Immediate effects of cervicothoracic junction mobilization versus thoracic manipulation on the range of motion and pain in mechanical neck pain with cervicothoracic junction dysfunction: a pilot randomized controlled trial

Abstract

Background Cervicothoracic (CT) junction hypomobility has been proposed as a contributing factor for neck pain. However, there are limited studies that compared the effect of CT junction mobilization against an effective intervention in neck pain. Thoracic spine manipulation is a nonspecific intervention for neck pain where remote spinal segments are treated based on the concept of regional interdependence. The effectiveness of segment-specific spinal mobilization in the cervical spine has been researched in the last few years, and no definite conclusions could be made from the previous studies. The above reasons warrant the investigation of the effects of a specific CT junction mobilization against a nonspecific thoracic manipulation intervention in neck pain. The present study aims to compare the immediate effects of C7-T1 Maitland mobilization with thoracic manipulation in individuals with mechanical neck pain presenting with CT junction dysfunction specifically. Methods A randomized clinical trial is conducted where participants with complaints of mechanical neck pain and CT junction dysfunction randomly assigned to either C7-T1 level Maitland mobilization group or mid-thoracic (T3-T6) manipulation group (active control group). In both the groups, the post graduate student (SJ) pursuing Master’s in orthopedic physiotherapy delivered the intervention. The outcomes of cervical flexion, extension, side flexion & rotation range of motion (ROM) were measured before & after the intervention with a cervical range of motion (CROM) device. Self-reported pain intensity was measured with the numerical pain rating scale (NPRS). The post-intervention between-group comparison was performed using a one-way ANCOVA test. Results Forty-two participants with mean age CT junction group: 35.14 ± 10.13 and Thoracic manipulation group: 38.47 ± 11.47 were recruited for the study. No significant differences in the post-intervention baseline adjusted outcomes of cervical ROM & self-reported pain intensity were identified between the groups after the treatment (p = 0.08, 0.95, 0.01, 0.39, 0.29, 0.27for flexion, extension, bilateral lateral flexion & rotations respectively) & neck pain intensity (p = 0.68). However, within-group, pre, and post comparison showed significant improvements in cervical ROM and pain in both groups. Conclusion This preliminary study identified that CT junction mobilization is not superior to thoracic manipulation on the outcomes of cervical ROM and neck pain when level-specific CT junction mobilization was compared with remote mid-thoracic manipulation in individuals with mechanical neck pain and CT junction dysfunction. Trial registration CTRI: 2018/04/013088, Registered 6 April 2018, http://ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=24418

Die Wirbelsäule – „hands on“-Anatomie der spinalen Übergänge beim Kleintier

“…Somit steht auch der anatomische CTÜ mit wichtigen Strukturen in Verbindung. Aufgrund regionaler Interdependanz können Schmerzen im Zervikalbereich auch mit Manipulationen an der thorakalen Wirbelsäule gleichsam erfolgreich behandelt werden 22 . So wurde die Manipulation des CTÜ unterstützend zu lokaler Therapie bei Dysfunktionen des Temporomandibulargelenks erfolgreich eingesetzt 23 .…”

Clinical Effectiveness and Efficacy of Chiropractic Spinal Manipulation for Spine Pain

“…The most frequent active comparators used against SMT were other interventions commonly used for the management of NP, such as exercise or physical therapy modalities (43)(44)(45)(46)(47)(48)(49)(50). Additional studies compared the application of SM to that of mobilization techniques or examined the effect of different SM application sites (cervical vs. thoracic) (51)(52)(53)(54)(55)(56)(57)(58). However, these trials often measured short-term effects after short periods of care, which may not be as informative to clinical practice.…”

“…Hence, mobilization is sometimes referred to as non-thrust SM (55,59). When directly comparing the application of SM to mobilization, several studies reported no significant differences in pain intensity, disability, range of motion or quality of life, although all outcomes improved significantly regardless of the intervention (41,51,54,(56)(57)(58). However, when comparing both interventions to a control (inactive treatment) group, neither was successful at reducing pain (41).…”

“…Additional studies compared the application of SM to that of mobilization techniques or examined the effect of different SM application sites (cervical vs . thoracic) ( 51 – 58 ). However, these trials often measured short-term effects after short periods of care, which may not be as informative to clinical practice.…”

The Effect of Joint Mobilization and Deep Cervical Flexor Training Applied to the Neck on Muscle Tone and Pain in Adults with Non-Specific Neck Pain

“…Ganesh et al [20] reported a significant increase in the cervical mobility by applying Maitland mobilization to patients with cervical pain who complained of symptoms for less than 12 weeks. Meanwhile, Joshi et al [21] reported that in a patient complaining of pain at the junction of the cervical vertebrae and the vertebrae, Maitland mobilization was applied to the cervical vertebrae to significantly increase the mobility in cervical flexion and extension, as well as outward flexion and rotation.…”