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Thoracic Manipulation for Neck Pain CPR

9/27/2017

0 Comments

 
With the progression of evidence-based practice, much of the research that is being performed is looking to determine what treatment techniques are most effective for a variety of injuries. Included in that research is the development of clinical prediction rules (CPR's), which are used to take various exam findings and cluster them to determine more effective treatment measures. The below findings for individuals with neck pain were initially found to have significant benefit from thoracic manipulations (Cleland et al, 2007):
-Symptoms < 30 days
-No symptoms distal to the shoulders
-Looking up does not aggravate symptoms
-FABQ Physical Activity Scale < 12
-Diminished upper thoracic kyphosis
-Cervical extension ROM < 30 deg

​-3 positive = +LR of 5.5
​-4 positive = +LR of 12
​-5-6 positive = +LR of > 12

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There is an extensive process for developing a CPR that has true utilization and application. After a CPR has been proposed, it must go through a validation procedure. When reviewed, this CPR was unable to be validated (Cleland et al, 2010); however, those in the manipulation group were still found to have improved short- and long-term disability. Just because it didn't have the other original intended effects, doesn't mean it may not have a use.

​Whether thinking about the thoracic spine in an anatomical sense or a neurophysiological one, manipulating the region can be incredibly useful. The T6-7 area has been shown to be a tension point as the vertebral canal is relatively narrow compared to the spinal cord here. Additionally, there is little movement in the spinal core here relative to the adjacent structures. These restrictions can affect nerve irritability and function. With manipulation and mobilization, the biomechanical aspect of nerve mobility can theoretically improve or it may simply be stimulating the nervous system in a novel way (or it may be purely psychological). Either way, manipulating the thoracic spine can be beneficial for many injuries. It's definitely a skill worth practicing and implementing!

​-Dr. Chris Fox, PT, DPT, OCS
​References:
Cleland JA, Childs JD, Fritz JM, Whitman JM, Eberhart SL. "Development of a clinical prediction rule for guiding treatment of a subgroup of patients with neck    pain: use of thoracic spine manipulation, exercise, and patient education." Phys Ther. 2007 Jan. Web. 08/18/2012.

Cleland JA, Mintken PE, Carpenter K, Fritz JM, Glynn P, Whitman J, Childs JD. Examination of a clinical prediction rule to identify patients with neck pain likely to benefit from thoracic spine thrust manipulation and a general cervical range of motion exercise: multi-center randomized clinical trial.
Phys Ther. 2010 Sep;90(9):1239-50.


TSPT now offering a comprehensive Cervical Spine Course

Interested in learning more about the cervical spine?
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LEARN MORE!
​(Save $10 with Promo: Neckpain)
This online course includes:
  • 4 interactive lectures (Anatomy & Biomechanics, Differential Diagnosis, Examination, Advanced Treatment Techniques )
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  • Links to our TSPT Cervical Home Exercise Program

Looking for advanced sports and orthopedic content? Take a look at our BRAND NEW Insider Access pages! New video and lecture content added monthly. 
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  • Home
  • About Us
  • Insider Access
    • About Insider Access
  • Online Courses
    • Hooper's Knee
    • Physical Therapist Entrepreneur Course
    • Physical Therapist Consultant Course
    • Orthopedic Management of the Cervical Spine
    • Return to Sport Essentials Course
  • Resources
    • Newsletter
    • Business Minded Sports Physio Podcast
    • Day in the Life of a Sports PT
    • Residency Corner
    • Special Tests >
      • Cervical Spine >
        • Alar Ligament Test
        • Bakody's Sign
        • Cervical Distraction Test
        • Cervical Rotation Lateral Flexion Test
        • Craniocervical Flexion Test (CCFT)
        • Deep Neck Flexor Endurance Test
        • Posterior-Anterior Segmental Mobility
        • Segmental Mobility
        • Sharp-Purser Test
        • Spurling's Maneuver
        • Transverse Ligament Test
        • ULNT - Median
        • ULNT - Radial
        • ULNT - Ulnar
        • Vertebral Artery Test
      • Thoracic Spine >
        • Adam's Forward Bend Test
        • Passive Neck Flexion Test
        • Thoracic Compression Test
        • Thoracic Distraction Test
        • Thoracic Foraminal Closure Test
      • Lumbar Spine/Sacroiliac Joint >
        • Active Sit-Up Test
        • Alternate Gillet Test
        • Crossed Straight Leg Raise Test
        • Extensor Endurance Test
        • FABER Test
        • Fortin's Sign
        • Gaenslen Test
        • Gillet Test
        • Gower's Sign
        • Lumbar Quadrant Test
        • POSH Test
        • Posteroanterior Mobility
        • Prone Knee Bend Test
        • Prone Instability Test
        • Resisted Abduction Test
        • Sacral Clearing Test
        • Seated Forward Flexion Test
        • SIJ Compression/Distraction Test
        • Slump Test
        • Sphinx Test
        • Spine Rotators & Multifidus Test
        • Squish Test
        • Standing Forward Flexion Test
        • Straight Leg Raise Test
        • Supine to Long Sit Test
      • Shoulder >
        • Active Compression Test
        • Anterior Apprehension
        • Biceps Load Test II
        • Drop Arm Sign
        • External Rotation Lag Sign
        • Hawkins-Kennedy Impingement Sign
        • Horizontal Adduction Test
        • Internal Rotation Lag Sign
        • Jobe Test
        • Ludington's Test
        • Neer Test
        • Painful Arc Sign
        • Pronated Load Test
        • Resisted Supination External Rotation Test
        • Speed's Test
        • Posterior Apprehension
        • Sulcus Sign
        • Thoracic Outlet Tests >
          • Adson's Test
          • Costoclavicular Brace
          • Hyperabduction Test
          • Roos (EAST)
        • Yergason's Test
      • Elbow >
        • Biceps Squeeze Test
        • Chair Sign
        • Cozen's Test
        • Elbow Extension Test
        • Medial Epicondylalgia Test
        • Mill's Test
        • Moving Valgus Stress Test
        • Push-up Sign
        • Ulnar Nerve Compression Test
        • Valgus Stress Test
        • Varus Stress Test
      • Wrist/Hand >
        • Allen's Test
        • Carpal Compression Test
        • Finkelstein Test
        • Phalen's Test
        • Reverse Phalen's Test
      • Hip >
        • Craig's Test
        • Dial Test
        • FABER Test
        • FAIR Test
        • Fitzgerald's Test
        • Hip Quadrant Test
        • Hop Test
        • Labral Anterior Impingement Test
        • Labral Posterior Impingement Test
        • Long-Axis Femoral Distraction Test
        • Noble Compression Test
        • Percussion Test
        • Sign of the Buttock
        • Trendelenburg Test
      • Knee >
        • Anterior Drawer Test
        • Dial Test (Tibial Rotation Test)
        • Joint Line Tenderness
        • Lachman Test
        • McMurray Test
        • Noble Compression Test
        • Pivot-Shift Test
        • Posterior Drawer Test
        • Posterior Sag Sign
        • Quad Active Test
        • Thessaly Test
        • Valgus Stress Test
        • Varus Stress Test
      • Foot/Ankle >
        • Anterior Drawer
        • Calf Squeeze Test
        • External Rotation Test
        • Fracture Screening Tests
        • Impingement Sign
        • Navicular Drop Test
        • Squeeze Test
        • Talar Tilt
        • Tarsal Tunnel Syndrome Test
        • Test for Interdigital Neuroma
        • Windlass Test