Comparison of the Effectiveness of Mobilization and Manipulation of the Thoracic Spine in Patients With Mechanical Neck Pain
Condition: Neck Pain
MeSH terms: Neck Pain
Study type: Interventional
Phase: Phase 1

Summary: 
      This study aims to compare whether or not there is a difference in the effectiveness of upper
      back (thoracic spine) mobilizations versus manipulations used in a population of patients
      with mechanical neck pain. The investigators hypothesize that patients receiving a
      manipulative technique will experience better outcomes than patients receiving the
      mobilization techniques and these results will be evident at a 48-hour follow-up.
    

Detailed description: 
      Patients with mechanical neck pain who meet the study's inclusion criteria, who do not meet
      the study's exclusion criteria will be offered an opportunity to participate in this study.
      They will be issued an informed consent detailing the study and will have time to decide
      whether or not to participate. Once they have enlisted in the study they will complete forms
      to assess their current functional level. The investigator will then perform a standard
      clinical exam on the upper quarter to include a comprehensive subjective examination, upper
      extremity strength, reflexes, sensory assessment, cervical range of motion, thoracic range of
      motion and pain assessment. Once the above data have been collected and the patient has met
      the criteria for the study, a second investigator will then choose a randomized and sealed
      envelope which will indicate the treatment to be performed. The patient will either receive
      mobilization or manipulation to the thoracic spine. Mobilizations will be performed in prone
      over the spinous processes of T1-T6. Each one will be performed for 30 seconds each with
      force directed posterioanterior. The manipulation will be performed in supine with the
      patient's arms crossed over his/her chest. The therapist will pull the patient's arms
      downward to create spinal flexion down to the level where the manipulation will occur. The
      therapist's manipulative hand will stabilize the lower vertebrae of the motion segment and
      his/her body will be used to push down through the patient's arms to perform a high velocity,
      low amplitude thrust of the superior vertebrae. The manipulation will first be attempted in
      the upper thoracic spine; if a cavitation is heard on the first attempt he/she will move onto
      the middle thoracic area. If a cavitation is not heard he/she will attempt a second time
      before moving on to the next area. Both areas will receive a maximum of two attempts. Once
      the manipulation or mobilization is performed the patient will be assigned one home exercise
      which includes rotation of the cervical spine in both directions for 10 reps, 3-4 times per
      day. The patient will return within 48 hours for final data collection which will include a
      global rating of change scale completed both by the therapist and the patient, pain diagram
      and scale, neck disability index, cervical and thoracic range of motion measurements, and a
      side effects questionnaire. The patient will then be discharged from the study and will
      continue with physical therapy as deemed appropriate at the time of examination.
    

Intervention name(s): spine mobilizations; spine manipulations
Intervention type(s): Procedure; Procedure
Allocation: Randomized
Intervention model: Single Group Assignment
Masking: Single
Primary purpose: Treatment
Keywords: Manipulation; Mobilization; Neck Pain; Physical Therapy