Repeated Applications of Thoracic Spine Thrust Manipulation do not Lead to Tolerance in Patients Presenting with Acute Mechanical Neck Pain: A Secondary Analysis

Abstract

It has been demonstrated that patients receiving mobilization techniques do not exhibit tolerance to repeated applications. However, this phenomenon has not been investigated for thoracic manipulation. Our aim was to determine if patients receiving thoracic thrust manipulation exhibit tolerance to repeated applications in acute mechanical neck pain. Forty-five patients were randomly assigned to two groups. The control group received electro- and thermotherapy for 5 sessions, and the experimental group received the same program and also received a thoracic thrust manipulation once a week for 3 consecutive weeks. Outcome measures included neck pain and cervical mobility. Within-session change scores for pain and mobility during treatment sessions #1, 3, and 5 were examined with a one-way repeated measured ANOVA. A 2-way ANOVA with session as within-subject variable and group as between-subject variable was used to compare change scores for each visit between groups to ascertain if there were significant between-group differences in within-session changes for the experimental versus the control group. The ANOVA showed that for either group the 3 within-session change scores were not significantly different (P > 0.1). The 2-way ANOVA revealed significant differences between groups for both pain and neck mobility in within-session change scores (all, P < 0.001). Change scores in each session were superior in the experimental group as compared to those in the control group. The results suggest that patients receiving thoracic manipulation do not exhibit tolerance to repeated applications with regard to pain and mobility measures in acute mechanical neck pain. Further studies should investigate the dose-response relationship of thoracic thrust manipulation in this population.

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

“…In our study, PPT was assessed bilaterally over the C5-6 zygapophyseal joint, lateral epicondyle, and tibialis anterior muscle, as previously described. [18][19][20][21]46 Although no study has focused on the reliability of PPT over these specific regions, previous studies have determined its reliability to be high (ICC = 0.89-0.92) for PPT measurements at these locations.…”

“…Although the thoracic thrust manipulation focused on segments T1 to T4, no specific segment was targeted with respect to the application of the thoracic spine thrust manipulation, similar to previous studies. 20,38 …”

Analysis of Thoracic Spine Thrust Manipulation for Reducing Neck Pain

“…In a comparative study carried out by Fernandez-delas-Penas et al 19) , a control group received five sessions of electrothermal therapy, and an experimental group received both electrothermal therapy and thoracic manipulation. The groups submitted to manipulation achieved lower pain scores in the first session (acute effect of manipulation: 25% reduction in pain) as well as after five sessions (63% accumulated reduction in pain), thereby demonstrating the efficacy of this technique in both the short and long terms.…”

“…Another form of measurement of pain is the patient's visual analogue pain scale (VAS). According to Cleland et al 18) and Fernandes-de-las-penas et al 19) , the VAS is a reliable and valid instrument to assess pain intensity and was selected as the outcome measure based on its ability to detect immediate changes in pain.…”

The effect of kinesiology tape on pain and neck range of motion after cervical manipulation

“…4 Few investigators have reported that neck pain remained unchanged or increased immediately following cervical manipulation. 5,6 Further, neck pain has been inversely related to neck ROM. 7 …”