Short-Term combined effects of Thoracic spine thrust Manipulation and Cervical spine nonthrust Manipulation in Individuals with Mechanical Neck pan: A RCT.
This study was released in the March 2013 edition of JOSPT.
Anyone who has worked in a physical therapy clinic understands that neck pain is a very common problem. Researchers estimate that as many as 1 in 4 patients in an outpatient PT clinic are referred for neck pain. This specific study by Masaracchio et al assessed the short-term (1 week follow up) effects of adding thoracic spine thrust manipulation in addition to cervical spine Grade III non-thrust P-A mobilizations. 66 participants were randomly selected to either the experimental or control group. Subjects were excluded if they had symptoms distal to the shoulder, pain for >3 months, or a Neck Disability Index score <20%. The subjects in the experimental group who received both the thoracic spine and cervical spine manual therapy had statistically significant changes in their pain as indicated by decreased scores on the Numeric Pain Rating Scale and significantly lower scores on the Neck Disability Index.
These results add to the body of literature suggesting the benefits of manual therapy in patients with mechanical neck pain. Different theories exist as to why the thoracic spine manipulation group showed greater improvements. First, there is a clear biomechanical link between the C-spine and T-spine. By moving the thoracic spine, the cervical spine pain generators experience decrease stress. Another explanation discusses changes in mechanoreceptor sensitivity when a thoracic spine thrust manipulation is performed. While thoracic spine manipulation may not have high specificity, several studies have demonstrated that "regardless of the manual therapy intervention chosen, individuals experienced a reduction in pain levels following manual therapy interventions."
Some people may argue that this study only assessed patients at 1-week follow up, and it did not investigate long term reductions in pain. With that said, by having the capability to significantly reduce a patients pain in 1-weeks time, you have much more freedom with your intervention selection. Lowering the significance of pain and disability will greatly improve patient satisfaction, patient buy-in, and your ability to prescribe the necessary exercises. To view the full article click here.
Masaracchio M, Cleland JA, Hellman M, Hagins M. (2013). Short-Term combined effects of Thoracic spine thrust Manipulation and Cervical spine nonthrust Manipulation in Individuals with Mechanical Neck pan: A Randomized control trial..JOSPT. 2013 March; 43(3): 118-127. Web. 20 September 2013.
Jose Traverso, PT
9/26/2013 12:29:26 am
Just a thought from my clinical point of view. Widespread efects to mobilizations grade V at the cervicothoracic junctions could be related to sympathetic ganglia located... funny how this happens... at the cervicothoracic region, specifically from C7 to T4. Is that weird?
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