Short-Term Response of Thoracic Spine Manipulation With or Without Trigger Point Dry Needling for Mechanical Neck Pain
Condition: Neck Pain
MeSH terms: Neck Pain
Study type: Interventional

Summary: 
      This study will assess the short term response of thoracic spinal manipulation with or
      without trigger point dry needling in 58 subjects with a primary complaint of mechanical neck
      pain.
    

Detailed description: 
      Neck pain is common, and return to duty rates after medical evacuation from theater for
      spinal pain is low. Muscles comprise the majority of the stability for the cervical spine,
      yet neck muscle function can be altered in the presence of pain. Research has consistently
      shown the benefit of including thoracic spine manipulation (SMT) in the treatment of patients
      with mechanical neck pain. Emerging evidence is now also showing promising benefit of
      including trigger point dry needling (TDN) for the treatment of mechanical neck pain.
      Treatment regimens commonly address anterior cervical stabilizing musculature, but little is
      known regarding the response to treatment of the deep posterior stabilizing musculature.

      This study will assess the short term response of thoracic SMT with or without TDN in 58
      subjects with a primary complaint of mechanical neck pain. Subjects will be randomized to
      receive 2 treatment visits approximately 2-3 days apart of either SMT+sham TDN or SMT+TDN.
      TDN will be directed to the upper trapezius and deep cervical extensor muscles of the neck.
      Outcomes of interest will be changes in function and pain. Assessments will be made at
      baseline, immediately after the first treatment, at the 2nd treatment, and approximately 5-7
      days after the 2nd treatment visit. A subgroup of 20 subjects (10 per group) will also have
      the upper trapezius and deep cervical extensor muscle activation assessed via shear wave
      elastography, and deep cervical flexor activation assessed via the craniocervical flexion
      test.
    

Intervention name(s): Thoracic spinal manipulation; Trigger point dry needling; Cervical range of motion exercises; Posterior neck muscle activation exercise; Trigger point dry needling sham; Seirin J-type stainless steel needles, 0-2-0.3 x 40-50 mm
Intervention type(s): Procedure; Procedure; Behavioral; Behavioral; Procedure; Device
Intervention description(s): 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; 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.; 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.; 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.; 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.; 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)
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Investigator)
Primary purpose: Treatment
Keywords: trigger point dry needling; thoracic spine manipulation; deep cervical extensor muscle; deep cervical flexor muscle; shear wave elastography