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Short-Term Effects of Thrust Versus Nonthrust Mobilization/Manipulation Directed at the Thoracic Spine in Patients With Neck Pain: A Randomized Clinical Trial

JA Cleland, PT, DPT, PhD, OCS, FAAOMPT, is Assistant Professor, Department of Physical Therapy, Franklin Pierce College, 5 Chenell Dr, Concord, NH 03301 (USA); Research Coordinator, Rehabilitation Services, Concord Hospital, Concord, NH; and Faculty, Manual Physical Therapy Fellowship Program, Regis University, Denver, Colo.
P Glynn, PT, DPT, OCS, FAAOMPT, is Physical Therapy Clinical Specialist, Newton-Wellesley Hospital, Newton, Mass, and Fellow, Manual Physical Therapy Fellowship Program, Regis University.
JM Whitman, PT, DSc, OCS, FAAOMPT, is Assistant Faculty, Department of Physical Therapy, and Faculty, Manual Physical Therapy Fellowship Program, Regis University.
SL Eberhart, PT, MPT, is Physical Therapist and Clinical II, Rehabilitation Services, Concord Hospital.
C MacDonald, PT, DPT, GCS, OCS, FAAOMPT, is Physical Therapist, Centennial Physical Therapy, Colorado Sport and Spine Centers, Colorado Springs, Colo.
JD Childs, PT, PhD, MBA, OCS, FAAOMPT, is Assistant Professor and Director of Research, Doctoral Program in Physical Therapy, US Army-Baylor University, San Antonio, Tex.

joshcleland{at}comcast.net

Background and Purpose: Evidence supports the use of manual physical therapy interventions directed at the thoracic spine in patients with neck pain. The purpose of this study was to compare the effectiveness of thoracic spine thrust mobilization/manipulation with that of nonthrust mobilization/manipulation in patients with a primary complaint of mechanical neck pain. The authors also sought to compare the frequencies, durations, and types of side effects between the groups.

Subjects: The subjects in this study were 60 patients who were 18 to 60 years of age and had a primary complaint of neck pain.

Methods: For all subjects, a standardized history and a physical examination were obtained. Self-report outcome measures included the Neck Disability Index (NDI), a pain diagram, the Numeric Pain Rating Scale (NPRS), and the Fear-Avoidance Beliefs Questionnaire. After the baseline evaluation, the subjects were randomly assigned to receive either thoracic spine thrust or nonthrust mobilization/manipulation. The subjects were reexamined 2 to 4 days after the initial examination, and they again completed the NDI and the NPRS, as well as the Global Rating of Change (GROC) Scale. The primary aim was examined with a 2-way repeated-measures analysis of variance (ANOVA), with intervention group (thrust versus nonthrust mobilization/manipulation) as the between-subjects variable and time (baseline and 48 hours) as the within-subject variable. Separate ANOVAs were performed for each dependent variable: disability (NDI) and pain (NPRS). For each ANOVA, the hypothesis of interest was the 2-way group x time interaction.

Results: Sixty patients with a mean age of 43.3 years (SD=12.7) (55% female) satisfied the eligibility criteria and agreed to participate in the study. Subjects who received thrust mobilization/manipulation experienced greater reductions in disability, with a between-group difference of 10% (95% confidence interval [CI]=5.3±14.7), and in pain, with a between-group difference of 2.0 (95% CI=1.4±2.7). Subjects in the thrust mobilization/manipulation group exhibited significantly higher scores on the GROC Scale at the time of follow-up. No differences in the frequencies, durations, and types of side effects existed between the groups.

Discussion and Conclusion: The results suggest that thoracic spine thrust mobilization/manipulation results in significantly greater short-term reductions in pain and disability than does thoracic nonthrust mobilization/manipulation in people with neck pain.