Benefits of Thoracic Thrust Manipulation when Applied with a Multi-Modal Treatment Approach in Individuals with Mechanical Neck Pain: A Pilot Randomized Trial

David Browder,Samannaaz S Khoja

doi:10.4172/2329-9096.1000306

David Browder, Samannaaz S Khoja

Open Access

https://doi.org/10.4172/2329-9096.1000306

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Abstract

Objectives: Mechanical neck pain is generally treated with a multimodal approach that includes electro/thermal modalities, exercise and non-thrust manual therapy to the neck. Recent studies reported beneficial effects of thoracic thrust manipulation (TTM) but evidence for additive effects of TTM over multimodal neck program (MNP) is limited. The purpose of this pilot study was to assess the supplementary effects of TTM on pain and disability when applied in addition to a MNP to treat mechanical neck pain. Methods: Twenty-two eligible subjects (age: 38 ± 11 years, BMI: 25 ± 5 Kg/m2, 68% female) were randomized to receive MNP only or MNP+TTM for a maximum of 12 sessions. Outcomes were assessed at baseline and at 6 weeks follow up, and consisted of the numeric pain rating scale (NPS), Neck Disability Index (NDI), Global Rating of Change, duration of care, and neck active range of motion (AROM). Results: At 6 weeks both groups showed similar improvement in pain and disability that were clinically important. The NPS improved 2.9 points in the MNP+TTM group and 2.7 points in MNP group. The NDI reduced 14.6% in MNP+TTM and 11.8% in MNP. Increases in neck range of motion were small and similar in both groups. The percentage of subjects who improved in the global rating of change was 60%. Both groups reported similar duration of care (40 and 33 days in the MNP and MNP+TTM respectively). Conclusion: TTM does not appear to provide additional benefits over the MNP on the outcomes of pain, disability, neck range of motion, duration of care or global perception of change.

Highlights

Neck pain affects around 30-50% of adults and is associated with activity limitation, absence from work, and a high economic burden [1,2,3,4]
Neck pain due to an unidentifiable patho-anatomic origin is termed as mechanical neck pain, which usually presents with stiffness around the cervical and shoulder region, and pain that is reproducible on cervical movements [5,6]
Cervical thrust manipulation is an effective form of manual therapy that reduces mechanical neck pain and improves range of motion [7,8,9], but at the same time exposes the patients to rare but severe complications related to vertebral artery injury [10,11,12,13,14,15]

Summary

Introduction

Neck pain affects around 30-50% of adults and is associated with activity limitation, absence from work, and a high economic burden [1,2,3,4]. Cervical thrust manipulation is an effective form of manual therapy that reduces mechanical neck pain and improves range of motion [7,8,9], but at the same time exposes the patients to rare but severe complications related to vertebral artery injury [10,11,12,13,14,15]. To avoid the potential complications related to thrust techniques, indirect techniques directed to the thoracic spine, such as thoracic thrust manipulation (TTM), are often used by clinicians to treat mechanical neck pain. Studies have demonstrated that TTM appears to increase neck movement, and reduces neck pain and disability, without the exposure to potential adverse events reported during cervical thrust manipulations [17,18,19,20,21,22,23,24]

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