Critically Appraised Topic
I was lead to pursue this question by a 43-year-old female who presents with insidious onset cervical spine pain described as a deep dull ache that has gotten progressively worse during recent months. Aggravating factors include typing on her computer and looking down to read. Objective findings include general lower cervical hypomobility on the right during ipsilateral extension/rotation quadrant testing. Significant forward head posture was also noted with concomitant thoracic kyphosis and bilateral shoulder protraction. During treatment, the PT chose to perform thoracic manipulation in an attempt the increase segmental mobility at the thoracic level, inducing a more normalized extension pattern along with the theoretical neurophysiologic elements of pain reduction post-facet cavitation caused by the manipulation. This intervention was followed by home exercise program (HEP) instruction and postural education.
Is the addition of thoracic manipulation to the treatment plan effective for reducing neck pain greater than a plan of care that excludes the technique?
Clinical Bottom Line
Based on the results of the two studies by Gonzalez et al. and Cheung et al., there is strong evidence to suggest that for adults diagnosed with chronic or acute mechanical neck pain (less than one month to greater than three months), implementing an intervention protocol that incorporates grade V thoracic manipulation (3-16 manipulations over 3-4 weeks), would result in greater improvements in pain and disability when compared to a protocol that excludes manipulation. Using validated and reliable outcome measures, both articles demonstrated clinically significant improvements in pain and disability for the groups that received thoracic manipulations. There were no adverse effects reported in either study and the cost of receiving the manipulation was only the estimated time of 2-3 minutes to administer.
Braga, Tony, "The therapeutic efficacy of thoracic spine manipulation when combined with common conservative interventions for patients with mechanical neck pain" (2014). PT Critically Appraised Topics. 45.