Objectives: To determine the difference on neck outcomes with directional manipulation to the thoracic spine. There is evidence that thoracic spine manipulation is effective in treating patients with neck pain. However, there is no research that determines if the assessment of directional hypomobility and the selection of thrust direction offer improved outcomes.
Methods: A total of 69 patients with cervical spine pain were randomly assigned to receive either a manipulation that was consistent with their thoracic spine motion loss (matched) or opposite their motion loss (unmatched). The patient was given care consistent with the orthopedic section guidelines for neck pain and the physical therapist's clinical reasoning. Baseline outcome measures (NPRS, NDI, GROC) were taken and reassessed two days and two weeks after treatment.
Results: Both groups had positive results when pain, neck disability index, and global rating of change were assessed. There was no difference between the matched and unmatched groups.
Discussion: Directional manipulation of hypomobile thoracic spine segments may not be required to improved outcomes in patients with neck pain. Future studies should assess a variety of factors when determining the best available treatment, including manual therapy procedures, exercise, and patient selection.
Level of evidence: 1b.
Keywords: Thoracic spine; neck pain; thoracic spine manipulation.
Short-term effects of thrust versus nonthrust mobilization/manipulation directed at the thoracic spine in patients with neck pain: a randomized clinical trial.Phys Ther. 2007 Apr;87(4):431-40. doi: 10.2522/ptj.20060217. Epub 2007 Mar 6. Phys Ther. 2007. PMID: 17341509 Clinical Trial.
Pragmatically Applied Cervical and Thoracic Nonthrust Manipulation Versus Thrust Manipulation for Patients With Mechanical Neck Pain: A Multicenter Randomized Clinical Trial.J Orthop Sports Phys Ther. 2018 Mar;48(3):137-145. doi: 10.2519/jospt.2018.7738. Epub 2018 Feb 6. J Orthop Sports Phys Ther. 2018. PMID: 29406835 Clinical Trial.
Short-term combined effects of thoracic spine thrust manipulation and cervical spine nonthrust manipulation in individuals with mechanical neck pain: a randomized clinical trial.J Orthop Sports Phys Ther. 2013 Mar;43(3):118-27. doi: 10.2519/jospt.2013.4221. Epub 2012 Dec 7. J Orthop Sports Phys Ther. 2013. PMID: 23221367 Clinical Trial.
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. J Orthop Sports Phys Ther. 2011. PMID: 21885904 Review.
Manipulation and mobilisation for neck pain contrasted against an inactive control or another active treatment.Cochrane Database Syst Rev. 2015 Sep 23;(9):CD004249. doi: 10.1002/14651858.CD004249.pub4. Cochrane Database Syst Rev. 2015. PMID: 26397370 Review.