A preliminary study comparing the use of cervical/upper thoracic mobilization and manipulation for individuals with mechanical neck pain

Abstract

Objectives: Neck pain is routinely managed using manual therapy (MT) to the cervical and thoracic spines. While both mobilizations and manipulations to these areas have been shown to reduce neck pain, increase cervical range of motion, and reduce disability, the most effective option remains elusive. The purpose of this preliminary trial was to compare the pragmatic use of cervical and thoracic mobilizations vs. manipulation for mechanical neck pain. Methods: This trial included 20 patients with mechanical neck pain. Each patient was randomized to receive either mobilization or manipulation to both the cervical and thoracic spines during their plan of care. Within-group analyses were made with Wilcoxon signed-rank tests and between-group analyses were made with Mann-Whitney U.Results: There were no between-group differences for any of the dependent variables including cervical active range of motion (CAROM) (P50.18), deep cervical flexion (DCF) endurance (P50.06), numerical pain rating scale (NPRS) (P50.26), the neck disability index (NDI, P50.33), patient-specific functional scale (PSFS, P50.20), or the global rating of change (GROC) scale (P50.94). Within-group results were significant for all outcome variables (P,0.001) from initial evaluation to discharge for both groups. Discussion: These findings were consistent with other trials previously conducted that applied the MT techniques in a pragmatic fashion, but varied from previous trials where the treatment was standardized. A larger experimental study is necessary to further examine the differences between mobilization and manipulation for neck pain.

The effect of short-term upper thoracic self-mobilization using a Kaltenborn wedge on pain and cervical dysfunction in patients with neck pain

“…In the comparison of cervical functional movement on the sagittal plane, there were significant intragroup increases in the flexion and extension in both the SMG group and the SSG group after the experiment, and there were significant intergroup increases in extension angles. This finding is consistent with those of previous papers 16 , 17 ) : self mobilization is effective for the functional improvement of the cervical spine. A study by Kim et al 18 ) demonstrates that joint mobilization in the upper thoracic shows significant improvement in terms of pain and joint ROM.…”

Immediate effects of cervical mobilisations on global perceived effect, movement associated pain and neck kinematics in patients with non-specific neck pain. A double blind placebo randomised controlled trial

“…GROC is a 15-point scale ranging from -7 (a very great deal worse), through 0 (no change), to +7 (a great deal better) 30 . It is widely used to evaluate change in neck pain [30][31][32][33] because of its validity and clinical relevance, and correlation with self-rated importance of change and patient satisfaction measures 34 , and has been recommended to be used as a core outcome measure by the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials 35 .…”

Effectiveness of Thoracic Manipulation on the Treatment of Patients With Mechanical Non-Specific Neck Pain

“…Joint manipulation is a high velocity low amplitude thrust applied at or near the end range of a targeted segment and is often associated with an audible click [13,14]. Recent studies support effectiveness of manual therapies in improving pain along with cervical active range of motion and function [6,[15][16][17]. The exact mechanisms underlying the effectiveness of manipulation is not known yet.…”