title: Thoracic spine manipulation for the management of patients with neck pain: a randomized clinical trial.
abstract: METHODS
  Randomized clinical trial.
  
  
  OBJECTIVE
  To investigate if patients with mechanical neck pain receiving thoracic spine thrust manipulation would experience superior outcomes compared to a group not receiving thrust manipulation.
  
  
  BACKGROUND
  Evidence has begun to emerge in support of thoracic thrust manipulation as an intervention n the management of mechanical neck pain. However, to make a strong recommendation for a clinical technique it is necessary to have multiple studies with convergent findings.
  
  
  METHODS
  Forty-five patients (21 females) were randomly assigned to 1 of 2 groups: a control group, which received electro-thermal therapy for 5 treatment sessions, and the experimental group, which received the same electro/thermal therapy program in addition to a thoracic spine thrust manipulation once a week for 3 consecutive weeks. Mixed-model analyses of variance (ANOVAs) were used to examine the effects of treatment on pain (100-mm visual analogue scale), disability (100-point disability scale), and cervical range of motion, with group as the between-subjects variable and time as the within-subjects variable. The primary analysis was the group-by-time interaction for pain.
  
  
  RESULTS
  The group-by-time interaction effects for the ANOVA models were statistically significant for pain, mobility, and disability (P< .05), indicating greater improvements in the manipulation group for all the outcome measures. Patients receiving thoracic manipulation experienced greater improvements in pain at the fifth (final) treatment session and at the 2-week and 4-week follow-up periods (P< .001), with pain improvement scores in the manipulation group of 16.8 mm and 26.6 mm greater than those in the comparison group at the 2- and 4-week follow-up periods, respectively. The experimental group also experienced significantly greater improvements in disability with a between-group difference of 8.8 points (95% confidence interval [CI]: 7.5, 10.1; P< .001) at the fifth visit and 8.0 points (95% CI: 5.8, 10.2; P< .001) at the 2-week follow-up.
  
  
  CONCLUSIONS
  The results of our study suggest that thoracic spine thrust manipulation results in superior clinical benefits that persist beyond the 1-mont follow-up period for patients with acute neck pain. Future studies should continue to investigate the effects of thoracic spine thrust manipulation, as compared to other physical therapy interventions, in a population with mechanical neck pain.
authors.affiliation: Centro de Fisioterapia Integral, Candas, Asturias, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: González-Iglesias
authors.forename: Cesar
authors.initials: C
authors.lastname: Fernández-de-las-Peñas
authors.forename: Joshua A
authors.initials: JA
authors.lastname: Cleland
authors.forename: Maria del Rosario
authors.initials: Mdel R
authors.lastname: Gutiérrez-Vega
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D005260:Female; D006801:Humans; D008297:Male; D020393:Manipulation, Spinal / Q000379:methods*; D019547:Neck Pain / Q000503:physiopathology / Q000534:rehabilitation / Q000628:therapy*; D010147:Pain Measurement; D011446:Prospective Studies; D016059:Range of Motion, Articular; D013904:Thoracic Vertebrae / Q000473:pathology*