title: Thoracic spine thrust manipulation versus cervical spine thrust manipulation in patients with acute neck pain: a randomized clinical trial.
abstract: METHODS
  Randomized clinical trial.
  
  
  OBJECTIVE
  To determine if patients who met the clinical prediction rule (CPR) criteria for the success of thoracic spine thrust joint manipulation (TJM) for the treatment of neck pain would have a different outcome if they were treated with a cervical spine TJM.
  
  
  BACKGROUND
  A CPR had been proposed to identify patients with neck pain who would likely respond favorably to thoracic spine TJM. Research on validation of that CPR had not been completed when this trial was initiated. In our clinical experience, though many patients with neck pain responded favorably to thoracic spine TJM, they often reported that their symptomatic cervical spine area had not been adequately addressed.
  
  
  METHODS
  Twenty-four consecutive patients, who presented to physical therapy with a primary complaint of neck pain and met 4 out of 6 of the CPR criteria for thoracic TJM, were randomly assigned to 1 of 2 treatment groups. The thoracic group received thoracic TJM and a cervical range-of-motion (ROM) exercise for the first 2 sessions, followed by a standardized exercise program for an additional 3 sessions. The cervical group received cervical TJM and the same cervical ROM exercise for the first 2 sessions, and the same exercise program given to the thoracic group for the next 3 sessions. Outcome measures collected at 1 week, 4 weeks, and 6 months from start of treatment included the Neck Disability Index, numeric pain rating scale, and Fear-Avoidance Beliefs Questionnaire.
  
  
  RESULTS
  Patients who received cervical TJM demonstrated greater improvements in Neck Disability Index (P ≤.001) and numeric pain rating scale (P ≤.003) scores at all follow-up times. There was also a statistically significant improvement in the Fear-Avoidance Beliefs Questionnaire physical activity subscale score at all follow-up times for the cervical group (P ≤.004). The number needed to treat to avoid an unsuccessful overall outcome was 1.8 at 1 week, 1.6 at 4 weeks, and 1.6 at 6 months.
  
  
  CONCLUSIONS
  Patients with neck pain who met 4 of 6 of the CPR criteria for successful treatment of neck pain with a thoracic spine TJM demonstrated a more favorable response when the TJM was directed to the cervical spine rather than the thoracic spine. Patients receiving cervical TJM also demonstrated fewer transient side-effects.
  
  
  METHODS
  Therapy, level 1b.
authors.affiliation: Department of Physical Therapy, University of Nevada, Las Vegas, NV, USA.
authors.forename: Emilio J
authors.initials: EJ
authors.lastname: Puentedura
authors.forename: Merrill R
authors.initials: MR
authors.lastname: Landers
authors.forename: Joshua A
authors.initials: JA
authors.lastname: Cleland
authors.forename: Paul E
authors.initials: PE
authors.lastname: Mintken
authors.forename: Peter
authors.initials: P
authors.lastname: Huijbregts
authors.forename: César
authors.initials: C
authors.lastname: Fernández-de-Las-Peñas
mesh_terms: D000208:Acute Disease; D000328:Adult; D000704:Analysis of Variance; D002574:Cervical Vertebrae; D004185:Disability Evaluation; D005081:Exercise Therapy / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D020393:Manipulation, Spinal / Q000379:methods*; D008875:Middle Aged; D019547:Neck Pain / Q000534:rehabilitation*; D010147:Pain Measurement; D016059:Range of Motion, Articular; D011795:Surveys and Questionnaires; D013904:Thoracic Vertebrae; D016896:Treatment Outcome