title: Thoracic manipulation versus mobilization in patients with mechanical neck pain: a systematic review.
abstract: OBJECTIVE
  Thoracic manipulation is widely used in physical therapy and has been shown to be effective at addressing mechanical neck pain. However, thoracic mobilization may produce similar effects. The purpose of this systematic review was to evaluate the current literature regarding the effectiveness of thoracic manipulation versus mobilization in patients with mechanical neck pain.
  
  
  METHODS
  ProQuest, NCBI-PubMed, APTA's Hooked on Evidence, Cochrane Library, CINAHL and SPORTDiscus were searched to identify relevant studies. Fourteen studies meeting the inclusion criteria were analyzed using the Physiotherapy Evidence Database (PEDro) scale and the GRADE approach.
  
  
  RESULTS
  The literature as assessed by the PEDro scale was fair and the GRADE method showed overall quality ranging from very low to moderate quality. The 14 included studies showed positive outcomes on cervical pain levels, range of motion, and/or disability with the use of thoracic manipulation or mobilization. There was a paucity of literature directly comparing thoracic manipulation and mobilization.
  
  
  CONCLUSIONS
  Current limitations in the body of research, specifically regarding the use of thoracic mobilization, limit the recommendation of its use compared to thoracic manipulation for patients with mechanical neck pain. There is, however, a significant amount of evidence, although of varied quality, for the short-term benefits of thoracic manipulation in treating patients with this condition. Further high quality research is necessary to determine which technique is more effective in treating patients with mechanical neck pain.
authors.affiliation: Franklin Pierce University, Goodyear, AZ, USA.
authors.forename: Jodi L
authors.initials: JL
authors.lastname: Young
authors.affiliation: Franklin Pierce University, Goodyear, AZ, USA.
authors.forename: Doug
authors.initials: D
authors.lastname: Walker
authors.affiliation: Franklin Pierce University, Goodyear, AZ, USA.
authors.forename: Shane
authors.initials: S
authors.lastname: Snyder
authors.affiliation: Franklin Pierce University, Goodyear, AZ, USA.
authors.forename: Kelly
authors.initials: K
authors.lastname: Daly
keywords: Manipulation; Mechanical neck pain; Mobilization; Systematic review; Thoracic