title: Upper cervical and upper thoracic thrust manipulation versus nonthrust mobilization in patients with mechanical neck pain: a multicenter randomized clinical trial.
abstract: METHODS
  Randomized clinical trial.
  
  
  OBJECTIVE
  To compare the short-term effects of upper cervical and upper thoracic high-velocity low-amplitude (HVLA) thrust manipulation to nonthrust mobilization in patients with neck pain.
  
  
  BACKGROUND
  Although upper cervical and upper thoracic HVLA thrust manipulation and nonthrust mobilization are common interventions for the management of neck pain, no studies have directly compared the effects of both upper cervical and upper thoracic HVLA thrust manipulation to nonthrust mobilization in patients with neck pain.
  
  
  METHODS
  Patients completed the Neck Disability Index, the numeric pain rating scale, the flexion-rotation test for measurement of C1-2 passive rotation range of motion, and the craniocervical flexion test for measurement of deep cervical flexor motor performance. Following the baseline evaluation, patients were randomized to receive either HVLA thrust manipulation or nonthrust mobilization to the upper cervical (C1-2) and upper thoracic (T1-2) spines. Patients were reexamined 48-hours after the initial examination and again completed the outcome measures. The effects of treatment on disability, pain, C1-2 passive rotation range of motion, and motor performance of the deep cervical flexors were examined with a 2-by-2 mixed-model analysis of variance (ANOVA).
  
  
  RESULTS
  One hundred seven patients satisfied the eligibility criteria, agreed to participate, and were randomized into the HVLA thrust manipulation (n = 56) and nonthrust mobilization (n = 51) groups. The 2-by-2 ANOVA demonstrated that patients with mechanical neck pain who received the combination of upper cervical and upper thoracic HVLA thrust manipulation experienced significantly (P<.001) greater reductions in disability (50.5%) and pain (58.5%) than those of the nonthrust mobilization group (12.8% and 12.6%, respectively) following treatment. In addition, the HVLA thrust manipulation group had significantly (P<.001) greater improvement in both passive C1-2 rotation range of motion and motor performance of the deep cervical flexor muscles as compared to the group that received nonthrust mobilization. The number needed to treat to avoid an unsuccessful outcome was 1.8 and 2.3 at 48-hour follow-up, using the global rating of change and Neck Disability Index cut scores, respectively.
  
  
  CONCLUSIONS
  The combination of upper cervical and upper thoracic HVLA thrust manipulation is appreciably more effective in the short term than nonthrust mobilization in patients with mechanical neck pain.
  
  
  METHODS
  Therapy, level 1b.
authors: Alabama Physical Therapy & Acupuncture, Montgomery, AL, USA. jamesdunning@hotmail.com
authors: James R
authors: JR
authors: Dunning
authors: Joshua A
authors: JA
authors: Cleland
authors: Mark A
authors: MA
authors: Waldrop
authors: Cathy F
authors: CF
authors: Arnot
authors: Ian A
authors: IA
authors: Young
authors: Michael
authors: M
authors: Turner
authors: Gisli
authors: G
authors: Sigurdsson
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D002574:Cervical Vertebrae; D016001:Confidence Intervals; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D007103:Immobilization / Q000379:methods*; D008297:Male; D008349:Manipulation, Orthopedic / Q000379:methods*; D009333:Neck / Q000473:pathology*; D019547:Neck Pain / Q000534:rehabilitation*; D010147:Pain Measurement; D026741:Physical Therapy Modalities; D016059:Range of Motion, Articular; D057566:Self Report; D013223:Statistics as Topic; D011795:Surveys and Questionnaires; D013904:Thoracic Vertebrae; D013997:Time Factors; D016896:Treatment Outcome