Thoracic Thrust Manipulation Research Articles

Effect of Thoracic Manipulation on Pain and Postural Sway in Chronic Mechanical Neck Pain Patients: A Quasi-experimental Study

Introduction: Mechanical Neck Pain (MNP) is a prevalent musculoskeletal problem. MNP has a high-risk of becoming chronic in nature. Recent studies demonstrate altered Postural Sway (PS) among MNP patients. There are various management strategies used for improving pain and PS among Chronic MNP (CMNP). Numerous studies have been done on the effect of thoracic thrust manipulation on pain. However, the evidence is deficient for the impact of thoracic manipulation on PS in MNP patients. Aim: To analyse the effect of Thoracic Spine Manipulation (TSM) on pain and PS in CMNP patients. Materials and Methods: The quasi-experimental study was carried out on 31 patients. All the patients received three sessions of thoracic manipulation on three consecutive days. Numeric Rating Scale (NRS) and PS were measured during three treatment sessions and at baseline. One-way repeated measure Analysis of Variance (ANOVA) was used to examine the effects of treatment on each outcome variable. Results: Thirty-one patients with a mean age of 22.23 (SD=2.667) years with 61.3% females, and 38.7% males fulfilled the prerequisite considerations to be in the study. Patients showed significant improvements in pain after TSM 1 (F=105.8, p<0.05). The PS measured as sway velocity based on the Center of Foot Pressure (COFP) showed a significant reduction in both anteroposterior direction (F=3.55, p=0.02) and mediolateral direction PSY (F=5.10, p=0.03). Conclusion: The results demonstrated that thoracic manipulation improves pain and reduces PS. The study concludes that TSM can alter PS immediately post manipulation. TSM can be an alternative to Cervical Spine Manipulation (CSM) in patients with a contraindication for CSM.

Upper body postures effect on neuromuscular activities of the lower limb during a squat: musculoskeletal modeling

Spinal manipulative techniques are commonly used in manual therapies but quantified descriptive and reliability data are lacking considering supine thoracic thrust manipulation.The purpose of this study is to explore and compare kinetic parameters during supine thoracic thrust manipulation performed at two different thoracic regions. Intra-rater task repeatability and influence of practitioners were estimated.Exploratory and agreement study.Kinetic parameters were assessed by examining reaction force magnitude and orientation (on the basis of the zenithal angle) using force platforms. Manipulative procedure (consisting in the application of 3 preloads followed by one thrust adjustment) at both intervertebral and costovertebral region was performed by different practitioners at three sessions. Application of thrust was allowed for experienced practitioners only. Preload force, peak force magnitude and vector force orientation were compared between anatomical sites, sessions and practitioners, and bias with limit of agreement were estimated.Repeatability analysis showed that practitioners achieved similar preload and peak force independent of the session, with comparable force orientation. Differences between practitioners were observed for preload and peak force but not regarding the zenithal angle during the thrust phase.The present study is the first that explores kinetic parameters for supine thoracic thrust manipulation applied on two different regions of the thorax. Results confirm consistency of performance among practitioners for supine manipulative techniques at intervertebral and costovertebral region. While task repeatability was confirmed, several differences were observed between practitioners. Further investigations would examine velocity, acceleration and potential neurophysiological effect of such manipulative technique.

Investigation of reaction force magnitude and orientation during supine thoracic thrust manipulation applied to intervertebral and costovertebral regions.

BackgroundSpinal manipulative techniques are commonly used in manual therapies but quantified descriptive and reliability data are lacking considering supine thoracic thrust manipulation. ObjectivesThe purpose of this study is to explore and compare kinetic parameters during supine thoracic thrust manipulation performed at two different thoracic regions. Intra-rater task repeatability and influence of practitioners were estimated. DesignExploratory and agreement study. MethodsKinetic parameters were assessed by examining reaction force magnitude and orientation (on the basis of the zenithal angle) using force platforms. Manipulative procedure (consisting in the application of 3 preloads followed by one thrust adjustment) at both intervertebral and costovertebral region was performed by different practitioners at three sessions. Application of thrust was allowed for experienced practitioners only. Preload force, peak force magnitude and vector force orientation were compared between anatomical sites, sessions and practitioners, and bias with limit of agreement were estimated. ResultsRepeatability analysis showed that practitioners achieved similar preload and peak force independent of the session, with comparable force orientation. Differences between practitioners were observed for preload and peak force but not regarding the zenithal angle during the thrust phase. ConclusionsThe present study is the first that explores kinetic parameters for supine thoracic thrust manipulation applied on two different regions of the thorax. Results confirm consistency of performance among practitioners for supine manipulative techniques at intervertebral and costovertebral region. While task repeatability was confirmed, several differences were observed between practitioners. Further investigations would examine velocity, acceleration and potential neurophysiological effect of such manipulative technique.

Reaction Force Magnitude and Orientation During Supine Thoracic Spine Thrust Manipulation: An Exploratory Analysis and Reliability of Preload and Impulse Phase

ObjectiveThe main purpose of this study was to explore specific kinetic parameters during supine thoracic thrust manipulation and to analyze task reliability and differences between various practitioners MethodsKinetic parameters were assessed by examining ground reaction force magnitude and orientation (on the basis of the zenithal angle) using force platforms. The manipulative procedure (consisting of the application of 3 preloads followed by 1 single thrust adjustment) was performed by different practitioners at 3 sessions. Application of thrust was allowed for trained practitioners only. Preload force, peak force, and vector force orientation were compared between sessions and practitioners. ResultsReliability analysis showed that practitioners achieved similar preload and peak force independent of the session, with comparable force orientation data. Differences between practitioners were observed for preload and peak force but not regarding the zenithal angle during the thrust phase. ConclusionThis study is the first that explores kinetic parameters for supine thoracic thrust manipulation. Task repeatability was confirmed and several differences were observed between practitioners. Certainly, there is a need for further investigation examining both dynamic parameters (ie, velocity and accelerations) and the potential neurologic effect of such manipulative technique.

Effectiveness of Pilates as an Adjunct to Conventional Therapy in Chronic Mechanical Neck Pain: A Randomized Controlled Trial

Background: Neck pain is one of the most common musculoskeletal disorders second to low back pain associated with chronic pain, restricted range of motion and muscular imbalance. Generally, the physiotherapy methods for mechanical neck pain consist of stretching and strengthening the neck muscles, cervical stabilization exercises, cervical mobilization exercises, thoracic thrust manipulation, ischemic compression on trigger points, kinesio-taping method and electrotherapy. The Pilates method is a system of exercise program that aims for body awareness through harmonization of body and mind which has been widely used to enhance physical fitness and rehabilitation in general.Purpose: The purpose of the study was to find out whether Pilates and conventional therapy can bring better results in treating chronic mechanical neck pain when compared to conventional therapy alone.Methods: 60 patients were selected randomly with mechanical neck pain. The study included 2 groups, control group and experimental group, the outcomes measures included Numerical rating pain scale (NRPS), Neck flexors endurance test (NFET) Neck disability index (NDI), Cervical range of motion (CROM). Independent “t” test was done for inter group analysis and paired t-test was done for intra group analysis.Results: Both the groups showed significant difference (P-0.000<0.05) at 12 weeks. The mean difference and paired t-test values of experimental group was greater when compared to control group at the end of 12 weeks.Conclusion: significant improvement was seen in both the groups in NPRS, NDI, NFET, ROM, but early improvement was noted in experimental group in terms of function when compared to conventional group after 12 weeks of treatment.

Functional Magnetic Resonance Imaging of Cerebral Hemodynamic Responses to Pain Following Thoracic Thrust Manipulation in Individuals With Neck Pain: A Randomized Trial

ObjectiveThe purpose of this study was to examine whether cerebral activation in response to noxious mechanical stimuli varies with thrust manipulation (TM) when compared with sham manipulation (SM) as measured by blood oxygenation level–dependent functional magnetic resonance imaging. MethodsTwenty-four volunteers (67% female) with complaints of acute or subacute mechanical (nontraumatic) neck pain satisfied eligibility requirements and agreed to participate. Participants were randomized to receive TM to the thoracic spine or SM, and then underwent functional magnetic resonance scanning while receiving noxious stimuli before and after TM or SM. An 11-point numeric pain rating scale was administered pre- and postmanipulation for neck pain and to determine perceptions of pain intensity with respect to neck pain and mechanical stimuli. Blood oxygenation level–dependent functional magnetic resonance imaging recorded the cerebral hemodynamic response to the mechanical stimuli. ResultsImaging revealed significant group differences, with those individuals in the manipulation group exhibiting increased areas of activation (postmanipulation) in the insular and somatosensory cortices and individuals in the sham group exhibiting greater areas of activation in the precentral gyrus, supplementary motor area, and cingulate cortices (P < .05). However, between-group differences on the numeric pain rating scale for mechanical stimuli and for self-reported neck pain were not statistically significant. ConclusionsThis study provides preliminary level 2b evidence suggesting cortical responses in patients with nontraumatic neck pain may vary between thoracic TM and a sham comparator.

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

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.

The Effects of Thoracic Thrust Manipulation and Neck Flexibility Exercises for the Management of the Patients with Mechanical Neck Pain

The Effects of Thoracic Thrust Manipulation and Neck Flexibility Exercises for the Management of the Patients with Mechanical Neck Pain

The effectiveness of cervical versus thoracic thrust manipulation for the improvement of pain, disability, and range of motion in patients with mechanical neck pain

Background:Many patients present to physical therapy with mechanical neck pain. Cervical and thoracic manipulations are being utilized in treating this impairment, but minimal evidence as to which technique is superior exists in the literature.Objective:The purpose of this systematic review is to identify whether cervical or thoracic manipulation is more effective at improving pain, range of motion (ROM), and disability in patients with mechanical neck pain.Methods:A comprehensive search of published literature from seven search engines (PubMed, ProQuest, PEDro, CINAHL, Healthsource, Cochrane Library, SPORTDiscus) yielded 13 studies that examined the effectiveness of either cervical manipulations, thoracic manipulations, or cervical and thoracic manipulations to relieve the effects of mechanical neck pain. Eleven of the studies included were randomized controlled trials (RCTs), while two were secondary analyses of RCTs. Each study was assessed using the PEDro scale and found to be of fair to high research quality.Results:The studies included in this systematic review produced both positive clinical and statistical differences in pain, disability, and ROM following manipulations of the cervical or thoracic spine.Conclusion:There is limited high-quality research directly comparing the two interventions, so determining whether cervical or thoracic thrust manipulation is superior cannot be concluded from this systematic review alone. However, based on the results found in this review, cervical and thoracic thrust manipulations are equally valuable in relieving pain, disability, and improving ROM for a patient with mechanical neck pain in the short term.

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

ObjectiveThe 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. MethodsFifty-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 10minutes 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. ResultsNo 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. ConclusionsThe 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.

Scapular kinematics pre- and post-thoracic thrust manipulation in individuals with and without shoulder impingement symptoms: a randomized controlled study.

Randomized controlled trial with immediate follow-up. To evaluate the immediate effects of a low-amplitude, high-velocity thrust thoracic spine manipulation (TSM) on pain and scapular kinematics during elevation and lowering of the arm in individuals with shoulder impingement syndrome (SIS). The secondary objective was to evaluate the immediate effects of TSM on scapular kinematics during elevation and lowering of the arm in individuals without symptoms. Considering the regional interdependence among the shoulder and the thoracic and cervical spines, TSM may improve pain and function in individuals with SIS. Comparing individuals with SIS to those without shoulder pathology may provide information on the effects of TSM specifically in those with SIS. Fifty subjects (mean ± SD age, 31.8 ± 10.9 years) with SIS and 47 subjects (age, 25.8 ± 5.0 years) asymptomatic for shoulder dysfunction were randomly assigned to 1 of 2 interventions: TSM or a sham intervention. Scapular kinematics were analyzed during elevation and lowering of the arm in the sagittal plane, and a numeric pain rating scale was used to assess shoulder pain during arm movement at preintervention and postintervention. For those in the SIS group, shoulder pain was reduced immediately after TSM and the sham intervention (mean ± SD preintervention, 2.9 ± 2.5; postintervention, 2.3 ± 2.5; P<.01; moderate effect size [Cohen d = 0.2]). Scapular internal rotation increased 0.5° ± 0.02° (P = .04; small effect size [Cohen d<0.1]) during elevation of the arm after TSM and sham intervention in the SIS group only. Subjects with and without SIS who received TSM and asymptomatic subjects who received the sham intervention had a significant increase (1.6° ± 2.7°) in scapular upward rotation postintervention (P<.05; small effect size [Cohen d<0.2]), which was not considered clinically significant. Scapular anterior tilt increased 1.0° ± 4.8° during elevation and lowering of the arm postmanipulation (P<.05; small effect size [Cohen d<0.2]) in the asymptomatic subjects who received TSM. Shoulder pain in individuals with SIS immediately decreased after a TSM. The observed changes in scapular kinematics following TSM were not considered clinically important. Therapy, level 4. J Orthop Sports Phys Ther 2014;44(7):475-487. Epub 22 May 2014. doi:10.2519/jospt.2014.4760.

Using Functional Magnetic Resonance Imaging to Determine if Cerebral Hemodynamic Responses to Pain Change Following Thoracic Spine Thrust Manipulation in Healthy Individuals

Case series. To use blood oxygenation level-dependent functional magnetic resonance imaging (fMRI) to determine if supraspinal activation in response to noxious mechanical stimuli varies pre- and post-thrust manipulation to the thoracic spine. Recent studies have demonstrated the effectiveness of thoracic thrust manipulation in reducing pain and improving function in some individuals with neck and shoulder pain. However, the mechanisms by which manipulation exerts such effects remain largely unexplained. The use of fMRI in the animal model has revealed a decrease in cortical activity in response to noxious stimuli following manual joint mobilization. Supraspinal mediation contributing to hypoalgesia in humans may be triggered following spinal manipulation. Ten healthy volunteers (5 women, 5 men) between the ages of 23 and 48 years (mean, 31.2 years) were recruited. Subjects underwent fMRI scanning while receiving noxious stimuli applied to the cuticle of the index finger at a rate of 1 Hz for periods of 15 seconds, alternating with periods of 15 seconds without stimuli, for a total duration of 5 minutes. Subjects then received a supine thrust manipulation directed to the midthoracic spine and were immediately returned to the scanner for reimaging with a second delivery of noxious stimuli. An 11-point numeric pain rating scale was administered immediately after the application of noxious stimuli, premanipulation and postmanipulation. Blood oxygenation level-dependent fMRI recorded the cerebral hemodynamic response to the painful stimuli premanipulation and postmanipulation. The data indicated a significant reduction in subjects' perception of pain (P<.01), as well as a reduction in cerebral blood flow as measured by the blood oxygenation level-dependent response following manipulation to areas associated with the pain matrix (P<.05). There was a significant relationship between reduced activation in the insular cortex and decreased subjective pain ratings on the numeric pain rating scale (r = 0.59, P<.05). This study provides preliminary evidence that suggests that supraspinal mechanisms may be associated with thoracic thrust manipulation and hypoalgesia. However, because the study lacked a control group, the results do not allow for the discernment of the causative effects of manipulation, which may also be related to changes in levels of subjects' fear, anxiety, or expectation of successful outcomes with manipulation. Future investigations should strive to elicit more conclusive findings in the form of randomized clinical trials.

In response to: Dunning J. How about an honorable mention for cervical and thoracic thrust manipulation? A passing mention would be more appropriate

In response to: Dunning J. How about an honorable mention for cervical and thoracic thrust manipulation? A passing mention would be more appropriate

Immediate Changes in Widespread Pressure Pain Sensitivity, Neck Pain, and Cervical Range of Motion After Cervical or Thoracic Thrust Manipulation in Patients With Bilateral Chronic Mechanical Neck Pain: A Randomized Clinical Trial

Randomized clinical trial. To compare the effects of cervical versus thoracic thrust manipulation in patients with bilateral chronic mechanical neck pain on pressure pain sensitivity, neck pain, and cervical range of motion (CROM). Evidence suggests that spinal interventions can stimulate descending inhibitory pain pathways. To our knowledge, no study has investigated the neurophysiological effects of thoracic thrust manipulation in individuals with bilateral chronic mechanical neck pain, including widespread changes on pressure sensitivity. Ninety patients (51% female) were randomly assigned to 1 of 3 groups: cervical thrust manipulation on the right, cervical thrust manipulation on the left, or thoracic thrust manipulation. Pressure pain thresholds (PPTs) over the C5-6 zygapophyseal joint, lateral epicondyle, and tibialis anterior muscle, neck pain (11-point numeric pain rating scale), and cervical spine range of motion (CROM) were collected at baseline and 10 minutes after the intervention by an assessor blinded to the treatment allocation of the patients. Mixed-model analyses of covariance were used to examine the effects of the treatment on each outcome variable, with group as the between-subjects variable, time and side as the within-subject variables, and gender as the covariate. The primary analysis was the group-by-time interaction. No significant interactions were found with the mixed-model analyses of covariance for PPT level (C5-6, P>.210; lateral epicondyle, P>.186; tibialis anterior muscle, P>.268), neck pain intensity (P = .923), or CROM (flexion, P = .700; extension, P = .387; lateral flexion, P>.672; rotation, P>.192) as dependent variables. All groups exhibited similar changes in PPT, neck pain, and CROM (all, P<.001). Gender did not influence the main effects or the interaction effects in the analyses of the outcomes (P>.10). The results of the current randomized clinical trial suggest that cervical and thoracic thrust manipulation induce similar changes in PPT, neck pain intensity, and CROM in individuals with bilateral chronic mechanical neck pain. However, changes in PPT and CROM were small and did not surpass their respective minimal detectable change values. Further, because we did not include a control group, we cannot rule out a placebo effect of the thrust interventions on the outcomes. Therapy, level 1b.J Orthop Sports Phys Ther 2012;42(9):806-814, Epub 18 June 2012. doi:10.2519/jospt.2012.4151.

Upper Cervical and Upper Thoracic Thrust Manipulation Versus Nonthrust Mobilization in Patients With Mechanical Neck Pain: A Multicenter Randomized Clinical Trial

Randomized clinical trial. To compare the short-term effects of upper cervical and upper thoracic high-velocity low-amplitude (HVLA) thrust manipulation to nonthrust mobilization in patients with neck pain. Although upper cervical and upper thoracic HVLA thrust manipulation and nonthrust mobilization are common interventions for the management of neck pain, no studies have directly compared the effects of both upper cervical and upper thoracic HVLA thrust manipulation to nonthrust mobilization in patients with neck pain. Patients completed the Neck Disability Index, the numeric pain rating scale, the flexion-rotation test for measurement of C1-2 passive rotation range of motion, and the craniocervical flexion test for measurement of deep cervical flexor motor performance. Following the baseline evaluation, patients were randomized to receive either HVLA thrust manipulation or nonthrust mobilization to the upper cervical (C1-2) and upper thoracic (T1-2) spines. Patients were reexamined 48-hours after the initial examination and again completed the outcome measures. The effects of treatment on disability, pain, C1-2 passive rotation range of motion, and motor performance of the deep cervical flexors were examined with a 2-by-2 mixed-model analysis of variance (ANOVA). One hundred seven patients satisfied the eligibility criteria, agreed to participate, and were randomized into the HVLA thrust manipulation (n = 56) and nonthrust mobilization (n = 51) groups. The 2-by-2 ANOVA demonstrated that patients with mechanical neck pain who received the combination of upper cervical and upper thoracic HVLA thrust manipulation experienced significantly (P<.001) greater reductions in disability (50.5%) and pain (58.5%) than those of the nonthrust mobilization group (12.8% and 12.6%, respectively) following treatment. In addition, the HVLA thrust manipulation group had significantly (P<.001) greater improvement in both passive C1-2 rotation range of motion and motor performance of the deep cervical flexor muscles as compared to the group that received nonthrust mobilization. The number needed to treat to avoid an unsuccessful outcome was 1.8 and 2.3 at 48-hour follow-up, using the global rating of change and Neck Disability Index cut scores, respectively. The combination of upper cervical and upper thoracic HVLA thrust manipulation is appreciably more effective in the short term than nonthrust mobilization in patients with mechanical neck pain. Therapy, level 1b.

Immediate effects of a thoracic spine thrust manipulation on the autonomic nervous system: a randomized clinical trial

Thoracic spine manipulation has been shown to be effective for the management of neck pain. The purpose of this study was to investigate the immediate effect of a T3–T4 spinal thrust manipulation on autonomic nervous system activity in subjects with chronic cervical pain. An additional aim was to determine if the manipulation resulted in an immediate pain relief in patients with chronic neck pain when compared to a placebo intervention. One hundred subjects with chronic neck pain were randomly assigned to receive either a thoracic thrust manipulation or a placebo intervention. The Friedman's test was used to evaluate the change in pupil diameter within both groups. The Wilcoxen signed-ranks test was used to explore pupil changes over time and to make paired comparisons of the pupil change between the groups. The Mann–Whitney U test was used to compare the change in pain perception for the chronic cervical pain group subjects receiving either the thrust manipulation or the placebo intervention. The results demonstrated that manipulation did not result in a change in sympathetic activity. Additionally, there was no significant difference in the subject's pain perception (P=0.961) when comparing the effects of the thrust manipulation to the placebo intervention within this group of subjects with chronic neck pain. The clinical impression of this study is that manipulation of the thoracic spine may not be effective in immediately reducing pain in patients with chronic neck pain.

Repeated Applications of Thoracic Spine Thrust Manipulation do not Lead to Tolerance in Patients Presenting with Acute Mechanical Neck Pain: A Secondary Analysis

It has been demonstrated that patients receiving mobilization techniques do not exhibit tolerance to repeated applications. However, this phenomenon has not been investigated for thoracic manipulation. Our aim was to determine if patients receiving thoracic thrust manipulation exhibit tolerance to repeated applications in acute mechanical neck pain. Forty-five patients were randomly assigned to two groups. The control group received electro- and thermotherapy for 5 sessions, and the experimental group received the same program and also received a thoracic thrust manipulation once a week for 3 consecutive weeks. Outcome measures included neck pain and cervical mobility. Within-session change scores for pain and mobility during treatment sessions #1, 3, and 5 were examined with a one-way repeated measured ANOVA. A 2-way ANOVA with session as within-subject variable and group as between-subject variable was used to compare change scores for each visit between groups to ascertain if there were significant between-group differences in within-session changes for the experimental versus the control group. The ANOVA showed that for either group the 3 within-session change scores were not significantly different (P > 0.1). The 2-way ANOVA revealed significant differences between groups for both pain and neck mobility in within-session change scores (all, P < 0.001). Change scores in each session were superior in the experimental group as compared to those in the control group. The results suggest that patients receiving thoracic manipulation do not exhibit tolerance to repeated applications with regard to pain and mobility measures in acute mechanical neck pain. Further studies should investigate the dose-response relationship of thoracic thrust manipulation in this population.

Thoracic Spine Manipulation for the Management of Patients With Neck Pain: A Randomized Clinical Trial

Randomized clinical trial. To investigate if patients with mechanical neck pain receiving thoracic spine thrust manipulation would experience superior outcomes compared to a group not receiving thrust manipulation. Evidence has begun to emerge in support of thoracic thrust manipulation as an intervention n the management of mechanical neck pain. However, to make a strong recommendation for a clinical technique it is necessary to have multiple studies with convergent findings. Forty-five patients (21 females) were randomly assigned to 1 of 2 groups: a control group, which received electro-thermal therapy for 5 treatment sessions, and the experimental group, which received the same electro/thermal therapy program in addition to a thoracic spine thrust manipulation once a week for 3 consecutive weeks. Mixed-model analyses of variance (ANOVAs) were used to examine the effects of treatment on pain (100-mm visual analogue scale), disability (100-point disability scale), and cervical range of motion, with group as the between-subjects variable and time as the within-subjects variable. The primary analysis was the group-by-time interaction for pain. The group-by-time interaction effects for the ANOVA models were statistically significant for pain, mobility, and disability (P< .05), indicating greater improvements in the manipulation group for all the outcome measures. Patients receiving thoracic manipulation experienced greater improvements in pain at the fifth (final) treatment session and at the 2-week and 4-week follow-up periods (P< .001), with pain improvement scores in the manipulation group of 16.8 mm and 26.6 mm greater than those in the comparison group at the 2- and 4-week follow-up periods, respectively. The experimental group also experienced significantly greater improvements in disability with a between-group difference of 8.8 points (95% confidence interval [CI]: 7.5, 10.1; P< .001) at the fifth visit and 8.0 points (95% CI: 5.8, 10.2; P< .001) at the 2-week follow-up. The results of our study suggest that thoracic spine thrust manipulation results in superior clinical benefits that persist beyond the 1-mont follow-up period for patients with acute neck pain. Future studies should continue to investigate the effects of thoracic spine thrust manipulation, as compared to other physical therapy interventions, in a population with mechanical neck pain.