Thoracic spine manipulation for the management of mechanical neck pain: A systematic review and meta-analysis

Michael Masaracchio, Kaitlin Kirker, Rebecca States, William J Hanney, Xinliang Liu, Morey Kolber, Michael Masaracchio, Kaitlin Kirker, Rebecca States, William J Hanney, Xinliang Liu, Morey Kolber

Abstract

Objective: To investigate the role of thoracic spine manipulation (TSM) on pain and disability in the management of mechanical neck pain (MNP).

Data sources: Electronic databases PubMed, CINAHL, Pedro, Embase, AMED, the Cochrane Library, and clinicaltrials.gov were searched in January 2018.

Study selection: Eligible studies were completed RCTs, written in English, had at least 2 groups with one group receiving TSM, had at least one measure of pain or disability, and included patients with MNP of any duration. The search identified 1717 potential articles, with 14 studies meeting inclusion criteria.

Study appraisal and synthesis methods: Methodological quality was evaluated independently by two authors using the guidelines published by the Cochrane Collaboration. Pooled analyses were analyzed using a random-effects model with inverse variance methods to calculate mean differences (MD) and 95% confidence intervals for pain (VAS 0-100mm, NPRS 0-10pts; 0 = no pain) and disability (NDI and NPQ 0-100%; 0 = no disability).

Results: Across the included studies, there was increased risk of bias for inadequate provider and participant blinding. The GRADE approach demonstrated an overall level of evidence ranging from very low to moderate. Meta-analysis that compared TSM to thoracic or cervical mobilization revealed a significant effect favoring the TSM group for pain (MD -13.63; 95% CI: -21.79, -5.46) and disability (MD -9.93; 95% CI: -14.38, -5.48). Meta-analysis that compared TSM to standard care revealed a significant effect favoring the TSM group for pain (MD -13.21; 95% CI: -21.87, -4.55) and disability (MD -11.36; 95% CI: -18.93, -3.78) at short-term follow-up, and a significant effect for disability (MD -4.75; 95% CI: -6.54, -2.95) at long-term follow-up. Meta-analysis that compared TSM to cervical spine manipulation revealed a non-significant effect (MD 3.43; 95% CI: -7.26, 14.11) for pain without a distinction between immediate and short-term follow-up.

Limitations: The greatest limitation in this systematic review was the heterogeneity among the studies making it difficult to assess the true clinical benefit, as well as the overall level of quality of evidence.

Conclusions: TSM has been shown to be more beneficial than thoracic mobilization, cervical mobilization, and standard care in the short-term, but no better than cervical manipulation or placebo thoracic spine manipulation to improve pain and disability.

Trial registration: PROSPERO CRD42017068287.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1. PRISMA flow diagram of search… — **Fig 1. PRISMA flow diagram of search results and studies included.**

Fig 2. Meta-analysis of TSM versus placebo… — **Fig 2. Meta-analysis of TSM versus placebo TSM for pain at immediate follow-up.**

Fig 3. Meta-analysis of TSM versus mobilization… — **Fig 3. Meta-analysis of TSM versus mobilization for pain without a distinction between immediate and short-term follow-up.**

Fig 4. Meta-analysis of TSM versus standard… — **Fig 4. Meta-analysis of TSM versus standard care for pain at short-term follow-up.**

Fig 5. Meta-analysis of TSM versus standard… — **Fig 5. Meta-analysis of TSM versus standard care for pain at long-term follow-up.**

Fig 6. Meta-analysis of TSM versus cervical… — **Fig 6. Meta-analysis of TSM versus cervical manipulation for pain without a distinction between immediate and short-term follow-up.**

Fig 7. Meta-analysis for TSM versus mobilization… — **Fig 7. Meta-analysis for TSM versus mobilization for disability without a distinction between immediate and short-term follow-up.**

Fig 8. Meta-analysis for TSM versus standard… — **Fig 8. Meta-analysis for TSM versus standard care for disability at short-term follow-up.**

Fig 9. Meta-analysis for TSM versus standard… — **Fig 9. Meta-analysis for TSM versus standard care for disability at long-term follow-up.**

References

1. Hoy DG, Protani M, De R, Buchbinder R. The epidemiology of neck pain. Best Pract Res Clin Rheumatol. 2010;24:783–92. 10.1016/j.berh.2011.01.019
1. Collaborators USBoD, Mokdad AH, Ballestros K, Echko M, Glenn S, Olsen HE, et al. The State of US Health, 1990–2016: Burden of Diseases, Injuries, and Risk Factors Among US States. JAMA. 2018;319:1444–72. 10.1001/jama.2018.0158
1. Cleland JA, Childs JD, McRae M, Palmer JA, Stowell T. Immediate effects of thoracic manipulation in patients with neck pain: a randomized clinical trial. Man Ther. 2005;10:127–35. 10.1016/j.math.2004.08.005
1. Cross KM, Kuenze C, Grindstaff TL, Hertel J. Thoracic spine thrust manipulation improves pain, range of motion, and self-reported function in patients with mechanical neck pain: a systematic review. J Orthop Sports Phys Ther. 2011;41:633–42. 10.2519/jospt.2011.3670
1. Gonzalez-Iglesias J, Fernandez-de-las-Penas C, Cleland JA, Alburquerque-Sendin F, Palomeque-del-Cerro L, Mendez-Sanchez R. Inclusion of thoracic spine thrust manipulation into an electro-therapy/thermal program for the management of patients with acute mechanical neck pain: a randomized clinical trial. Man Ther. 2009;14:306–13. 10.1016/j.math.2008.04.006
1. Martinez-Segura R, De-la-Llave-Rincon AI, Ortega-Santiago R, Cleland JA, Fernandez-de-Las-Penas C. Immediate changes in widespread pressure pain sensitivity, neck pain, and cervical range of motion after cervical or thoracic thrust manipulation in patients with bilateral chronic mechanical neck pain: a randomized clinical trial. J Orthop Sports Phys Ther. 2012;42:806–14. 10.2519/jospt.2012.4151
1. Masaracchio M, Cleland JA, Hellman M, Hagins M. Short-term combined effects of thoracic spine thrust manipulation and cervical spine nonthrust manipulation in individuals with mechanical neck pain: a randomized clinical trial. J Orthop Sports Phys Ther. 2013;43:118–27. 10.2519/jospt.2013.4221
1. Blanpied PR, Gross AR, Elliott JM, Devaney LL, Clewley D, Walton DM, et al. Neck Pain: Revision 2017. J Orthop Sports Phys Ther. 2017;47:A1–A83.
1. Austin GP, Benesky WT. Thoracic pain in a collegiate runner. Man Ther. 2002;7:168–72.
1. Bautista-Aguirre F, Oliva-Pascual-Vaca A, Heredia-Rizo AM, Bosca-Gandia JJ, Ricard F, Rodriguez-Blanco C. Effect of cervical vs. thoracic spinal manipulation on peripheral neural features and grip strength in subjects with chronic mechanical neck pain: a randomized controlled trial. Eur J Phys Rehabil Med. 2017;53:333–41. 10.23736/S1973-9087.17.04431-8
1. Casanova-Mendez A, Oliva-Pascual-Vaca A, Rodriguez-Blanco C, Heredia-Rizo AM, Gogorza-Arroitaonandia K, Almazan-Campos G. Comparative short-term effects of two thoracic spinal manipulation techniques in subjects with chronic mechanical neck pain: a randomized controlled trial. Man Ther. 2014;19:331–7. 10.1016/j.math.2014.03.002
1. 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;87:9–23. 10.2522/ptj.20060155
1. Cleland JA, Mintken PE, Carpenter K, Fritz JM, Glynn P, Whitman J, et al. 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;90:1239–50. 10.2522/ptj.20100123
1. Dunning JR, Cleland JA, Waldrop MA, Arnot CF, Young IA, Turner M, et al. Upper cervical and upper thoracic thrust manipulation versus nonthrust mobilization in patients with mechanical neck pain: a multicenter randomized clinical trial. J Orthop Sports Phys Ther. 2012;42:5–18. 10.2519/jospt.2012.3894
1. Gonzalez-Iglesias J, Fernandez-de-las-Penas C, Cleland JA, Gutierrez-Vega Mdel R. Thoracic spine manipulation for the management of patients with neck pain: a randomized clinical trial. J Orthop Sports Phys Ther. 2009;39:20–7. 10.2519/jospt.2009.2914
1. Groeneweg R, van Assen L, Kropman H, Leopold H, Mulder J, Smits-Engelsman BCM, et al. Manual therapy compared with physical therapy in patients with non-specific neck pain: a randomized controlled trial. Chiropr Man Therap. 2017;25:12 10.1186/s12998-017-0141-3
1. Lau HM, Wing Chiu TT, Lam TH. The effectiveness of thoracic manipulation on patients with chronic mechanical neck pain—a randomized controlled trial. Man Ther. 2011;16:141–7. 10.1016/j.math.2010.08.003
1. Leaver AM, Maher CG, Herbert RD, Latimer J, McAuley JH, Jull G, et al. A randomized controlled trial comparing manipulation with mobilization for recent onset neck pain. Arch Phys Med Rehabil. 2010;91:1313–8. 10.1016/j.apmr.2010.06.006
1. Puentedura EJ, March J, Anders J, Perez A, Landers MR, Wallmann HW, et al. Safety of cervical spine manipulation: are adverse events preventable and are manipulations being performed appropriately? A review of 134 case reports. J Man Manip Ther. 2012;20:66–74. 10.1179/2042618611Y.0000000022
1. Khoja SS, Browder DA, Daliman D, Piva SR. Benefits of thoracic thrust manipulation when applied with a multi-modal treatment approach in individuals with mechanical neck pain: A pilot randomized trial. Int J Phys Med Rehabil. 2015;3:1–8.
1. Krauss J, Creighton D, Ely JD, Podlewska-Ely J. The immediate effects of upper thoracic translatoric spinal manipulation on cervical pain and range of motion: a randomized clinical trial. J Man Manip Ther. 2008;16:93–9. 10.1179/106698108790818530
1. Lee KW, Kim WH. Effect of thoracic manipulation and deep craniocervical flexor training on pain, mobility, strength, and disability of the neck of patients with chronic nonspecific neck pain: a randomized clinical trial. J Phys Ther Sci. 2016;28:175–80. 10.1589/jpts.28.175
1. Bialosky JE, Bishop MD, Price DD, Robinson ME, George SZ. The mechanisms of manual therapy in the treatment of musculoskeletal pain: a comprehensive model. Man Ther. 2009;14:531–8. 10.1016/j.math.2008.09.001
1. Wainner RS, Whitman JM, Cleland JA, Flynn TW. Regional interdependence: a musculoskeletal examination model whose time has come. J Orthop Sports Phys Ther. 2007;37:658–60. 10.2519/jospt.2007.0110
1. Norlander S, Aste-Norlander U, Nordgren B, Sahlstedt B. Mobility in the cervico-thoracic motion segment: an indicative factor of musculo-skeletal neck-shoulder pain. Scand J Rehabil Med. 1996;28:183–92.
1. Norlander S, Gustavsson BA, Lindell J, Nordgren B. Reduced mobility in the cervico-thoracic motion segment—a risk factor for musculoskeletal neck-shoulder pain: a two-year prospective follow-up study. Scand J Rehabil Med. 1997;29:167–74.
1. Norlander S, Nordgren B. Clinical symptoms related to musculoskeletal neck-shoulder pain and mobility in the cervico-thoracic spine. Scand J Rehabil Med. 1998;30:243–51.
1. Fukui S, Ohseto K, Shiotani M. Patterns of pain induced by distending the thoracic zygapophyseal joints. Reg Anesth. 1997;22:332–6.
1. Salom-Moreno J, Ortega-Santiago R, Cleland JA, Palacios-Cena M, Truyols-Dominguez S, Fernandez-de-las-Penas C. 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. J Manipulative Physiol Ther. 2014;37:312–9. 10.1016/j.jmpt.2014.03.003
1. Suvarnnato T, Puntumetakul R, Kaber D, Boucaut R, Boonphakob Y, Arayawichanon P, et al. The effects of thoracic manipulation versus mobilization for chronic neck pain: a randomized controlled trial pilot study. J Phys Ther Sci. 2013;25:865–71. 10.1589/jpts.25.865
1. Cleland JA, Glynn P, Whitman JM, Eberhart SL, MacDonald C, Childs JD. Short-term effects of thrust versus nonthrust mobilization/manipulation directed at the thoracic spine in patients with neck pain: a randomized clinical trial. Phys Ther. 2007;87:431–40. 10.2522/ptj.20060217
1. Puentedura EJ, Landers MR, Cleland JA, Mintken PE, Huijbregts P, Fernandez-de-Las-Penas C. Thoracic spine thrust manipulation versus cervical spine thrust manipulation in patients with acute neck pain: a randomized clinical trial. J Orthop Sports Phys Ther. 2011;41:208–20. 10.2519/jospt.2011.3640
1. Huisman PA, Speksnijder CM, de Wijer A. The effect of thoracic spine manipulation on pain and disability in patients with non-specific neck pain: a systematic review. Disability and rehabilitation. 2013;35:1677–85. 10.3109/09638288.2012.750689
1. Young JL, Walker D, Snyder S, Daly K. Thoracic manipulation versus mobilization in patients with mechanical neck pain: a systematic review. J Man Manip Ther. 2014;22:141–53. 10.1179/2042618613Y.0000000043
1. Furlan AD, Malmivaara A, Chou R, Maher CG, Deyo RA, Schoene M, et al. 2015 Updated Method Guideline for Systematic Reviews in the Cochrane Back and Neck Group. Spine (Phila Pa 1976). 2015;40:1660–73.
1. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol. 2009;62:e1–34. 10.1016/j.jclinepi.2009.06.006
1. Mintken PE, DeRosa C, Little T, Smith B, American Academy of Orthopaedic Manual Physical T. AAOMPT clinical guidelines: A model for standardizing manipulation terminology in physical therapy practice. J Orthop Sports Phys Ther. 2008;38:A1–6.
1. Lee MS, Pittler MH, Shin BC, Ernst E. Tai chi for osteoporosis: a systematic review. Osteoporos Int. 2008;19:139–46. 10.1007/s00198-007-0486-x
1. Cleland JA, Childs JD, Whitman JM. Psychometric properties of the Neck Disability Index and Numeric Pain Rating Scale in patients with mechanical neck pain. Arch Phys Med Rehabil. 2008;89:69–74. 10.1016/j.apmr.2007.08.126
1. Kelly AM. The minimum clinically significant difference in visual analogue scale pain score does not differ with severity of pain. Emerg Med J. 2001;18:205–7. 10.1136/emj.18.3.205
1. Sim J, Jordan K, Lewis M, Hill J, Hay EM, Dziedzic K. Sensitivity to change and internal consistency of the Northwick Park Neck Pain Questionnaire and derivation of a minimal clinically important difference. Clin J Pain. 2006;22:820–6. 10.1097/01.ajp.0000210937.58439.39
1. Jette AM. Toward a common language for function, disability, and health. Phys Ther. 2006;86:726–34.
1. Stineman MG, Henry-Sanchez JT, Kurichi JE, Pan Q, Xie D, Saliba D, et al. Staging activity limitation and participation restriction in elderly community-dwelling persons according to difficulties in self-care and domestic life functioning. Am J Phys Med Rehabil. 2012;91:126–40. 10.1097/PHM.0b013e318241200d
1. Carnes D, Mullinger B, Underwood M. Defining adverse events in manual therapies: a modified Delphi consensus study. Man Ther. 2010;15:2–6. 10.1016/j.math.2009.02.003
1. Furlan AD, Pennick V, Bombardier C, van Tulder M, Editorial Board CBRG. 2009 updated method guidelines for systematic reviews in the Cochrane Back Review Group. Spine (Phila Pa 1976). 2009;34:1929–41.
1. Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008;336:924–6. 10.1136/
1. Sillevis R, Cleland J, Hellman M, Beekhuizen K. Immediate effects of a thoracic spine thrust manipulation on the autonomic nervous system: a randomized clinical trial. J Man Manip Ther. 2010;18:181–90. 10.1179/106698110X12804993427126
1. Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration 2011. Available from .
1. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327:557–60. 10.1136/bmj.327.7414.557
1. Cleland JA, Flynn TW, Childs JD, Eberhart S. The audible pop from thoracic spine thrust manipulation and its relation to short-term outcomes in patients with neck pain. J Man Manip Ther. 2007;15:143–54. 10.1179/106698107790819828
1. Puentedura EJ, O'Grady WH. Safety of thrust joint manipulation in the thoracic spine: a systematic review. J Man Manip Ther. 2015;23:154–61. 10.1179/2042618615Y.0000000012
1. Puentedura EJ, Slaughter R, Reilly S, Ventura E, Young D. Thrust joint manipulation utilization by U.S. physical therapists. J Man Manip Ther. 2017;25:74–82. 10.1080/10669817.2016.1187902
1. Delitto A, George SZ, Van Dillen LR, Whitman JM, Sowa G, Shekelle P, et al. Low back pain. J Orthop Sports Phys Ther. 2012;42:A1–57.
1. Fritz JM, Brennan GP. Preliminary examination of a proposed treatment-based classification system for patients receiving physical therapy interventions for neck pain. Phys Ther. 2007;87:513–24. 10.2522/ptj.20060192
1. Fritz JM, Cleland JA, Brennan GP. Does adherence to the guideline recommendation for active treatments improve the quality of care for patients with acute low back pain delivered by physical therapists? Med Care. 2007;45:973–80. 10.1097/MLR.0b013e318070c6cd
1. Fritz JM, Cleland JA, Childs JD. Subgrouping patients with low back pain: evolution of a classification approach to physical therapy. J Orthop Sports Phys Ther. 2007;37:290–302. 10.2519/jospt.2007.2498
1. Fritz JM, Lindsay W, Matheson JW, Brennan GP, Hunter SJ, Moffit SD, et al. Is there a subgroup of patients with low back pain likely to benefit from mechanical traction? Results of a randomized clinical trial and subgrouping analysis. Spine (Phila Pa 1976). 2007;32:E793–800.
1. Collins CK, Masaracchio M, Brismee JM. The future of orthopedic manual therapy: what are we missing? J Man Manip Ther. 2017;25:169–71. 10.1080/10669817.2017.1358249
1. Collins CK, Gilden B. A Non-Operative Approach to the Management of Chronic Exertional Compartment Syndrome in a Triathlete: A Case Report. Int J Sports Phys Ther. 2016;11:1160–76.
1. Masaracchio M, Kirker K, Collins CK, Hanney W, Liu X. An Intervention-Based Clinical Reasoning Framework to Guide the Management of Thoracic Pain in a Dancer: A Case Report. Int J Sports Phys Ther. 2016;11:1135–49.
1. Delitto A. American Physical Therapy Association. Rothstein roundtable debates implementation of human movement system. Next Conference and Exposition2015.
1. Sedgwick P. Meta-analyses: how to read a funnel plot. British Medical Journal. 2013;346:1342–3.
1. Cochrane Handbook for Systematic Reviews of Interventions Version Cochrane Collaboration; 2011. Available from .

Source: PubMed

Thoracic spine manipulation for the management of mechanical neck pain: A systematic review and meta-analysis

Abstract

Conflict of interest statement

Figures

References

Sponsors et collaborateurs

Les conditions médicales

Interventions en matière de drogue