title: Short-term combined effects of thoracic spine thrust manipulation and cervical spine nonthrust manipulation in individuals with mechanical neck pain: a randomized clinical trial.
abstract: METHODS
  Randomized clinical trial.
  
  
  OBJECTIVE
  To investigate the short-term effects of thoracic spine thrust manipulation combined with cervical spine nonthrust manipulation (experimental group) versus cervical spine nonthrust manipulation alone (comparison group) in individuals with mechanical neck pain.
  
  
  BACKGROUND
  Research has demonstrated improved outcomes with both nonthrust manipulation directed at the cervical spine and thrust manipulation directed at the thoracic spine in patients with neck pain. Previous studies have not determined if thoracic spine thrust manipulation may increase benefits beyond those provided by cervical nonthrust manipulation alone.
  
  
  METHODS
  Sixty-four participants with mechanical neck pain were randomized into 1 of 2 groups, an experimental or comparison group. Both groups received 2 treatment sessions of cervical spine nonthrust manipulation and a home exercise program consisting of active range-of-motion exercises, and the experimental group received additional thoracic spine thrust manipulations. Outcome measures were collected at baseline and at a 1-week follow-up, and included the numeric pain rating scale, the Neck Disability Index, and the global rating of change.
  
  
  RESULTS
  Participants in the experimental group demonstrated significantly greater improvements (P<.001) on both the numeric pain rating scale and Neck Disability Index at the 1-week follow-up compared to those in the comparison group. In addition, 31 of 33 (94%) participants in the experimental group, compared to 11 of 31 participants (35%) in the comparison group, indicated a global rating of change score of +4 or higher at the 1-week follow-up, with an associated number needed to treat of 2.
  
  
  CONCLUSIONS
  Individuals with neck pain who received a combination of thoracic spine thrust manipulation and cervical spine nonthrust manipulation plus exercise demonstrated better overall short-term outcomes on the numeric pain rating scale, the Neck Disability Index, and the global rating of change.
authors.affiliation: 　Department of Physical Therapy, School of Health Professions, Long Island University, Brooklyn, NY 11201, USA. 　michael.masaracchio@liu.edu
authors.forename: Michael
authors.initials: M
authors.lastname: Masaracchio
authors.forename: Joshua A
authors.initials: JA
authors.lastname: Cleland
authors.forename: Madeleine
authors.initials: M
authors.lastname: Hellman
authors.forename: Marshall
authors.initials: M
authors.lastname: Hagins
mesh_terms: D000293:Adolescent; D000328:Adult; D002574:Cervical Vertebrae / Q000503:physiopathology*; 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* / Q000628:therapy; D010147:Pain Measurement; D016059:Range of Motion, Articular / Q000502:physiology*; D012720:Severity of Illness Index; D013904:Thoracic Vertebrae / Q000503:physiopathology*; D016896:Treatment Outcome; D055815:Young Adult