Steve Karas1, Megan J Olson Hunt2, Bill Temes3, Martin Thiel4, Trenton Swoverland5, Brett Windsor6. 1. Physical Therapy, Chatham University, Pittsburgh, PA, USA. 2. Natural and Applied Sciences (Statistics), University of Wisconsin-Green Bay, Green Bay, WI, USA. 3. Therapeutic Associates Physical Therapy, Instructor North American Institute of Orthopedic Manual Therapy, Eugene, OR, USA. 4. Department of Physiotherapy and Rehabilitation, Baltic Sea-Clinic, Bad Schwartau, Germany. 5. Mallers & Swoverland Orthopaedic Physical Therapy, Fort Wayne, IN, USA. 6. North American Institute of Orthopedic Manual Therapy, Eugene, OR, USA.
Abstract
OBJECTIVES: To determine the difference on neck outcomes with directional manipulation to the thoracic spine. There is evidence that thoracic spine manipulation is effective in treating patients with neck pain. However, there is no research that determines if the assessment of directional hypomobility and the selection of thrust direction offer improved outcomes. METHODS: A total of 69 patients with cervical spine pain were randomly assigned to receive either a manipulation that was consistent with their thoracic spine motion loss (matched) or opposite their motion loss (unmatched). The patient was given care consistent with the orthopedic section guidelines for neck pain and the physical therapist's clinical reasoning. Baseline outcome measures (NPRS, NDI, GROC) were taken and reassessed two days and two weeks after treatment. RESULTS: Both groups had positive results when pain, neck disability index, and global rating of change were assessed. There was no difference between the matched and unmatched groups. DISCUSSION: Directional manipulation of hypomobile thoracic spine segments may not be required to improved outcomes in patients with neck pain. Future studies should assess a variety of factors when determining the best available treatment, including manual therapy procedures, exercise, and patient selection. LEVEL OF EVIDENCE: 1b.
OBJECTIVES: To determine the difference on neck outcomes with directional manipulation to the thoracic spine. There is evidence that thoracic spine manipulation is effective in treating patients with neck pain. However, there is no research that determines if the assessment of directional hypomobility and the selection of thrust direction offer improved outcomes. METHODS: A total of 69 patients with cervical spine pain were randomly assigned to receive either a manipulation that was consistent with their thoracic spine motion loss (matched) or opposite their motion loss (unmatched). The patient was given care consistent with the orthopedic section guidelines for neck pain and the physical therapist's clinical reasoning. Baseline outcome measures (NPRS, NDI, GROC) were taken and reassessed two days and two weeks after treatment. RESULTS: Both groups had positive results when pain, neck disability index, and global rating of change were assessed. There was no difference between the matched and unmatched groups. DISCUSSION: Directional manipulation of hypomobile thoracic spine segments may not be required to improved outcomes in patients with neck pain. Future studies should assess a variety of factors when determining the best available treatment, including manual therapy procedures, exercise, and patient selection. LEVEL OF EVIDENCE: 1b.
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