A Comparison of Two Thoracic Manipulation Techniques to Improve Neck Pain

Study Overview
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Brief Summary
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The purpose of this study is to compare the short-term effects of two different thoracic spine thrust manipulation techniques on neck range-of-motion, pain, and self-reported disability in individuals experiencing neck pain.

Detailed Description
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The study will be conducted at the Musculoskeletal clinical facility in the Dept. of Physical Therapy and Athletic Training, Northern Arizona University, Flagstaff AZ. The investigators aim to test a maximum of 76 participants in this study. A phone screening will determine initial eligibility. If the participant meets the inclusion criteria and is not excluded after the phone screen, an appointment will be scheduled. Final eligibility will be determined in the initial session after the participant completes the outcome measures and is evaluated by a licensed physical therapist. Participants will be involved in the study over a 4 week period. Each participant will be asked to attend 4 sessions, with one week in between each session as follows: Week 0 = baseline assessment and treatment 1; Week 1= treatment 2; Week 2 = treatment 3; and week 4 = follow-up assessment. After completion of the baseline assessment, qualified participants will be randomly assigned to either a supine or prone thoracic spine thrust manipulation intervention.

Official Title
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A Comparison of Two Thoracic Manipulation Techniques to Improve Neck Pain: A Randomized Control Trial

Conditions
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Neck Pain

Intervention / Treatment
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* Other: Supine thoracic spine thrust manipulation
* Other: Seated thoracic spine thrust manipulation


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Between 20 and 50 years of age (inclusive) Primary complaint of neck pain with or without symptoms that spread down into one arm Overall rating of neck pain intensity is at least 3/10; the overall rating is the average of the participant's rating of current, least, and worst pain experienced over the previous 24 hours on separate numeric pain rating scales where 0 corresponds to no pain and 10 corresponds to worst possible pain Neck Disability Index (NDI) score > 10 points (measure of self-reported disability with a 0 to 50-point scale where higher scores indicate higher levels of disability) Proficient in speaking and reading English to complete outcome questionnaires Exclusion Criteria: Neck pain related to a motor vehicle accident or other trauma within the previous 6 weeks Neck pain that spreads down into both arms Low back pain or thoracic origin of pain Nerve root involvement; defined as the presence of two or more neurological findings (e.g., decreased strength, diminished deep tendon reflex, or decreased sensation) at the same nerve root level Diagnosis of cervical spinal stenosis (narrowing of the central canal that contains the spinal cord) History of spinal tumors, spinal infection, cervical spine fracture, or previous neck surgery Pending legal action related to current episode of neck pain Contraindications to thoracic spine thrust manipulation serious pathologies or conditions (tumor, fracture, metabolic diseases, rheumatoid arthritis, osteoporosis, history of prolonged steroid use) hyperreflexia unsteadiness during gait nystagmus loss of visual acuity impaired sensation of the face altered taste the presence of pathological reflexes pregnancy or considering pregnancy

Ages Eligible for Study
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Minimum Age: 20 Years
Maximum Age: 50 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Supine thoracic spine manipulation<br>Supine thoracic spine thrust manipulation (lying face-up on the treatment table) will be given 2 times at 3 treatment sessions (Weeks 0, 1, and 2) | Other: Supine thoracic spine thrust manipulation<br>* The participant will be positioned so that small amplitude quick stretch can be applied to the least mobile area of the thoracic spine that is identified during the spinal segmental mobility testing. The thoracic spine thrust manipulation will be applied at an appropriate range of motion as identified by the clinician.<br>|
| Active Comparator: Seated thoracic spine manipulation<br>Seated thoracic spine thrust manipulation will be given 2 times at 3 treatment sessions (Weeks 0, 1, and 2). | Other: Seated thoracic spine thrust manipulation<br>* The participant will be positioned so that small amplitude quick stretch can be applied to the least mobile area of the thoracic spine that is identified during the spinal segmental mobility testing. The thoracic spine thrust manipulation will be applied at an appropriate range of motion as identified by the clinician.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Numerical Pain Rating Scale (NPRS) | Each participant's neck pain intensity will be assessed by use of the Numeric Pain Rating Scale (NPRS of 0-10) | Change in NPRS scores at different time points (Baseline (Week 0) during initial visit before 1st treatment, Week 1, Week 2, and Week 3) | 
| Neck Range of Motion | Cervical range of motion measured with the Goniometer | Change in Neck ROM at different time points (Baseline (Week 0) during initial visit before 1st treatment, Week 1, Week 2, and Week 3) | 
| Neck Disability Index (NDI) | The Neck Disability Index (NDI) is a self-reported measure of disability consisting of a 0-50 point scale where higher scores indicate higher levels of disability | Change in NDI at different time points (Baseline (Week 0) during initial visit before 1st treatment, Week 1, Week 2, and Week 3) | 
| Shortened version of the Disabilities of the Arm, Shoulder, and Hand questionnaire (Quick DASH) | The shortened version of the Disabilities of the Arm, Shoulder, and Hand (Quick DASH) questionnaire is a self-report measure of function that can assess how neck pain may be impacting daily activities that require use of the upper limb | Change in QuickDASH scores at different time points (Baseline (Week 0) during initial visit before 1st treatment, Week 1, Week 2, and Week 3) |