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Young I.1, Pozzi F.2, Dunning J.3, Linkonnis R.4, Michener L.2
1Spine & Sport, Savannah, United States, 2University of Southern California, Division of Biokinesiology and Physical Therapy, Los Angeles, United States, 3Alabama Physical Therapy & Acupunture, Montgomery, United States, 4Center for Physical Therapy, Richmond, United States
Background: Thoracic spine manipulation has been successfully used in patients with neck pain. However, there is limited evidence to support this treatment specifically for patients with cervical radiculopathy.
Purpose: To assess the immediate and short term effects of thoracic manipulation on patient-rated outcomes of pain and disability, and impairments of cervical range of motion (CROM) and deep neck flexor (DNF) strength in patients with cervical radiculopathy.
Methods: Participants were diagnosed with cervical radiculopathy with at least 3 of 4 positive tests of Spurlings, upper limb tension test-median nerve bias, cervical distraction, and cervical rotation towards the symptomatic side 60°. Participants (N=43) were randomized to receive either an active supine upper/mid thoracic spine manipulation (N=22) or a sham manipulation (N=21). The active manipulation was a supine high-velocity low-amplitude thrust to the upper and lower thoracic spine. During the sham manipulation, an open hand was placed in the same position as the active technique, but no manipulation thrust was applied to the thoracic spine. Outcome measures collected immediately after manipulation and 48 to 72 hours included the neck disability index (NDI), numeric pain rating scale (neck and upper extremity), CROM, and DNF strength. Outcomes were compared between groups over time using a 2 x 3 repeated measures ANOVA with group as between subjects factor. With a significant interaction, outcomes were compared between baseline and post-48 hours using a paired sample t-test. Believability as an active treatment was assessed post-treatment using a chi-square test.
Results: Significant group by time interactions were found post-manipulation for the NDI (p 0.001), neck pain
(p 0.001), upper extremity pain (p=0.006); DNF strength (p 0.001) and CROM [flexion (p=0.008); extension (p=0.003); rotation on the symptomatic side (p 0.001); rotation on the non-symptomatic side (p=0.009); side-bending on the symptomatic side (p=0.005)]. At 48-72 hours after treatment, the active manipulation group reported a greater decrease in NDI (mean difference=-8 points, p 0.001), neck pain (mean difference=-2.5 points, p 0.001) and upper extremity pain (mean difference=-2.31 points,
p 0.001) compared to the sham group. The active group reported greater increases CROM [flexion (mean difference=7.95°, p= 0.004), extension (mean difference=7.59°, p=0.003), side bending
(mean difference=8.18°, p 0.001), rotation (mean difference=12°, p 0.001) on the symptomatic side], and greater DNF strength (mean difference=7.13seconds, p 0.001). Greater proportion of participants in the active group (90%) believed they received the active intervention as the sham group (57%)
(χ2=6.435, p= 0.011).
Conclusion(s): Individuals with cervical radiculopathy treated with one session of thoracic manipulation reported meaningful improvements of NDI, CROM, DNF strength, and neck/upper extremity pain as compared to individuals treated with sham manipulation. Improvements lasted for up to 72-hours post-treatment. More participants in the active group believed they received the active treatment, which may have influenced differences in outcomes between groups.
Implications: One session of thoracic spine manipulation provides short-term benefits in pain, disability and neck impairments in patients with cervical radiculopathy. This treatment technique provided very short-term benefits. Further research is needed to determine longer term benefits in patients with cervical radiculopathy.
Funding acknowledgements: None
Topic: Musculoskeletal: spine
Ethics approval: Office of Research, Virginia Commonwealth University (IRB #: HM13804)
All authors, affiliations and abstracts have been published as submitted.
