title: Effect of cervical vs. thoracic spinal manipulation on peripheral neural features and grip strength in subjects with chronic mechanical neck pain: a randomized controlled trial.
abstract: BACKGROUND
  Cervical and thoracic spinal manipulative therapy has shown positive impact for relief of pain and improve function in non-specific mechanical neck pain. Several attempts have been made to compare their effectiveness although previous studies lacked a control group, assessed acute neck pain or combined thrust and non-thrust techniques.
  
  
  OBJECTIVE
  To compare the immediate effects of cervical and thoracic spinal thrust manipulations on mechanosensitivity of upper limb nerve trunks and grip strength in patients with chronic non-specific mechanical neck pain.
  
  
  METHODS
  Randomized, single-blinded, controlled clinical trial.
  
  
  METHODS
  Private physiotherapy clinical consultancy.
  
  
  METHODS
  Eighty-eight subjects (32.09±6.05 years; 72.7% females) suffering neck pain (grades I or II) of at least 12 weeks of duration.
  
  
  METHODS
  Participants were distributed into three groups: 1) cervical group (N.=28); 2) thoracic group (N.=30); and 3) control group (N.=30). One treatment session consisting of applying a high-velocity low-amplitude spinal thrust technique over the lower cervical spine (C7) or the upper thoracic spine (T3) was performed, while the control group received a sham-manual contact. Measurements were taken at baseline and after intervention of the pressure pain threshold over the median, ulnar and radial nerves. Secondary measures included assessing free-pain grip strength with a hydraulic dynamometer.
  
  
  RESULTS
  No statistically significant differences were observed when comparing between-groups in any of the outcome measures (P>0.05). Those who received thrust techniques, regardless of the manipulated area, reported an immediate increase in mechanosensitivity over the radial (both sides) and left ulnar nerve trunks (P<0.05), and grip strength (P<0.001). For those in the control group, right hand grip strength and pain perception over the radial nerve also improved (P≤0.025).
  
  
  CONCLUSIONS
  Low-cervical and upper-thoracic thrust manipulation is no more effective than placebo to induce immediate changes on mechanosensitivity of upper limb nerve trunks and grip strength in patients with chronic non-specific mechanical neck pain.
  
  
  CONCLUSIONS
  A single treatment session using cervical or thoracic thrust techniques is not enough to achieve clinically relevant changes on neural mechanosensitivity and grip strength in chronic non-specific mechanical neck pain.
authors.affiliation: Department of Physical Therapy, European University, Valencia, Spain.|Madrid Osteopathic School, Madrid, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Bautista-Aguirre
authors.affiliation: Department of Physiotherapy, Faculty of Nursing, Physiotherapy and Podology, University of Sevilla, Sevilla, Spain - angeloliva@us.es.
authors.forename: Ángel
authors.initials: Á
authors.lastname: Oliva-Pascual-Vaca
authors.affiliation: Department of Physiotherapy, Faculty of Nursing, Physiotherapy and Podology, University of Sevilla, Sevilla, Spain.
authors.forename: Alberto M
authors.initials: AM
authors.lastname: Heredia-Rizo
authors.affiliation: Madrid Osteopathic School, Madrid, Spain.
authors.forename: Juan J
authors.initials: JJ
authors.lastname: Boscá-Gandía
authors.affiliation: Madrid Osteopathic School, Madrid, Spain.
authors.forename: François
authors.initials: F
authors.lastname: Ricard
authors.affiliation: Department of Physiotherapy, Faculty of Nursing, Physiotherapy and Podology, University of Sevilla, Sevilla, Spain.
authors.forename: Cleofás
authors.initials: C
authors.lastname: Rodriguez-Blanco
mesh_terms: D000328:Adult; D002574:Cervical Vertebrae; D059350:Chronic Pain / Q000628:therapy*; D005260:Female; D018737:Hand Strength / Q000502:physiology; D006801:Humans; D008297:Male; D008349:Manipulation, Orthopedic / Q000379:methods*; D020393:Manipulation, Spinal / Q000379:methods*; D019547:Neck Pain / Q000628:therapy*; D010147:Pain Measurement; D016059:Range of Motion, Articular; D016037:Single-Blind Method; D013904:Thoracic Vertebrae