Study: NCT02415660

Intervention type: PROCEDURE
Group type: SHAM_COMPARATOR
Intervention: Thoracic spinal manipulation
Description: All patients will receive 3 different thrust joint manipulations to the middle and upper thoracic spine region. Each technique will be applied up to 2 times, per the discretion of the treating therapist discretion

Intervention type: PROCEDURE
Group type: EXPERIMENTAL
Intervention: Thoracic spinal manipulation
Description: All patients will receive 3 different thrust joint manipulations to the middle and upper thoracic spine region. Each technique will be applied up to 2 times, per the discretion of the treating therapist discretion

Intervention type: PROCEDURE
Group type: EXPERIMENTAL
Intervention: Trigger point dry needling
Description: The TDN treatment will consist of a trained investigator inserting a needle through the participant's skin, into the deep cervical extensor muscles and/or the upper trapezius muscles using FDA approved (FDA regulation # 880.5580) disposable 0.2-0.3 x 40-50 mm stainless steel Seirin J-type needles (Seirin, Japan). Those subjects randomized to TDN will undergo this treatment.

Intervention type: BEHAVIORAL
Group type: SHAM_COMPARATOR
Intervention: Cervical range of motion exercises
Description: The patient will be instructed to place 5 fingers along the manubrium, and to flex the neck down until the chin touches the fingers. The patient will then be instructed to rotate the head as far as comfortably possible to one side, and then to the other side for 10 repetitions to each side, 3-4 times per day. The patient will progress from 5 fingers, to 4, 3, 2 and eventually 1 finger as neck mobility improves.

Intervention type: BEHAVIORAL
Group type: EXPERIMENTAL
Intervention: Cervical range of motion exercises
Description: The patient will be instructed to place 5 fingers along the manubrium, and to flex the neck down until the chin touches the fingers. The patient will then be instructed to rotate the head as far as comfortably possible to one side, and then to the other side for 10 repetitions to each side, 3-4 times per day. The patient will progress from 5 fingers, to 4, 3, 2 and eventually 1 finger as neck mobility improves.

Intervention type: BEHAVIORAL
Group type: SHAM_COMPARATOR
Intervention: Posterior neck muscle activation exercise
Description: The patient will be instructed to sit upright in a chair, and place 1-2 fingers over the C2 spinous process. Education to localize this landmark will be provided. The patient will then perform an isometric chin tuck exercise against the resistance they will apply at C2. This position will be held x 5 seconds and repeated 10 times, 3-4 times per day.

Intervention type: BEHAVIORAL
Group type: EXPERIMENTAL
Intervention: Posterior neck muscle activation exercise
Description: The patient will be instructed to sit upright in a chair, and place 1-2 fingers over the C2 spinous process. Education to localize this landmark will be provided. The patient will then perform an isometric chin tuck exercise against the resistance they will apply at C2. This position will be held x 5 seconds and repeated 10 times, 3-4 times per day.

Intervention type: PROCEDURE
Group type: SHAM_COMPARATOR
Intervention: Trigger point dry needling sham
Description: The sham group will receive a simulated TDN. Using a toothpick in a needle guide-tube, the investigator will tap, rest, and twist the toothpick for approximately 30 seconds in the same 2 muscles, 2 sites in each muscle. The sham treatment will not penetrate the skin.

Intervention type: DEVICE
Group type: EXPERIMENTAL
Intervention: Seirin J-type stainless steel needles, 0-2-0.3 x 40-50 mm
Description: A trained investigator will insert the needle through the participants skin into the deep cervical extensors and/or the upper trapezius muscles. Needles are FDA approved (#880.5580)