Thoracic spine thrust manipulation improves pain, range of motion, and self-reported function in patients with mechanical neck pain: a systematic review

J Orthop Sports Phys Ther. 2011 Sep;41(9):633-42. doi: 10.2519/jospt.2011.3670. Epub 2011 Aug 31.


Study design: Systematic review.

Background: Neck pain is a common diagnosis in the physical therapy setting, yet there is no gold standard for treatment. This study is part of a growing body of literature on the use of thoracic spine thrust manipulation for the treatment of individuals with mechanical neck pain.

Objective: The purpose of this systematic review was to determine the effects of thoracic spine thrust manipulation on pain, range of motion, and self-reported function in patients with mechanical neck pain.

Methods: Six online databases were comprehensively searched from their respective inception to October 2010. The primary search terms included "thoracic mobilization," "thoracic spine mobilization," "thoracic manipulation," and "thoracic spine manipulation." Of the 44 studies assessed for inclusion, 6 randomized controlled trials were retained. Between-group mean differences and effect sizes for pretreatment-to-posttreatment change scores, using Cohen's d formula, were calculated for pain, range of motion, and subjective function at all stated time intervals.

Results: Effect size point estimates for the pain change scores were significant for global assessment across all studies (range, 0.38-4.03) but not conclusively significant at the end range of active rotation (range, 0.02-1.79). Effect size point estimates were large among all range-of-motion change measures (range, 1.40-3.52), and the effect size point estimates of the change scores among the functional questionnaires (range, 0.47-3.64) also indicated a significant treatment effect.

Conclusions: Thoracic spine thrust manipulation may provide short-term improvement in patients with acute or subacute mechanical neck pain. However, the body of literature is weak, and these results may not be generalizable.

Level of evidence: Therapy, level 1b-.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Humans
  • Male
  • Manipulation, Spinal / adverse effects
  • Manipulation, Spinal / methods*
  • Neck Pain / therapy*
  • Range of Motion, Articular / physiology*
  • Thoracic Vertebrae / physiopathology
  • Treatment Outcome