Cervical Spine Manipulation Research Articles

Kinematics of the upper cervical spine during high velocity-low amplitude manipulation. Analysis of intra- and inter-operator reliability for pre-manipulation positioning and impulse displacements

To date, kinematics data analyzing continuous 3D motion of upper cervical spine (UCS) manipulation is lacking. This in vitro study aims at investigating inter- and intra-operator reliability of kinematics during high velocity low amplitude manipulation of the UCS.Three fresh specimens were used. Restricted dissection was realized to attach technical clusters to each bone (skull to C2). Motion data was obtained using an optoelectronic system during manipulation. Kinematics data were integrated into specific-subject 3D models to provide anatomical motion representation during thrust manipulation. The reliability of manipulation kinematics was assessed for three practitioners performing two sessions of three repetitions on two separate days.For pre-manipulation positioning, average UCS ROM (SD) were 10° (5°), 22° (5°) and 14° (4°) for lateral bending, axial rotation and flexion–extension, respectively. For the impulse phase, average axial rotation magnitude ranged from 7° to 12°. Reliability analysis showed average RMS up to 8° for pre-manipulation positioning and up to 5° for the impulse phase.As compared to physiological ROM, this study supports the limited angular displacement during manipulation for UCS motion components, especially for axial rotation. Kinematics reliability confirms intra- and inter-operator consistency although pre-manipulation positioning reliability is slightly lower between practitioners and sessions.

Global and regional kinematics of the cervical spine during upper cervical spine manipulation: A reliability analysis of 3D motion data

Studies reporting spine kinematics during cervical manipulation are usually related to continuous global head–trunk motion or discrete angular displacements for pre-positioning. To date, segmental data analyzing continuous kinematics of cervical manipulation is lacking. The objective of this study was to investigate upper cervical spine (UCS) manipulation in vitro. This paper reports an inter- and intra-rater reliability analysis of kinematics during high velocity low amplitude manipulation of the UCS. Integration of kinematics into specific-subject 3D models has been processed as well for providing anatomical motion representation during thrust manipulation.Three unembalmed specimens were included in the study. Restricted dissection was realized to attach technical clusters to each bone of interest (skull, C1–C4 and sternum). During manipulation, bone motion data was computed using an optoelectronic system. The reliability of manipulation kinematics was assessed for three experimented practitioners performing two trials of 3 repetitions on two separate days.During UCS manipulation, average global head–trunk motion ROM (±SD) were 14 ± 5°, 35 ± 7° and 14 ± 8° for lateral bending, axial rotation and flexion-extension, respectively. For regional ROM (C0–C2), amplitudes were 10 ± 5°, 30 ± 5° and 16 ± 4° for the same respective motions. Concerning the reliability, mean RMS ranged from 1° to 4° and from 3° to 6° for intra- and inter-rater comparisons, respectively.The present results confirm the limited angular displacement during manipulation either for global head–trunk or for UCS motion components, especially for axial rotation. Additionally, kinematics variability was low confirming intra- and inter-practitioners consistency of UCS manipulation achievement.

The Association Between Cervical Spine Manipulation and Carotid Artery Dissection: A Systematic Review of the Literature

ObjectiveControversy surrounds the safety of cervical spine manipulation. Ischemic stroke secondary to cervical spine manipulation is a hypothesized adverse event. In Canada, the seriousness of these events and their perceived association to cervical spine manipulation has led some members of the public to call for a ban of the procedure. The primary objective of this study was to determine the incidence of internal carotid artery (ICA) dissection after cervical spine manipulation in patients who experience neck pain and its associated disorders. The secondary objective was to determine whether cervical spine manipulation is associated with an increased risk of ICA dissection in patients with neck pain, upper back pain, or headaches. MethodsWe systematically searched MEDLINE, CINAHL, Alternative Health, AMED, Index to Chiropractic Literature, and EMBASE from 1970 to November 2012. Two independent reviewers used standardized criteria to screen the eligibility of articles. We considered cohort studies, case-control studies, and randomized clinical trials that addressed our objectives. We planned to critically appraise eligible articles using the Scottish Intercollegiate Guideline Network methodology. ResultsWe did not find any epidemiologic studies that measured the incidence of cervical spine manipulation and ICA dissection. Similarly, we did not find any studies that determined whether cervical spine manipulation is associated with ICA dissection. ConclusionsThe incidence of ICA dissection after cervical spine manipulation is unknown. The relative risk of ICA dissection after cervical spine manipulation compared with other health care interventions for neck pain, back pain, or headache is also unknown. Although several case reports and case series raise the hypothesis of an association, we found no epidemiologic studies that validate this hypothesis.

Bilateral Posterior and Lateral Ponticles Resulting In the Formation of Vertebral Artery Canal for the Atlas: Case Report

Atlas first cervical vertebra having no spine and body differs from other vertebra. Contains two archs anterior and posterior. Posterior arch contains groove for vertebral artery. During routine osteology classes for undergraduate medical students, we observed presence of bilateral posterior and lateral ponticles which are forming canal for vertebral artery on behind and lateral to lateral mass of atlas. Present case report is very rare anomaly which may lead to stenosis of vertebral artery and may be useful for orthopaedics during surgical manipulation of cervical spine. First cervical vertebra called as atlas, which support the globe of the head. The name of the atlas derived from a deity of Greek mythology called atlas. It is ring shaped having two arch anterior and posterior. Atlas differes from other vertebra without body and spine. Contains weight bearing two lateal mass with articular facets. Posterior arch forms 3/5 th of circumference of atlantal ring, having groove called as sulcus arteriae vertebralis which transmits vertebral artery and first cervical nerve. Rarely this groove may be converted into foramen by complete posterior ponticles connecting the superior articular facet to posterior arch. This foramina called by different names as saggitale foramen and atlantal posterior foramen, arcuate foramen,a variant of Kimmerle's anomaly, canalis vertbralis, retroarticular vertebral artery ring, arcuate foramen ,retroarticular canal , and retrocondilar vertebral artery ring, ponticulus posticus. Some times very rarely can see lateral ponticles .These spicule extend from the superior edge of the lateral mass of atlas to posterior root of the transverse process. Presences of bilateral posterior and lateral ponticles are very rare.In this case we are reporting presence of both ponticles bilaterally resulting canal for vertebarl artery.

Changes in Vertebral Artery Blood Flow Following Various Head Positions and Cervical Spine Manipulation

ObjectiveThe objective of the study was to investigate the cerebrovascular hemodynamic response of cervical spine positions including rotation and cervical spine manipulation in vivo using magnetic resonance imaging technology on the vertebral artery (VA). MethodsThis pilot study was conducted as a blinded examiner cohort with 4 randomized clinical tasks. Ten healthy male participants aged 24 to 30 years (mean, 26.8 years) volunteered to participate in the study. None of the participants had a history of disabling neck, arm, or headache pain within the last 6 months. They did not have any current or history of neurologic symptoms. In a neutral head position, physiologic measures of VA blood flow and velocity at the C1-2 spinal level were obtained using phase-contrast magnetic resonance imaging after 3 different head positions and a chiropractic upper cervical spinal manipulation. A total of 30 flow-encoded phase-contrast images were collected over the cardiac cycle, in each of the 4 conditions, and were used to provide a blood flow profile for one complete cardiac cycle. Differences between flow (in milliliters per second) and velocity (in centimeters per second) variables were evaluated using repeated-measures analysis of variance. ResultsThe side-to-side difference between ipsilateral and contralateral VA velocities was not significant for either velocities (P = .14) or flows (P = .19) throughout the conditions. There were no other interactions or trends toward a difference for any of the other blood flow or velocity variables. ConclusionsThere were no significant changes in blood flow or velocity in the vertebral arteries of healthy young male adults after various head positions and cervical spine manipulations.

Immediate effects of lower cervical spine manipulation on handgrip strength and free-throw accuracy of asymptomatic basketball players: a pilot study

ObjectiveThe purpose of this pilot study was to collect preliminary information for a study to determine the immediate effects of a single unilateral chiropractic manipulation to the lower cervical spine on handgrip strength and free-throw accuracy in asymptomatic male recreational basketball players. MethodsFor this study, 24 asymptomatic male recreational right-handed basketball players (age = 26.3 ± 9.2 years, height = 1.81 ± 0.07 m, body mass = 82.6 ± 10.4 kg [mean ± SD]) underwent baseline dominant handgrip isometric strength and free-throw accuracy testing in an indoor basketball court. They were then equally randomized to receive either (1) diversified left lower cervical spine chiropractic manipulative therapy (CMT) at C5/C6 or (2) placebo CMT at C5/C6 using an Activator adjusting instrument on zero force setting. Participants then underwent posttesting of isometric handgrip strength and free-throw accuracy. A paired-samples t test was used to make within-group pre to post comparisons and between-group pre to post comparisons. ResultsNo statistically significant difference was shown between either of the 2 basketball performance variables measured in either group. Isometric handgrip strength marginally improved by 0.7 kg (mean) in the CMT group (P = .710). Free-throw accuracy increased by 13.2% in the CMT group (P = .058). The placebo CMT group performed the same or more poorly during their second test session. ConclusionsThe results of this preliminary study showed that a single lower cervical spine manipulation did not significantly impact basketball performance for this group of healthy asymptomatic participants. A slight increase in free-throw percentage was seen, which deserves further investigation. This pilot study demonstrates that a larger study to evaluate if CMT affects handgrip strength and free-throw accuracy is feasible.

Paraplegia in a chiropractic patient secondary to atraumatic dural arteriovenous fistula with perimedullary hypertension: case report

Intracranial dural arteriovenous fistulas are abnormal communications between higher-pressure arterial circulation and lower-pressure venous circulation. This abnormal communication can result in important and frequently misdiagnosed neurological abnormalities.A case of rapid onset paraplegia following cervical chiropractic manipulation is reviewed. The patient’s generalized spinal cord edema, lower extremity paraplegia and upper extremity weakness, were initially believed to be a complication of the cervical spinal manipulation that had occurred earlier on the day of admission. Subsequent diagnostic testing determined the patient suffered from impaired circulation of the cervical spinal cord produced by a Type V intracranial arteriovenous fistula and resultant venous hypertension in the pontomesencephalic and anterior spinal veins.The clinical and imaging findings of an intracranial dural arteriovenous fistula with pontomesencephalic venous congestion and paraplegia are reviewed.This case report emphasizes the importance of thorough and serial diagnostic imaging in the presence of sudden onset paraplegia and the potential for error when concluding atypical neurological presentations are the result of therapeutic misadventure.

The quality of reports on cervical arterial dissection following cervical spinal manipulation.

BackgroundCervical artery dissection (CAD) and stroke are serious harms that are sometimes associated with cervical spinal manipulation therapy (cSMT). Because of the relative rarity of these adverse events, studying them prospectively is challenging. As a result, systematic review of reports describing these events offers an important opportunity to better understand the relation between adverse events and cSMT. Of note, the quality of the case report literature in this area has not yet been assessed.Purpose1) To systematically collect and synthesize available reports of CAD that have been associated with cSMT in the literature and 2) assess the quality of these reports.MethodsA systematic review of the literature was conducted using several databases. All clinical study designs involving CADs associated with cSMT were eligible for inclusion. Included studies were screened by two independent reviewers for the presence/absence of 11 factors considered to be important in understanding the relation between CAD and cSMT.ResultsOverall, 43 articles reported 901 cases of CAD and 707 incidents of stroke reported to be associated with cSMT. The most common type of stroke reported was ischemic stroke (92%). Time-to-onset of symptoms was reported most frequently (95%). No single case included all 11 factors.ConclusionsThis study has demonstrated that the literature infrequently reports useful data toward understanding the association between cSMT, CADs and stroke. Improving the quality, completeness, and consistency of reporting adverse events may improve our understanding of this important relation.

Bilateral and multiple cavitation sounds during upper cervical thrust manipulation

BackgroundThe popping produced during high-velocity, low-amplitude (HVLA) thrust manipulation is a common sound; however to our knowledge, no study has previously investigated the location of cavitation sounds during manipulation of the upper cervical spine. The primary purpose was to determine which side of the spine cavitates during C1-2 rotatory HVLA thrust manipulation. Secondary aims were to calculate the average number of pops, the duration of upper cervical thrust manipulation, and the duration of a single cavitation.MethodsNineteen asymptomatic participants received two upper cervical thrust manipulations targeting the right and left C1-2 articulation, respectively. Skin mounted microphones were secured bilaterally over the transverse process of C1, and sound wave signals were recorded. Identification of the side, duration, and number of popping sounds were determined by simultaneous analysis of spectrograms with audio feedback using custom software developed in Matlab.ResultsBilateral popping sounds were detected in 34 (91.9%) of 37 manipulations while unilateral popping sounds were detected in just 3 (8.1%) manipulations; that is, cavitation was significantly (P < 0.001) more likely to occur bilaterally than unilaterally. Of the 132 total cavitations, 72 occurred ipsilateral and 60 occurred contralateral to the targeted C1-2 articulation. In other words, cavitation was no more likely to occur on the ipsilateral than the contralateral side (P = 0.294). The mean number of pops per C1-2 rotatory HVLA thrust manipulation was 3.57 (95% CI: 3.19, 3.94) and the mean number of pops per subject following both right and left C1-2 thrust manipulations was 6.95 (95% CI: 6.11, 7.79). The mean duration of a single audible pop was 5.66 ms (95% CI: 5.36, 5.96) and the mean duration of a single manipulation was 96.95 ms (95% CI: 57.20, 136.71).ConclusionsCavitation was significantly more likely to occur bilaterally than unilaterally during upper cervical HVLA thrust manipulation. Most subjects produced 3–4 pops during a single rotatory HVLA thrust manipulation targeting the right or left C1-2 articulation; therefore, practitioners of spinal manipulative therapy should expect multiple popping sounds when performing upper cervical thrust manipulation to the atlanto-axial joint. Furthermore, the traditional manual therapy approach of targeting a single ipsilateral or contralateral facet joint in the upper cervical spine may not be realistic.

Cerebrospinal fluid leak secondary to chiropractic manipulation

Background:There is a paucity of quality data on the incidence of adverse outcomes of chiropractic manipulation. Spontaneous intracranial hypotension (SIH) subsequent to cervical spinal manipulation has been documented. However, no imaging correlates have previously been presented demonstrating a clear causal relationship to manipulation with follow-up and correlating with clinical symptomatology.Case Description:We present a case of subacute cervical cerebrospinal fluid (CSF) leak resulting from chiropractic manipulation of the cervical spine. The patient is a 29-year-old female who received manipulation one week prior to developing symptoms of severe orthostatic headache, nausea, and vomiting. Magnetic resonance imaging (MRI) revealed a new C5-C6 ventral CSF collection. Symptomatic onset corresponded with the recent cervical chiropractic adjustment. We present serial imaging correlating with her symptomatology and review the pertinent literature on complications of chiropractic manipulation.Conclusion:Our case of ventral CSF leak with symptoms of intracranial hypotension demonstrated spontaneous symptomatic resolution without permanent neurological sequelae.

Short-Term Combined Effects of Thoracic Spine Thrust Manipulation and Cervical Spine Nonthrust Manipulation in Individuals With Mechanical Neck Pain: A Randomized Clinical Trial

Randomized clinical trial. To investigate the short-term effects of thoracic spine thrust manipulation combined with cervical spine nonthrust manipulation (experimental group) versus cervical spine nonthrust manipulation alone (comparison group) in individuals with mechanical neck pain. Research has demonstrated improved outcomes with both nonthrust manipulation directed at the cervical spine and thrust manipulation directed at the thoracic spine in patients with neck pain. Previous studies have not determined if thoracic spine thrust manipulation may increase benefits beyond those provided by cervical nonthrust manipulation alone. Sixty-four participants with mechanical neck pain were randomized into 1 of 2 groups, an experimental or comparison group. Both groups received 2 treatment sessions of cervical spine nonthrust manipulation and a home exercise program consisting of active range-of-motion exercises, and the experimental group received additional thoracic spine thrust manipulations. Outcome measures were collected at baseline and at a 1-week follow-up, and included the numeric pain rating scale, the Neck Disability Index, and the global rating of change. Participants in the experimental group demonstrated significantly greater improvements (P<.001) on both the numeric pain rating scale and Neck Disability Index at the 1-week follow-up compared to those in the comparison group. In addition, 31 of 33 (94%) participants in the experimental group, compared to 11 of 31 participants (35%) in the comparison group, indicated a global rating of change score of +4 or higher at the 1-week follow-up, with an associated number needed to treat of 2. Individuals with neck pain who received a combination of thoracic spine thrust manipulation and cervical spine nonthrust manipulation plus exercise demonstrated better overall short-term outcomes on the numeric pain rating scale, the Neck Disability Index, and the global rating of change.

Short-term effects of spinal thrust joint manipulation in patients with chronic neck pain: a randomized clinical trial

Objective: To compare the effects of an isolated application of cervical spine thrust joint manipulation vs. the application of cervical, cervico-thoracic junction and thoracic manipulation on neck pain, disability and cervical range of motion in chronic neck pain. Design: Randomized clinical trial. Setting: Clinical practice. Participants: Eighty-two patients (41 females) with chronic mechanical neck pain. Interventions: Patients were randomly assigned to a cervical spine manipulation group or a full manipulative group who received mid-cervical, cervico-thoracic and thoracic joint manipulations. Measurements: Neck pain intensity (11-point numeric pain rating scale), self-reported disability (Neck Disability Index) and cervical range of motion were collected at baseline and one week after the intervention by an assessor blinded to the allocation of the patients. Results: A significant Group * Time interaction for Neck Disability Index (P = 0.022), but not for neck pain (P = 0.612), was found: patients in the full manipulative group exhibited greater reduction in disability than those who received the cervical spine manipulation alone, whereas both groups experienced similar decreases in neck pain. Patients in both groups experienced similar increases in cervical range of motion (P > 0.4). No effect of gender was observed (P > 0.299). Conclusions: In patients with chronic mechanical neck pain, manipulation of the cervical and thoracic spine leads to a greater reduction in disability at one week than after manipulation of the cervical spine alone, whereas changes in pain and range of motion are not affected differently.

Suboccipital Decompression Enhances Heart Rate Variability Indices of Cardiac Control in Healthy Subjects

Osteopathic manipulative treatment (OMT) focused on the upper cervical spine is theorized to affect the function of the vagus nerve and thereby influence the parasympathetic branch of the autonomic nervous system. This study was designed to determine the acute effect of upper cervical spine manipulation on cardiac autonomic control as measured by heart rate variability. Nineteen healthy, young adult subjects underwent three different experimental interventions administered in random order: cervical OMT, sham manipulation, and time control. Six minutes of electrocardiographic data were collected before and after each intervention, and heart rate variability was assessed by both time-domain and frequency-domain measures. No differences in resting heart rate or any measure of heart rate variability were observed between the baseline periods prior to each intervention. The OMT protocol resulted in an increase in the standard deviation of the normal-to-normal intervals (0.12±0.082 seconds, p<0.01), an increase in the high frequency spectral power (p=0.03), and a decrease in the low/high frequency spectral ratio (p=0.01) relative to the sham and time control conditions. No significant differences between sham and time control were observed (p>0.11 for all variables). These data support the hypothesis that upper cervical spine manipulation can acutely affect measures of heart rate variability in healthy individuals.

Cerebral Embolus Following Chiropractic Manipulation in a Patient with a Calcified Carotid Artery

Dissection of the cervicocranial vessels is the principal cause of ischemic brain injury following cervical spinal manipulation. Cervical spinal manipulation leading to cerebral embolus in the absence of dissection is not described in the literature. Current case documents cerebral embolism originating from extensively calcified internal carotid artery immediately following cervical spinal manipulation in the absence of dissection. We describe a case and imaging findings of a 63-year-old male who underwent cervical spinal manipulation and developed sudden onset of left-arm numbness and weakness. Computed tomography angiography demonstrated extensively calcified right internal carotid artery at the site of redone carotid endarterectomy as well as calcified embolus in the right inferior middle cerebral artery. Calcified carotid artery may be at risk for embolization following cervical spinal manipulation. Our recommendation is that, patients with extensively calcified carotid arteries should refrain from aggressive neck maneuvers and cervical spine manipulation therapy to avoid liberation of cerebral embolus.

Chiropractic Manipulation of the Neck and Cervical Artery Dissection

Letters17 July 2012Chiropractic Manipulation of the Neck and Cervical Artery DissectionRaymond E. Bertino, MD, Arun V. Talkad, MD, Jeffrey R. DeSanto, MD, Jane H. Maksimovic, DO, and Shyam G. Patel, MDRaymond E. Bertino, MDFrom University of Illinois College of Medicine at Peoria, Peoria, IL 61637.Search for more papers by this author, Arun V. Talkad, MDFrom University of Illinois College of Medicine at Peoria, Peoria, IL 61637.Search for more papers by this author, Jeffrey R. DeSanto, MDFrom University of Illinois College of Medicine at Peoria, Peoria, IL 61637.Search for more papers by this author, Jane H. Maksimovic, DOFrom University of Illinois College of Medicine at Peoria, Peoria, IL 61637.Search for more papers by this author, and Shyam G. Patel, MDFrom University of Illinois College of Medicine at Peoria, Peoria, IL 61637.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-157-2-201207170-00023 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Background: Chiropractic manipulation of the neck can cause cervical artery dissection and stroke, although the incidence of these complications is unknown (1–4). Patients younger than 45 years with vertebral artery dissection and stroke are 5 times more likely to have visited a chiropractor in the previous 30 days than an age-matched control group (1).Case Report: In mid-March 2012, a 37-year-old registered nurse with a history of chronic neck pain went to her chiropractor. She had seen the same chiropractor for 12 to 15 years, usually going once a month for cervical spine manipulation. Because of a new symptom (pain ...

Should we abandon cervical spine manipulation for mechanical neck pain? Yes

Benedict Wand and colleagues (doi:10.1136/bmj.e3679) argue that the risks of cervical spine manipulation are not justified, but David Cassidy and colleagues think it is a valuable addition to patient care

Should we abandon cervical spine manipulation for mechanical neck pain? No

Should we abandon cervical spine manipulation for mechanical neck pain? No

Vertebral artery strains during high-speed, low amplitude cervical spinal manipulation

Spinal manipulative therapy (SMT) has been recognized as an effective treatment modality for many back, neck and musculoskeletal problems. One of the major issues of the use of SMT is its safety, especially with regards to neck manipulation and the risk of stroke. The vast majority of these accidents involve the vertebro-basilar system, specifically the vertebral artery (VA) between C2/C1. However, the mechanics of this region of the VA during SMT are unexplored. Here, we present first ever data on the mechanics of this region during cervical SMT performed by clinicians. VA strains obtained during SMT are significantly smaller than those obtained during diagnostic and range of motion testing, and are much smaller than failure strains. We conclude from this work that cervical SMT performed by trained clinicians does not appear to place undue strain on VA, and thus does not seem to be a factor in vertebro-basilar injuries.

Biomechanical characterization of cervical spinal manipulation in living subjects and cadavers

BackgroundCervical spinal manipulative therapy (cSMT) is a common therapeutic modality used in the treatment of neck pain and headaches. Cadaveric necks have been used as a model for assessing the effects of cSMT on vertebral artery mechanics. However, there have been no previous studies comparing the biomechanical indices of cSMT performed in living subjects versus cadavers. MethodsThe preload force, peak force and duration of cSMT performed by two chiropractors were recorded in 28 subjects with and without neck pain, and in five cadavers. ResultsThere were no statistical differences in terms of the preload, peak force and duration of cSMT in living subjects with versus without neck pain. However, all three parameters differed statistically in living subjects versus cadavers; and both preload and peak forces were significantly higher for cadaveric cSMT; the average peak force was 190.3±85.5N (mean±SD) in living subjects, versus 283.9±53.6N in cadavers. Furthermore, the duration was significantly faster for cadaveric cSMT (175±100ms in living subjects versus 120±30ms in cadavers. These observations were consistent for both chiropractors. ConclusionsWhen performed in cadavers, cSMT tends to be more “aggressive” in terms of all biomechanical indices used to describe cSMT.

Efectos hipoalgésicos y de movilidad cervical tras la manipulación vertebral cervical o la manipulación vertebral dorsal en pacientes con cervicalgia mecánica subaguda: estudio piloto

PurposeTo compare the immediate effects on neck pain, active cervical range of motion and pressure pain thresholds after a single cervical or thoracic spine manipulation in patients with subacute mechanical neck pain. MethodsA randomized single-blinded pilot study was conducted. Subjects were divided randomly into either a cervical spine manipulation group (n=9) or a thoracic spine manipulation group (n=9). Outcome measures were neck pain at rest (visual analogue scale), active cervical range of motion and pressure pain thresholds over C5-C6 zygapophyseal joints and both lateral epicondyles, before treatment and 5minutes after treatment by an assessor blinded to the treatment allocation. Intragroup and intergroup comparisons were made with different analyses of variance (ANOVA) and the T-student test. ResultsEighteen patients, 7 males and 11 females, with subacute mechanical neck pain participated. Within-group changes showed a significant improvement in neck pain, cervical mobility and pressure pain thresholds in both groups (p<.05). The intergroup comparison did not show significant differences between either manipulative groups in any of the measures (p>.05). Therefore, both groups exhibited similar improvements in the outcomes. ConclusionsOur results suggest that a single cervical spine manipulation or a single thoracic thrust spine manipulation produce similar effects in reducing neck pain at rest and in increasing active cervical range of motion and segmental pressure pain thresholds in individuals with sub-acute mechanical neck pain. Future randomized clinical trials with greater sample sizes are now needed to further confirm our results.