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09-01-2012 | General practice | Article

Upper back, neck manipulation technique effective in patients with neck pain


Free abstract

MedWire News: A combination of upper cervical and upper thoracic high-velocity low-amplitude (HVLA) thoracic thrust manipulation may be more effective than nonthrust mobilization in patients with neck pain, suggest study findings.

The US researchers report that a single session of HVLA thrust manipulation, directed to both the upper cervical (C1-2) and thoracic (T1-2) spine, resulted in greater improvements in disability, pain, atlantoaxial joint range-of-motion (ROM), and motor performance of the deep cervical flexor muscles than nonthrust mobilization directed to the same regions.

James Dunning (Nova Southeastern University, Fort Lauderdale, Florida) and co-investigators randomly assigned 107 patients with neck pain to receive either 1 hour of HVLA thrust manipulation (n=56) or nonthrust mobilization (n=51) to the upper cervical and upper thoracic spine.

Patients were included if they presented with a primary complaint of neck pain, were aged between 18 and 70 years, and had a Neck Disability Index (NDI) score of 20% or more (≥10 points on a 0-50 scale) at baseline.

All participants completed the NDI, numeric pain rating scale, flexion-rotation test for measurement of C1-2 passive rotation ROM, and the craniocervical flexion test for measurement of deep cervical flexor motor performance at baseline and 48 hours post-treatment.

As reported in the Journal of Orthopaedic and Sports Physical Therapy, patients who received the combination of upper cervical and thoracic HVLA thrust manipulation experienced a 58% decrease in pain and a 50% decrease in disability at 48 hours.

By contrast, patients who received the nonthrust mobilization treatment only had a 13% decrease in pain and showed a 13% increase in disability.

The differences between the two groups were statistically significant.

Furthermore, the HVLA thrust manipulation group had a significantly greater improvement in both passive C1-2 rotation ROM and motor performance of the deep cervical flexor muscles compared with the group receiving nonthrust mobilization.

These findings suggest that "the combination of HVLA thrust manipulation procedures directed to both the upper cervical and upper thoracic articulations may enhance the overall outcomes of patients with mechanical neck pain," write Dunning et al.

However, they note that they only examined the short-term follow-up, and therefore caution that it is "not known if the benefits of HVLA thrust manipulation would be maintained in the long term."

They conclude that future studies should "examine the effectiveness of different types and dosages of manual therapy and include long-term follow-up data collection."

By Nikki Withers

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