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19-09-2011 | Hospice medicine | Article

Thoracic spine thrust manipulation reduces mechanical neck pain


Free abstract

MedWire News: Thoracic spine thrust manipulation improves pain, range of motion, and self-reported function in patients with mechanical neck pain, indicate results of a systematic review.

The reduction in pain occurred immediately, note the authors, and persisted up to 6 months.

Neck pain is "a common musculoskeletal condition with a 12-month prevalence among the general and work force populations of 30% to 50%," explain Kevin Cross (UVA-Healthsouth, Charlottesville, USA) and team.

While treatment for patients classified with mechanical neck pain has been investigated, there is no consensus within the literature on a gold standard for treatment, they add.

The researchers therefore analyzed data from six randomized controlled trials to evaluate the effects of thoracic spine thrust manipulation on pain, cervical range of motion (ROM) and patient self-reported function in patients with mechanical neck pain.

Each of the included studies reported the use of one or more nonspecific thoracic spine thrust manipulation techniques, performed in either a supine or sitting position.

Cross and co-authors say that the effect size point estimates for the change in global pain scores were significant across all studies, ranging from 0.38 to 4.03. However, for the change in pain at the end of active left and right cervical rotation the effect size point estimates were generally smaller, ranging from 0.02 to 1.79. This indicates that "conclusive treatment effects on pain at the end range of cervical rotation were not present," they say.

The average mean improvement for cervical flexion and extension ranged from 8.1° to 12.0° and 7.0° to 11.4°, respectively, while the mean cervical rotation improvements varied from 7.7° to 12.5°. The effect size point estimates for ROM change scores were large, varying from 1.39 to 3.23.

Self-reported functional outcome measures, as assessed by the Neck Disability Index and the Northwick Park Neck Pain Questionnaire, were moderate to large, varying from 0.47 to 3.64.

"The results of this systematic review indicate that thoracic spine thrust manipulation may be utilized in the management of acute or subacute mechanical neck pain to reduce pain, improve cervical ROM, and improve function," the team concludes in the Journal of Orthopaedic and Sports Physical Therapy.

However, the researchers caution that although the individual randomized controlled trials were of high quality, "the overall body of literature had significant flaws that limit the generalizability of the results."

They suggest that "future research should establish treatment parameters that include short- and long-term effects, as well as compare treatment effectiveness to interventions directed at the cervical spine."

By Nikki Withers

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