A randomized clinical trial to compare the immediate effects of seated thoracic manipulation and targeted supine thoracic manipulation on cervical spine flexion range of motion and pain

Karas, Steve; Hunt, Megan J. Olson

doi:10.1179/2042618613y.0000000052

Cited by 20 publications

(15 citation statements)

References 24 publications

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“…In this study, specifi c supine thoracic fl exion manipulation demonstrated a clinical benefi t for cervical pain reduction over nonspecifi c seated thoracic manipulation. 79 In the absence of consistent direction from scientifi c evidence, clinicians should use sound clinical decision making with regard for the impairments and functional limitations found during the examination when choosing which specifi c techniques to perform. Patient comfort during these techniques is a high priority and clinicians should consider this when assessing which technique to implement.…”

Section: Thoracic Hypomobility With Neck Painmentioning

confidence: 99%

Thoracic Spine Manual Therapy for Aging and Older Individuals

Masaracchio

Ojha

MacDonald

2015

Topics in Geriatric Rehabilitation

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With the advancement of medicine and technology, along with improvements in preventative medicine, the average age of the US population continues to rise. Research estimates that by the year 2050, there will be more than 65 million older adults living, with 19 million being older than 85 years. As the population ages, more individuals will seek out physical therapy services for spine-related pathologies. Little evidence is currently available on the safety and effectiveness of manual therapy interventions in older adults. The purpose of this review was to discuss the safety and effectiveness of manual therapy interventions targeted at the thoracic spine in older individuals.sents the highest prevalence rates among the 4 conditions identifi ed. 4 These conditions, in addition to other less common conditions such as ankylosing spondylosis, frequently contribute to thoracic pain or immobility in the older adult. In addition, the presence of osteoporosis paired with the potential increased rate of falls results in higher risks of compression fractures in the thoracic spine in older adults. 3 Although primary thoracic pain has been cited as occurring less frequently than neck or low back pain, 5 it can be equally and/or more severe and disabling. 6 , 7 The point prevalence for thoracic spine pain ranges from 3% to 70%, with a 1-month prevalence that ranges from 10% to 38%, a 3-month prevalence between 13% and 39%, and a 1-year prevalence ranging from 25% to 55%. 8 In addition, there is research to suggest that thoracic spine pain increases during the middle adult years (40-50 years), with a decrease in later adult years ( > 70 years). 9 Furthermore, because of the proximity of the thoracic spine to the cervical, lumbar, and shoulder regions, dysfunction in the thoracic spine and/or rib cage can potentially have an infl uence on pain, mobility, and stability in these regions. While mechanisms are unclear, substantial evidence suggests that manual therapy interventions directed at the thoracic spine can decrease pain and improve motion in the thoracic spine and adjacent regions. 10-20 According to the Guide to Physical Therapy Practice, 21 manual therapy can be defi ned as techniques that involve skilled passive movements to the joints and/or related soft tissues that can be applied at varying speeds and amplitudes, including a small-amplitude, high-velocity movement (thrust manipulation). 10 Considering the central role the thoracic spine has in spinal health, the aging population, and the relative cost-effectiveness of manual therapy for managing spinal pain, 22 the main aims of this article are to review thoracic spine anatomy, biomechanics, pathoanatomy, and differential diagnosis to establish the current knowledge of the role of manual therapy and exercise as interventions in the management of thoracic spinal pain in older individuals. THORACIC SPINE ANATOMY AND MECHANICSThe thoracic spine is conceptually divided into 3 regions: an upper (T1-T3), a middle (T4-T7), and a lower (T8-T12) thoracic spine. 23 In addition...

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Section: Thoracic Hypomobility With Neck Painmentioning

confidence: 99%

Thoracic Spine Manual Therapy for Aging and Older Individuals

Masaracchio

Ojha

MacDonald

2015

Topics in Geriatric Rehabilitation

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“…Although the RI approach of using thoracic manipulation for the management of neck and shoulder pain has shown positive outcomes, many of the aforementioned studies only assess immediate, short-term outcomes. 14,[41][42][43]45,51 Few studies have followed patients for longer time frames, such as 12 months. 48 When considering the existing body of knowledge in this area, some important questions remain.…”

Section: Future Areas Of Studymentioning

confidence: 99%

Regional interdependence and manual therapy directed at the thoracic spine

McDevitt

Young

Mintken

et al. 2015

Journal of Manual & Manipulative Therapy

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Thoracic spine manipulation is commonly used by physical therapists for the management of patients with upper quarter pain syndromes. The theoretical construct for using thoracic manipulation for upper quarter conditions is a mainstay of a regional interdependence (RI) approach. The RI concept is likely much more complex and is perhaps driven by a neurophysiological response including those related to peripheral, spinal cord and supraspinal mechanisms. Recent evidence suggests that thoracic spine manipulation results in neurophysiological changes, which may lead to improved pain and outcomes in individuals with musculoskeletal disorders. The intent of this narrative review is to describe the research supporting the RI concept and its application to the treatment of individuals with neck and/or shoulder pain. Treatment utilizing both thrust and non-thrust thoracic manipulation has been shown to result in improvements in pain, range of motion and disability in patients with upper quarter conditions. Research has yet to determine optimal dosage, techniques or patient populations to which the RI approach should be applied; however, emerging evidence supporting a neurophysiological effect for thoracic spine manipulation may negate the need to fully answer this question. Certainly, there is a need for further research examining both the clinical efficacy and effectiveness of manual therapy interventions utilized in the RI model as well as the neurophysiological effects resulting from this intervention.

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“…[5,6] Several studies have found that thoracic spine manipulation can increase cervical spine range of motion when reassessing the patient immediately or in the short-term after treatment. [3,[7][8][9][10][11][12][13] There is less evidence these outcomes remain significant in the medium-term, when follow-up is at least two weeks after the initial assessment. [14,15] There is also agreement that treating the thoracic spine will have immediate and short-term positive effects on neck pain.…”

Section: Introductionmentioning

confidence: 99%