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

Abstract

Study Design Randomized clinical trial. Objective 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. Background 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. Methods 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. Results 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. Conclusion 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. Level of Evidence Therapy, level 1b. J Orthop Sports Phys Ther 2013;43(3):118–127. Epub 7 December 2012. doi:10.2519/jospt.2013.4221

Immediate Effects of High Velocity Low Amplitude Thrust Manipulation of the Thoracic Spine on Mechanical Neck Pain, Disability and Cervical Range of Motion

“…The results of this study demonstrated that patients who had mechanical neck pain benefited from thoracic spine HVLA thrust along with the conventional treatment which included isometric exercises, range of motion exercises and stretching exercises of the trapezius and levator scapulae muscles. The results of this study are consistent with the previous studies done so far that have demonstrated the effectiveness of thoracic spinal manipulation along with cervical spine thrust and non thrust manipulation plus exercises in patients with mechanical neck pain [3]. The significance of this study is that along with its long term benefits as proved in previous researches, HVLA thrust of the thoracic spine has an immediate beneficial effect on pain in patients with mechanical neck pain.…”

“…Alterations in one part of the spine can cause compensatory or beneficial changes in the other parts of the spine. Due to manipulation of the thoracic spine, the biomechanical relationship between the thoracic spine and cervical spine improves thus causing reduction of mechanical stress on the pain generators [3]. Muscles adjacent to and opposite to the site of manipulation elicit a response due to manipulation.…”

“…The therapist placed both his hands on the patient's upper thoracic spine and the patient was asked to take a deep breath in and exhale. The high velocity low amplitude thrust was performed on exhalation [3,6]. High velocity low amplitude thrusts were given by a trained manual therapist.…”

“…The participants were explained their role in the study and a written consent was taken from the patients. Numerical pain rating scale (NPRS) and Neck Disability Index (NDI) [3] were explained to the patient and the scores pre and post intervention was used as the outcome measures. Along with this goniometric evaluation of cervical ROM pre and post intervention was also used as the outcome measure [9].…”

“…Research states that human body is structurally and functionally interrelated. Any type of mechanical stresses, injury or asymmetry can lead to changes in other parts of the body which can either be related or unrelated to the source [3]. Neck pain interferes in activities of daily living of some individuals which can become chronic.…”