Thoracic spine manipulation for the management of mechanical neck pain: A systematic review and meta-analysis

Abstract

Objective To investigate the role of thoracic spine manipulation (TSM) on pain and disability in the management of mechanical neck pain (MNP). Data sources Electronic databases PubMed, CINAHL, Pedro, Embase, AMED, the Cochrane Library, and clinicaltrials.gov were searched in January 2018. Study selection Eligible studies were completed RCTs, written in English, had at least 2 groups with one group receiving TSM, had at least one measure of pain or disability, and included patients with MNP of any duration. The search identified 1717 potential articles, with 14 studies meeting inclusion criteria. Study appraisal and synthesis methods Methodological quality was evaluated independently by two authors using the guidelines published by the Cochrane Collaboration. Pooled analyses were analyzed using a random-effects model with inverse variance methods to calculate mean differences (MD) and 95% confidence intervals for pain (VAS 0-100mm, NPRS 0-10pts; 0 = no pain) and disability (NDI and NPQ 0–100%; 0 = no disability). Results Across the included studies, there was increased risk of bias for inadequate provider and participant blinding. The GRADE approach demonstrated an overall level of evidence ranging from very low to moderate. Meta-analysis that compared TSM to thoracic or cervical mobilization revealed a significant effect favoring the TSM group for pain (MD -13.63; 95% CI: -21.79, -5.46) and disability (MD -9.93; 95% CI: -14.38, -5.48). Meta-analysis that compared TSM to standard care revealed a significant effect favoring the TSM group for pain (MD -13.21; 95% CI: -21.87, -4.55) and disability (MD -11.36; 95% CI: -18.93, -3.78) at short-term follow-up, and a significant effect for disability (MD -4.75; 95% CI: -6.54, -2.95) at long-term follow-up. Meta-analysis that compared TSM to cervical spine manipulation revealed a non-significant effect (MD 3.43; 95% CI: -7.26, 14.11) for pain without a distinction between immediate and short-term follow-up. Limitations The greatest limitation in this systematic review was the heterogeneity among the studies making it difficult to assess the true clinical benefit, as well as the overall level of quality of evidence. Conclusions TSM has been shown to be more beneficial than thoracic mobilization, cervical mobilization, and standard care in the short-term, but no better than cervical manipulation or placebo thoracic spine manipulation to improve pain and disability. Trial registration PROSPERO CRD42017068287

Evidence for decreased Neurologic Pain Signature activation following thoracic spinal manipulation in healthy volunteers and participants with neck pain

“…Participants received a single session of either verum (Studies 1 and 2) or sham (Study 2) thoracic SM immediately following the pre-intervention functional imaging. Thoracic SM is commonly used in the treatment of non-specific neck pain with effectiveness similar to cervical SM (Cross et al, 2011; Huisman et al, 2013; Masaracchio et al, 2019). In Study 2, participants were randomly assigned to the verum or sham intervention using a computer-generated sequence.…”

Back Pain: Chiropractor’s View

“…Several other recent systematic reviews of spinal manipulation have all concluded that manipulation produces modest clinical effects that are similar in effectiveness to other recommended therapies for low back pain and neck pain and that serious adverse events are extremely rare. Also, as noted previously, the most current American College of Physicians guideline for the non-pharmacological management of low back pain recommends spinal manipulation as one of the frontline treatments for low back pain (Rubenstein et al 2019;Masaracchio et al 2019).…”

Attitudes Towards Chiropractic: A Repeated Cross-Sectional Survey of Canadian Family Physicians 

“…Most family physicians disagreed that chiropractic care was effective for non-musculoskeletal conditions, and systematic reviews on this topic provide little support to challenge this assertion. [32][33][34][35] Most respondents agreed that chiropractic care is effective for certain musculoskeletal complaints, and spinal manipulation, which is commonly provided by chiropractors, has received support for management of axial complaints from recent systematic reviews [36][37][38][39][40][41] and clinical practice guidelines [42][43][44] . Paradoxically, support from the scienti c literature was a common reason given for referral of patients for chiropractic care, while reliance on research literature for information on chiropractic was associated with more negative attitudes.…”