Thoracic vs Cervical Spine Manipulation for Acute Neck Pain

Puentedura EJ et al. Thoracic spine thrust manipulation vs cervical spine thrust manipulation in pts with acute neck pain: A randomized clinical trial. JOSPT. April 2011

  • While treatment directed at the thoracic spine has demonstrated benefit and arguably has less risk associated with it, it may not completely address the symptoms and mobility impairments that pts present with. It is the authors’ contention that adding cervical thrust manipulation to a comprehensive treatment approach improves clinical outcomes.

  • In the thoracic thrust manipulation group, all pts received 3 different thrust manipulation techniques and were given a cervical ROM exercise, the 3-finger cervical rotation exercise as described by Richard Erhard. All patients were then instructed in a standardized exercise program consisting of cervical ROM and scapulothoracic resistance exercises.

  • For the cervical thrust manipulation group, cervical thrust manipulation was performed during the first 2 treatment sessions along with the prescription of the same 3-finger rotation exercise. For all manipulations in both groups, a max of two attempts per technique was allowed.

  • Outcome measures included NDI, NPRS and GROC and were taken at baseline, 1 week, 4 weeks, and 6 months

  • Only 1 pt in the cervical group reported a transient side-effect after the first treatment (increased neck pain) and none reported any after the second treatment. Conversely, 8 pts reported minor post-treatment side effects after the first treatment and 7 after the second.

  • The results of this study indicate that pts with neck pain who fit the CPR for thoracic spine thrust manipulation may benefit more from directed cervical spine thrust manipulation. Pts in the cervical manipulation group showed significantly greater improvements in all outcome measures and had fewer transient post-treatment side effects when compared to the thoracic spine thrust manipulation group.

  • The limitations in this study include sample size, the duration of symptoms in the cervical group, though a by-product of randomization, was still significantly shorter than in the thoracic group (11.7 vs 18.8 days) and that may partially account for the difference in outcomes observed between the two groups.

  • Overall, the authors conclude that in pts with acute neck pain (< 30 days), and who meet 4/6 of CPR criteria for thoracic manipulation, may benefit more from direct cervical spine thrust manipulation