Thoracic spine manipulation for the management of patients with neck pain: a randomized clinical trial

Abstract

Design: Randomized clinical trial.

Objectives: 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.

Background: 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.

Methods and measures: 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.

Results: 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.

Conclusions: 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.