Immediate changes in neck pain intensity and widespread pressure pain sensitivity in patients with bilateral chronic mechanical neck pain: a randomized controlled trial of thoracic thrust manipulation vs non-thrust mobilization

J Manipulative Physiol Ther. 2014 Jun;37(5):312-9. doi: 10.1016/j.jmpt.2014.03.003. Epub 2014 May 28.


Objective: The purpose of this study was to compare the effects of thoracic thrust manipulation vs thoracic non-thrust mobilization in patients with bilateral chronic mechanical neck pain on pressure pain sensitivity and neck pain intensity.

Methods: Fifty-two patients (58% were female) were randomly assigned to a thoracic spine thrust manipulation group or of thoracic non-thrust mobilization group. Pressure pain thresholds (PPTs) over C5-C6 zygapophyseal joint, second metacarpal, and tibialis anterior muscle and neck pain intensity (11-point Numerical Pain Rate Scale) were collected at baseline and 10 minutes after the intervention by an assessor blinded to group allocation. Mixed-model analyses of variance (ANOVAs) were used to examine the effects of the treatment on each outcome. The primary analysis was the group * time interaction.

Results: No significant interactions were found with the mixed-model ANOVAs for any PPT (C5-C6: P>.252; second metacarpal: P>.452; tibialis anterior: P>.273): both groups exhibited similar increases in PPT (all, P<.01), but within-group and between-group effect sizes were small (standardized mean score difference [SMD]<0.22). The ANOVA found that patients receiving thoracic spine thrust manipulation experienced a greater decrease in neck pain (between-group mean difference: 1.4; 95% confidence interval, 0.8-2.1) than did those receiving thoracic spine non-thrust mobilization (P<.001). Within-group effect sizes were large for both groups (SMD>2.1), and between-group effect size was also large (SMD = 1.3) in favor of the manipulative group.

Conclusions: The results of this randomized clinical trial suggest that thoracic thrust manipulation and non-thrust mobilization induce similar changes in widespread PPT in individuals with mechanical neck pain; however, the changes were clinically small. We also found that thoracic thrust manipulation was more effective than thoracic non-thrust mobilization for decreasing intensity of neck pain for patients with bilateral chronic mechanical neck pain.

Keywords: Manual Therapy; Neck Pain; Pressure; Spine.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Analysis of Variance
  • Female
  • Humans
  • Male
  • Manipulation, Spinal / methods*
  • Neck Pain / therapy*
  • Pain Measurement
  • Pain Threshold
  • Single-Blind Method
  • Thoracic Vertebrae