik und direkt daraus folgend die Qualität der Bewegungsregulation haben einen wesentlichen Einfluss auf die Entwicklung degenerativer Veränderungen. So ist die Sensorik der Kopf-HWS-Region ein essenzielles Element der Positionierung des Kopfes im Raum und zum übrigen Körper, der optischen Funktion und der posturalen Regulationen. Dysfunktionelle Afferenzmuster der zervikalen Mechanosensoren haben somit besonders komplexe Auswirkungen auf die Sensomotorik und somit das muskuloskelettale System.

Die Manuelle Therapie sorgt für Schmerzlinderung sowie die Normalisierung der Biomechanik und ist damit die funktionelle Voraussetzung für „eine physiologische“ Sensomotorik, die nach der Intervention durch Training qualifiziert und dauerhaft erhalten werden muss. Die Manuelle Therapie ist somit vorrangig unmittelbare Schmerztherapie und das Training nachhaltige Schmerz-, Psycho- und die Struktur reorganisierende Funktionstherapie.

Der erste Teil dieses Artikels in der MSK 01/2025 gab einen Überblick zu dem Zusammenhang zwischen Funktions- und sensomotorischen Störungen (https://bit.ly/4k1D4O8). Dieser zweite Teil behandelt die komplexe Situation der Kopf-HWS-Region.

Abstract

Reversible functional disorders are already widespread in early life. The disturbed biomechanics are inextricably linked to an altered afferent pattern of sensory information, which leads to sensorimotor dysfunctions. This combination leads to conditional disadvantages and degenerative developments, including pain. The quality of the sensory system and, as a direct consequence, the quality of movement regulation has a significant influence on the development of degenerative changes. The sensory system of the head and cervical spine region is an essential element in the positioning of the head in space and about the rest of the body, in visual function, and in postural regulation. Dysfunctional afferent patterns of the cervical mechanosensors therefore have particularly complex effects on sensorimotor function and thus on the musculoskeletal system.

Manual therapy provides pain relief, normalizes biomechanics, and is therefore the functional prerequisite for “physiological” sensorimotor function, which must be qualified and permanently maintained through training after the intervention. Manual therapy is therefore primarily direct pain therapy and training is sustainable pain therapy, psychotherapy, and structural reorganization therapy.

The first part, published in the first issue of MSK 2025, provided an overview of the relationship between functional and sensorimotor disorders (https://bit.ly/4k1D4O8). This second part deals with the complex situation of the head and cervical spine region.

Schlüsselwörter

Funktionsstörungen Wirbelsäule - Fehlbelastungen - Sensomotorik - Manuelle Therapie - Schmerzen - Bewegungsqualität - Training

Keywords

functional disorders of the spine - incorrect loads - sensorimotor function - manual therapy - pain - quality of movement - training

Publication History

Article published online:
15 May 2025

• Literatur

• 1 Büsken F, Lataster A, Herrler A. The innervation of the cervical facet joints-an anatomical and histological approach. Clin Anat 2022; 35: 780-788
• 2 Liu JX, Thornell LE, Pedrosa-Domellöf F. Muscle spindles in the deep muscles of the human neck: a morphological and immunocytochemical study. J Histochem Cytochem 2003; 51: 175-186
• 3 Lepley AS, Lepley LK. Mechanisms of Arthrogenic Muscle Inhibition. J Sport Rehabil 2021; 31: 707-716
• 4 Konishi Y, Yoshii R, Ingersoll CD. Gamma Loop Dysfunction as a Possible Neurophysiological Mechanism of Arthrogenic Muscle Inhibition: A Narrative Review of the Literature. J Sport Rehabil 2022; 31: 736-741
• 5 Partanen JV, Lajunen HR, Liljander SK. Muscle spindles as pain receptors. BMJ Neurol Open 2023; 5: e000420
• 6 Peng B, Yang L, Li Y. et al. Cervical Proprioception Impairment in Neck Pain-Pathophysiology, Clinical Evaluation, and Management: A Narrative Review. Pain Ther 2021; 10: 143-164
• 7 Reddy RS, Meziat-Filho N, Ferreira AS. et al. Comparison of neck extensor muscle endurance and cervical proprioception between asymptomatic individuals and patients with chronic neck pain. J Bodyw Mov Ther 2021; 26: 180-186
• 8 Reddy RS, Tedla JS, Alshahrani MS. et al. Comparison and correlation of cervical proprioception and muscle endurance in general joint hypermobility participants with and without non-specific neck pain – a cross-sectional study. PeerJ 2022; 10: e13097
• 9 Raizah A, Reddy RS, Alshahrani MS. et al. A Cross-Sectional Study on Mediating Effect of Chronic Pain on the Relationship between Cervical Proprioception and Functional Balance in Elderly Individuals with Chronic Neck Pain: Mediation Analysis Study. J Clin Med 2023; 12: 3140
• 10 Falla D. Unravelling the complexity of muscle impairment in chronic neck pain. Man Ther 2004; 9: 125-133
• 11 Manchikanti L, Manchikanti KN, Cash KA. et al. Age-related prevalence of facet-joint involvement in chronic neck and low back pain. Pain Physician 2008; 11: 67-75
• 12 Manchikanti L, Kosanovic R, Cash KA. et al. Assessment of Prevalence of Cervical Facet Joint Pain with Diagnostic Cervical Medial Branch Blocks: Analysis Based on Chronic Pain Model. Pain Physician 2020; 23: 531-540
• 13 Koskimies K, Sutinen P, Aalto H. et al. Postural stability, neck proprioception and tension neck. Acta Otolaryngol Suppl 1997; 529: 95-97
• 14 McCarthy J, Castro P, Cottier R. et al. Multisensory contribution in visuospatial orientation: an interaction between neck and trunk proprioception. Exp Brain Res 2021; 239: 2501-2508
• 15 Mooti R, Park H. Contribution of Cervical Proprioception, Vision, and Vestibular Feedback on Reducing Dynamic Head-Trunk Orientation Error in the Yaw Direction. Front Neurosci 2022; 15: 774448
• 16 Treleaven J, Takasaki H, Grip H. Altered trunk head co-ordination in those with persistent neck pain. Musculoskelet Sci Pract 2019; 39: 45-50
• 17 Franov E, Straub M, Bauer CM. et al. Head kinematics in patients with neck pain compared to asymptomatic controls: a systematic review. BMC Musculoskelet Disord 2022; 23: 156
• 18 Brinjikji W, Luetmer PH, Comstock B. et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol 2015; 36: 811-816
• 19 Laube W. Bewegungsmangel Dekonditionierung, Krankheit, Schmerzen, Alter. Heidelberg-Berlin: Springer; 2023
• 20 Lascurain-Aguirrebeña I, Newham D, Critchley DJ. Mechanism of Action of Spinal Mobilizations: A Systematic Review. Spine (Phila Pa 1976) 2016; 41: 159-172
• 21 Haavik-Taylor H, Murphy B. Cervical spine manipulation alters sensorimotor integration: a somatosensory evoked potential study. Clin Neurophysiol 2007; 118: 391-402
• 22 Gross A, Langevin P, Burnie SJ. et al. Manipulation and mobilisation for neck pain contrasted against an inactive control or another active treatment. Cochrane Database Syst Rev 2015; 2015: CD004249
• 23 De Carvalho DE, Callaghan JP. The effect of lumbar spinal manipulation on biomechanical factors and perceived transient pain during prolonged sitting: a laboratory-controlled cross-sectional study. Chiropr Man Therap 2022; 30: 62
• 24 Rodríguez-Sanz J, Malo-Urriés M, Lucha-López MO. et al. Is Cervical Stabilization Exercise Immediately Effective in Patients with Chronic Neck Pain and Upper Cervical Spine Dysfunction? Randomized Controlled Trial. Life (Basel) 2022; 12: 714
• 25 Laube W. Sensomotorik und Schmerz. Wechselwirkung von Bewegungsreizen und Schmerzempfinden. Berlin – Heidelberg: Springer; 2020
• 26 Laube W. Schmerztherapie ohne Medikamente - Leitfaden zur endogenen Schmerzhemmung für Ärzte und Therapeuten. Berlin – Heidelberg: Springer; 2022
• 27 Bernal-Utrera C, Gonzalez-Gerez JJ, Anarte-Lazo E. et al. Manual therapy versus therapeutic exercise in non-specific chronic neck pain: a randomized controlled trial. Trials 2020; 21: 682
• 28 Celenay ST, Akbayrak T, Kaya DO. A Comparison of the Effects of Stabilization Exercises Plus Manual Therapy to Those of Stabilization Exercises Alone in Patients With Nonspecific Mechanical Neck Pain: A Randomized Clinical Trial. J Orthop Sports Phys Ther 2016; 46: 44-55
• 29 Rodríguez-Sanz J, Malo-Urriés M, Corral-de-Toro J. et al. Does the Addition of Manual Therapy Approach to a Cervical Exercise Program Improve Clinical Outcomes for Patients with Chronic Neck Pain in Short- and Mid-Term? A Randomized Controlled Trial. Int J Environ Res Public Health 2020; 17: 6601
• 30 Rodríguez-Sanz J, Malo-Urriés M, Lucha-López MO. et al. Effects of the Manual Therapy Approach of Segments C0-1 and C2-3 in the Flexion-Rotation Test in Patients with Chronic Neck Pain: A Randomized Controlled Trial. Int J Environ Res Public Health 2021; 18: 753
• 31 Arsh A, Darain H, Iqbal M. et al. Effectiveness of manual therapy to the cervical spine with and without manual therapy to the upper thoracic spine in the management of non-specific neck pain; a randomized controlled trial. J Pak Med Assoc 2020; 70: 399-403
• 32 Bautista-Aguirre F, Oliva-Pascual-Vaca Á, Heredia-Rizo AM. et al. Effect of cervical vs. thoracic spinal manipulation on peripheral neural features and grip strength in subjects with chronic mechanical neck pain: a randomized controlled trial. Eur J Phys Rehabil Med 2017; 53: 333-341
• 33 Bae S, Jung J, Moon D. Impact of Movement Control Training Using a Laser Device on the Neck Pain and Movement of Patients with Cervicogenic Headache: A Pilot Study. Healthcare (Basel) 2023; 11: 1439
• 34 Skillgate E, Pico-Espinosa OJ, Côté P. et al. Effectiveness of deep tissue massage therapy, and supervised strengthening and stretching exercises for subacute or persistent disabling neck pain. The Stockholm Neck (STONE) randomized controlled trial. Musculoskelet Sci Pract 2020; 45: 102070
• 35 Derksen F, Bensing J, Lagro-Janssen A. Effectiveness of empathy in general practice: a systematic review. Br J Gen Pract 2013; 63: e76-e84
• 36 Rasmussen-Barr E, Halvorsen M, Bohman T. et al. Summarizing the effects of different exercise types in chronic neck pain – a systematic review and meta-analysis of systematic reviews. BMC Musculoskelet Disord 2023; 24: 806
• 37 Hayden JA, Ellis J, Ogilvie R. et al. Exercise therapy for chronic low back pain. Cochrane Database Syst Rev 2021; 9: CD009790