Acute effects of single and multiple level thoracic manipulations on chronic mechanical neck pain: a randomized controlled trial

Rungthip Puntumetakul, Thavatchai Suvarnnato, Phurichaya Werasirirat, Sureeporn Uthaikhup, Junichiro Yamauchi, Rose Boucaut, Rungthip Puntumetakul, Thavatchai Suvarnnato, Phurichaya Werasirirat, Sureeporn Uthaikhup, Junichiro Yamauchi, Rose Boucaut

Abstract

Background: Thoracic spine manipulation has become a popular alternative to local cervical manipulative therapy for mechanical neck pain. This study investigated the acute effects of single-level and multiple-level thoracic manipulations on chronic mechanical neck pain (CMNP).

Methods: Forty-eight patients with CMNP were randomly allocated to single-level thoracic manipulation (STM) at T6-T7 or multiple-level thoracic manipulation (MTM), or to a control group (prone lying). Cervical range of motion (CROM), visual analog scale (VAS), and the Thai version of the Neck Disability Index (NDI-TH) scores were measured at baseline, and at 24-hour and at 1-week follow-up.

Results: At 24-hour and 1-week follow-up, neck disability and pain levels were significantly (P<0.05) improved in the STM and MTM groups compared with the control group. CROM in flexion and left lateral flexion were increased significantly (P<0.05) in the STM group when compared with the control group at 1-week follow-up. The CROM in right rotation was increased significantly after MTM compared to the control group (P<0.05) at 24-hour follow-up. There were no statistically significant differences in neck disability, pain level at rest, and CROM between the STM and MTM groups.

Conclusion: These results suggest that both single-level and multiple-level thoracic manipulation improve neck disability, pain levels, and CROM at 24-hour and 1-week follow-up in patients with CMNP.

Keywords: neck disability; neck pain; pain level; thoracic manipulation.

Figures

Figure 1
Figure 1
Flow diagram of subject recruitment throughout the course of the study. Abbreviation: NDI-TH, Thai version of the Neck Disability Index.
Figure 2
Figure 2
(A) Thoracic manipulation (screw thrust) (B) Segmental mobility in flexion testing and (C) Segmental mobility in extension testing.
Figure 3
Figure 3
(A) NDI-TH, baseline and after treatment; (B) pain level at rest, baseline and after treatment. Notes:aSignificant difference between baseline and 24 hours post-intervention (P<0.005) for MTM; bsignificant difference between baseline and 24 hours post-intervention (P<0.005) for STM; csignificant difference between baseline and 1 week post-intervention (P<0.005) for MTM; dsignificant difference between baseline and 1 week post-intervention (P<0.005) for STM. ♦ represents the control group, ■ represents the MTM group, and ▲ represents the STM group. Abbreviations: NDI-TH, Thai version of the Neck Disability Index; VAS, Visual Analog Scale; MTM, multiple-level thoracic manipulation; STM, single-level thoracic manipulation.

References

    1. Fejer R, Ohm-Kyvik K, Hartvigsen J. The prevalence of neck pain in the world population: a systematic critical review of the literature. Eur Spine J. 2006;15(6):834–848.
    1. Gummesson C, Isacsson SO, Isacsson AH, et al. The transition of reported pain in different body regions: a one-year follow-up study. BMC Musculoskelet Disord. 2006;7(2):17.
    1. Cote P, Cassidy JD, Carroll L. The Saskatchewan Health and Back Pain Survey. The prevalence of neck pain and related disability in Saskatchewan adults. Spine. 1998;23(15):1689–1698.
    1. Gross AR, Kay TM, Kennedy C, et al. Clinical practice guidelines on the use of manipulation or mobilization in the treatment of adults with mechanical neck disorders. Man Ther. 2002;7(4):193–205.
    1. Hurwitz EL, Morgenstern H, Harber P, Kominski GF, Yu F, Adams AH. A randomized trial of chiropractic manipulation and mobilization for patients with neck pain: clinical outcomes from the UCLA neck-pain study. Am J Public Health. 2002;92(10):1634–1641.
    1. Martinez-Segura R, Fernandez-de-las-Penas C, Ruiz-Saez M, Lopez-Jimenez C, Rodriguez-Blanco C. Immediate effects on neck pain and active range of motion after a single cervical high-velocity low-amplitude manipulation in subjects presenting with mechanical neck pain: a randomized controlled trial. J Manipulative Physiol Ther. 2006;29(7):511–517.
    1. Hoving JL, De Vet HC, Koes BW, et al. Manual therapy, physical therapy, or continued care by the general practitioner for patients with neck pain: long-term results from a pragmatic randomized clinical trial. Clin J Pain. 2006;22(4):370–377.
    1. Kanlayanaphotporn R, Chiradejnant A, Vachalathiti R. The immediate effects of mobilization technique on pain and range of motion in patients presenting with unilateral neck pain: a randomized controlled trial. Arch Phys Med Rehabil. 2009;90(2):187–192.
    1. Gross A, Miller J, Sylva J, et al. Manipulation or mobilisation for neck pain: a Cochrane review. Man Ther. 2010;15(4):315–333.
    1. Leaver AM, Maher CG, Herbert RD, et al. A randomized controlled trial comparing manipulation with mobilisation for recent onset neck pain. Arch Phys Med Rehabil. 2010;91(9):1313–1318.
    1. Gross AR, Kay T, Hondras M, et al. Manual therapies for mechanical neck disorders: a systematic review. Man Ther. 2002;7(3):131–149.
    1. Cleland JA, Childs MJD, McRae M, Palmer JA, Stowell T. Immediate effects of thoracic manipulation in patients with neck pain: a randomized clinical trial. Man Ther. 2005;10(2):127–135.
    1. Cleland JA, Glynn P, Whitman JM, Eberhart SL, MacDonald C, Childs JD. Short-term effects of thrust versus non-thrust mobilization/manipulation directed at the thoracic spine in patients with neck pain: a randomized clinical trial. Phys Ther. 2007;87(4):431–440.
    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. 2008;14(3):1–8.
    1. Lau HMC, 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(2):141–147.
    1. Puentedura EJ, Landers MR, Cleland JA, Mintken PE, Huijbregts P, Fernández-de-Las Peñas 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(4):208–220.
    1. Cagnie B, Vinck E, Beernaert A, Cambier D. How common are side effects of spinal manipulation and can these side effects be predicted? Man Ther. 2004;9(3):151–156.
    1. Fernandez de las Penas C, Palomeque-del-Cerro L, Rodriguez-Blonco C, Gomez-Coneasa A, Miangolarra-Page JC. Changes in neck pain and active range of motion after a single thoracic spine manipulation in subjects presenting with mechanical neck pain: a case series. J Manipulative Physiol Ther. 2007;30(4):312–320.
    1. Dommisse GF. Morphological aspects of the lumbar spine and lumbosacral region. Orthop Clin North Am. 1975;6(1):163–175.
    1. Butler DS. Mobilization of the Nervous System. Melbourne, Australia: Churchill Livingstone; 1991.
    1. Suvarnnato T, Puntumetakul R, Kaber D, et al. The effects of thoracic manipulation versus mobilization for chronic neck pain: a pilot randomized controlled study. J Phys Ther Sci. 2013;25(7):865–871.
    1. Maitland G, Hengeveld E, Banks K, English K. Maitland’s Vertebral Manipulation. 6th ed. Oxford, UK: Butterworth-Heinemann; 2000.
    1. Uthaikhup S, Paungmali A, Pirunsan U. Validation of Thai versions of the Neck Disability Index and Neck Pain and Disability Scale in patients with neck pain. Spine. 2011;36(21):E1415–E1421.
    1. Bijur PE, Silver W, Gallagher JE. Reliability of the visual analog scale for measurement of acute pain. Acad Emerg Med. 2001;8(12):1153–1157.
    1. Bird SB, Dickson EW. Clinically significant changes in pain along the visual analog scale. Ann Emerg Med. 2001;38(6):639–643.
    1. Gallagher EJ, Liebman M, Bijur PE. Prospective validation of clinically important changes in pain severity measured on a visual analog sale. Ann Emerg Med. 2001;38(6):633–638.
    1. Suvarnnato T, Puntumethaku R, Boonprakop Y, Phadungkit S. Intratester reliability of three clinical methods of measuring active cervical range of motion in normal subjects: a preliminary study. J Med Tech Phys Ther. 2010;22(2):160–166.
    1. George SZ, Fritz JM, Childs JD, Brenan GP. Sex differences in predictors of outcome in selected physical therapy interventions of acute low back pain. J Orthop Sports Phys Ther. 2006;36(6):354–363.
    1. Vicenzino B, Paungmali A, Buratowsky S, Wright A. Specific manipulative therapy treatment for chronic lateral epicondylalgia produces uniquely characteristic hypoalgesia. Man Ther. 2001;6(4):205–212.
    1. Paungmali A, O’Leary S, Souvlis T, Vincenzino B. Hypoalgesic and symthoexcitatory effects of mobilization with movement for lateral epicondylalgia. Phys Ther. 2003;83(4):374–383.
    1. Melzack R, Wall PD. Pain mechanisms: a new theory. Science. 1965;150:971–979.
    1. Pickar JG. Neurophysiological effects of spinal manipulation. Spine J. 2002;2(5):357–371.
    1. Gray H. Anatomy: Descriptive and Surgical. London, UK: Chartwell; 1991.
    1. Bialosky JE, Bishop MD, George SZ, et al. Placebo response to manual therapy: something out of nothing? J Man Manip Ther. 2011;19(1):11–19.
    1. Perillo L, Femminella B, Farronato D, Baccetti T, Contardo L, Perinetti G. Do malocclusion and Helkimo Index ≥ 5 correlate with body posture? J Oral Rehabil. 2011;38(4):242–252.
    1. Perillo L, Esposito M, Contiello M, Lucchese A, Santini AC, Carotenuto M. Occlusal traits in developmental dyslexia: a preliminary study. Neuropsychiatr Dis Treat. 2013;9(8):1231–1237.
    1. Perillo L, Esposito M, Caprioglio A, Attanasio S, Santini AC, Carotenuto M. Orthodontic treatment need for adolescents in the Campania region: the malocclusion impact on self-concept. Patient Prefer Adherence. 2014;19(8):353–359.
    1. Edmondston SJ, Singer KP. Thoracic spine: anatomical and biomechanical considerations for manual therapy. Man Ther. 1997;2(3):132–143.
    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(4):243–251.
    1. Senstad O, Leboeuf-Yde C, Borchgrevink C. Frequency and characteristics of side effects of spinal manipulative therapy. Spine. 1997;22(4):435–441.

Source: PubMed

Sponsor e collaboratori

Condizioni mediche

Interventi farmacologici

3
Sottoscrivi