title: Changes in neck pain and active range of motion after a single thoracic spine manipulation in subjects presenting with mechanical neck pain: a case series.
abstract: OBJECTIVE
  Our aim was to report changes in neck pain at rest, active cervical range of motion, and neck pain at end-range of cervical motion after a single thoracic spine manipulation in a case series of patients with mechanical neck pain.
  
  
  METHODS
  Seven patients with mechanical neck pain (2 men, 5 women), 20 to 33 years old, were included. All patients received a single thoracic manipulation by an experienced manipulative therapist. The outcome measures of these cases series were neck pain at rest, as measured by a numerical pain rating scale; active cervical range of motion; and neck pain at the end of each neck motion (eg, flexion or extension). These outcomes were assessed pre treatment, 5 minutes post manipulation, and 48 hours after the intervention. A repeated-measures analysis was made with parametric tests. Within-group effect sizes were calculated using Cohen d coefficients.
  
  
  RESULTS
  A significant (P < .001) decrease, with large within-group effect sizes (d > 1), in neck pain at rest were found after the thoracic spinal manipulation. A trend toward an increase in all cervical motions (flexion, extension, right or left lateral flexion, and right or left rotation) and a trend toward a decrease in neck pain at the end of each cervical motion were also found, although differences did not reach the significance (P > .05). Nevertheless, medium to large within-group effect sizes (0.5 < d < 1) were found between preintervention data and both postintervention assessments in both active range of motion and neck pain at the end of each neck motion.
  
  
  CONCLUSIONS
  The present results demonstrated a clinically significant reduction in pain at rest in subjects with mechanical neck pain immediately and 48 hours following a thoracic manipulation. Although increases in all tested ranges of motion were obtained, none of them reached statistical significance at either posttreatment point. The same was found for pain at the end of range of motion for all tested ranges, with the exception of pain at the end of forward flexion at 48 hours. More than one mechanism likely explains the effects of thoracic spinal manipulation. Future controlled studies comparing spinal manipulation vs spinal mobilization of the thoracic spine are required.
authors.affiliation: Escuela de Osteopatía de Madrid, Madrid, Spain. cesarfdlp@yahoo.es <cesarfdlp@yahoo.es>
authors.forename: César
authors.initials: C
authors.lastname: Fernández-de-las-Peñas
authors.forename: Luis
authors.initials: L
authors.lastname: Palomeque-del-Cerro
authors.forename: Cleofás
authors.initials: C
authors.lastname: Rodríguez-Blanco
authors.forename: Antonia
authors.initials: A
authors.lastname: Gómez-Conesa
authors.forename: Juan C
authors.initials: JC
authors.lastname: Miangolarra-Page
mesh_terms: D000328:Adult; D002574:Cervical Vertebrae / Q000503:physiopathology; D002908:Chronic Disease; D005260:Female; D006801:Humans; D008297:Male; D020393:Manipulation, Spinal / Q000379:methods*; D019547:Neck Pain / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D010147:Pain Measurement; D016059:Range of Motion, Articular; D013904:Thoracic Vertebrae; D016896:Treatment Outcome