title: Immediate changes in neck pain intensity and widespread pressure pain sensitivity in patients with bilateral chronic mechanical neck pain: a randomized controlled trial of thoracic thrust manipulation vs non-thrust mobilization.
abstract: OBJECTIVE
  The purpose of this study was to compare the effects of thoracic thrust manipulation vs thoracic non-thrust mobilization in patients with bilateral chronic mechanical neck pain on pressure pain sensitivity and neck pain intensity.
  
  
  METHODS
  Fifty-two patients (58% were female) were randomly assigned to a thoracic spine thrust manipulation group or of thoracic non-thrust mobilization group. Pressure pain thresholds (PPTs) over C5-C6 zygapophyseal joint, second metacarpal, and tibialis anterior muscle and neck pain intensity (11-point Numerical Pain Rate Scale) were collected at baseline and 10 minutes after the intervention by an assessor blinded to group allocation. Mixed-model analyses of variance (ANOVAs) were used to examine the effects of the treatment on each outcome. The primary analysis was the group * time interaction.
  
  
  RESULTS
  No significant interactions were found with the mixed-model ANOVAs for any PPT (C5-C6: P>.252; second metacarpal: P>.452; tibialis anterior: P>.273): both groups exhibited similar increases in PPT (all, P<.01), but within-group and between-group effect sizes were small (standardized mean score difference [SMD]<0.22). The ANOVA found that patients receiving thoracic spine thrust manipulation experienced a greater decrease in neck pain (between-group mean difference: 1.4; 95% confidence interval, 0.8-2.1) than did those receiving thoracic spine non-thrust mobilization (P<.001). Within-group effect sizes were large for both groups (SMD>2.1), and between-group effect size was also large (SMD = 1.3) in favor of the manipulative group.
  
  
  CONCLUSIONS
  The results of this randomized clinical trial suggest that thoracic thrust manipulation and non-thrust mobilization induce similar changes in widespread PPT in individuals with mechanical neck pain; however, the changes were clinically small. We also found that thoracic thrust manipulation was more effective than thoracic non-thrust mobilization for decreasing intensity of neck pain for patients with bilateral chronic mechanical neck pain.
authors.affiliation: Professor, Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, Alcorcón, Spain.
authors.forename: Jaime
authors.initials: J
authors.lastname: Salom-Moreno
authors.affiliation: Professor, Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, Alcorcón, Spain.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Ortega-Santiago
authors.affiliation: Professor, Department of Physical Therapy, Rehabilitation Services, Concord Hospital, Concord, NH.
authors.forename: Joshua Aland
authors.initials: JA
authors.lastname: Cleland
authors.affiliation: Clinical Researcher, Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, Alcorcón, Spain.
authors.forename: Maria
authors.initials: M
authors.lastname: Palacios-Ceña
authors.affiliation: Professor, Department of Physical Therapy, Universidad Camilo José Cela, Madrid, Spain.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Truyols-Domínguez
authors.affiliation: Professor, Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, Alcorcón, Spain. Electronic address: cesar.fernandez@urjc.es.
authors.forename: César
authors.initials: C
authors.lastname: Fernández-de-las-Peñas
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D005260:Female; D006801:Humans; D008297:Male; D020393:Manipulation, Spinal / Q000379:methods*; D019547:Neck Pain / Q000628:therapy*; D010147:Pain Measurement; D017288:Pain Threshold; D016037:Single-Blind Method; D013904:Thoracic Vertebrae
keywords: Manual Therapy; Neck Pain; Pressure; Spine