Does thoracic thrust manipulation provide better functional outcomes than non-thrust thoracic mobilization in patients with chronic neck pain?
Neck pain is a very common diagnosis in the physical therapy world, but there is no gold standard for treatment. Manual techniques such as manipulation and mobilization are becoming more widely used and accepted to treat the cervical spine, however there is still a lot of debate as to which of these, if either is the superior form of treatment. This clinical question asks whether or not there is statistical significance between thoracic thrust manipulation versus non-thrust thoracic mobilization in the treatment of chronic, mechanical neck pain. Described below are three recent articles that outline the effectiveness of thoracic manipulation versus mobilization in treating chronic neck pain.
The first article is a 2014 randomized controlled trial by Salom- Moreno et. al. They compared the effects of thoracic thrust manipulation vs thoracic non-thrust mobilization in patients with bilateral chronic mechanical neck pain on pressure pain sensitivity and neck pain intensity. Fifty- two patients were randomly assigned to a thoracic spine thrust manipulation group or to a thoracic non- thrust mobilization group. Pain pressure thresholds and neck pain intensity were collected at baseline and 10 minutes after the intervention. The results suggested that thoracic thrust manipulation and non- thrust mobilization produce similar changes in pain pressure threshold in patients with mechanical neck pain, however, manipulation was slightly more effective than mobilization for decreasing intensity of neck pain. A couple limitations to this study included the fact that there was no control group to compare to and they only looked at the short-term effects as opposed to long-term.
http://www.sciencedirect.com.proxy.kumc.edu:2048/science/article/pii/S0161475414000670
The second article is a 2014 systematic review by Young et. al. They evaluated the current literature regarding the effectiveness of thoracic manipulation versus mobilization in patients with mechanical neck pain. They used 14 studies and analyzed them using the PEDro scale and the GRADE approach. All/14 studies showed positive outcomes on cervical pain levels, range of motion and/or disability with the use of thoracic manipulation or mobilization. However,there was insufficient evidence in the literature directly comparing thoracic manipulation and mobilization.
http://www.maneyonline.com/doi/full/10.1179/2042618613Y.0000000043
The third article is a 2013 randomized controlled trial pilot study by Suvarnnatoet. al. They investigated the effects of thoracic manipulation versus mobilization on chronic neck pain. Thirty- nine chronic neck pain patients were assigned to single level thoracic manipulation, single level thoracic mobilization, or a control group. The cervical range of motion and VAS pain ratings were measured before, immediately after, and at a 24-hour follow- up. The study demonstrated reductions in VAS pain ratings and increases in cervical range of motion at immediate and 24-hour follow- ups from both single level thoracic spine manipulation and thoracic mobilization in chronic neck pain. There was no significant difference between the two.
http://www.ncbi.nlm.nih.gov.proxy.kumc.edu:2048/pmc/articles/PMC3820396/
From a clinical perspective,this information is helpful in understanding that at this point in time, the literature does not definitely support or recommend one technique over the other and negates the fact that manipulation is superior to mobilization in a general sense for providing better functional outcomes. As a result, further high quality research is necessary to determine which technique is more effective in treating neck pain. Obviously, the safety of manual techniques to the spine, particularly with manipulation, should always be considered. Adverse events after manual therapy are common and transient, which is another topic in-and- of itself. Taking this literature into account, my personal approach to utilizing manual therapy to treat neck pain will be to first use lower grade mobilizations to sufficiently assess joint mobility and end feel prior to considering manipulative techniques. If no progress is made, only then would I consider another method of treatment. However, this always depends on the patient and their comfort with the treatment being provided.
Salom-Moreno, J., Ortega-Santiago, R., Cleland, J.A., Palacios-Cena, M., Truyols- Dominguez, S., & Fernandez de las Penas, C. 2014. Immediate changes in neck pain intensity and widespread pressure pain sensitivity in patients with bilateral chronic mechanical neck pain: a randomized controlled trial of thoracic thrust manipulation vs non- thrust mobilization. Journal of manipulative and physiological therapeutics. Vol. 37(5). pp. 312-19.
Suvarnnato, T., Puntumetakul, R., Kaber, D., Boucaut, R., Boonphakob, Y., Arayawichanon, P., & Chatchawan, U. 2013. The effects of thoracic manipulation versus mobilization for chronic neck pain: a randomized controlled trial pilot study. Journal of physical therapy science. Vol. 25(7). pp. 865-71.
Young, J.L., Walker, D., Snyder, S., & Daly, K. 2014. Thoracic manipulation versus mobilization in patients with mechanical neck pain: a systematic review. Journal of manual and manipulative therapy. Vol. 22(3). pp. 141-53.
