title: Examination of motor and hypoalgesic effects of cervical vs thoracic spine manipulation in patients with lateral epicondylalgia: a clinical trial.
abstract: OBJECTIVE
  The purpose of this study was to compare the effects of a cervical vs thoracic spine manipulation on pressure pain threshold (PPT) and pain-free grip strength in patients with lateral epicondylalgia (LE).
  
  
  METHODS
  A single-blind randomized clinical trial was completed with 18 participants with LE. Each subject attended 1 experimental session. Participants were randomized to receive either a cervical or thoracic spine manipulation. Pressure pain threshold over the lateral epicondyle of both elbows pain-free grip strength on the affected arm and maximum grip force on the unaffected side were assessed preintervention and 5 minutes postintervention by an examiner blind to group assignment. A 3-way analysis of variance with time and side as within-subject variable and intervention as between-subject variable was used to evaluate changes in PPT and pain-free grip.
  
  
  RESULTS
  The analysis of variance detected a significant interaction between group and time (F = 31.7, P < .000) for PPT levels. Post hoc testing revealed that the cervical spine manipulation produced a greater increase of PPT in both sides compared with thoracic spine manipulation (P < .001). For pain-free grip strength, no interaction between group and time (F = .66, P = .42) existed.
  
  
  CONCLUSIONS
  Cervical spine manipulation produced greater changes in PPT than thoracic spine manipulation in patients with LE. No differences between groups were identified for pain-free grip. Future studies with larger sample sizes are required to further examine the effects of manipulation on mechanisms of pain and motor control in upper extremity conditions.
authors.affiliation: Physical Therapist and Professor, Deparment of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Rey Juan Carlos University, Alcorcón, Madrid, Spain. josue.fernandez@urjc.es
authors.forename: Josue
authors.initials: J
authors.lastname: Fernández-Carnero
authors.forename: Joshua A
authors.initials: JA
authors.lastname: Cleland
authors.forename: Roy La Touche
authors.initials: RL
authors.lastname: Arbizu
mesh_terms: D000328:Adult; D002574:Cervical Vertebrae; D005260:Female; D018737:Hand Strength / Q000502:physiology*; D006801:Humans; D008297:Male; D020393:Manipulation, Spinal; D008875:Middle Aged; D010147:Pain Measurement; D017288:Pain Threshold; D011312:Pressure; D016037:Single-Blind Method; D013716:Tennis Elbow / Q000503:physiopathology / Q000628:therapy*; D013904:Thoracic Vertebrae