There are contradicting findings regarding the effect of thoracic spine manipulation in decreasing pain and disability in patients with chronic mechanical neck pain. Hence, the purpose of this review was to evaluate the current evidence on the effectiveness of thoracic spine thrust manipulation in decreasing pain intensity, and neck disability among subjects with chronic mechanical neck pain. We made a comprehensive search of literature published between 2010 and 2020 from the electronic databases of PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, and Physiotherapy Evidence Database (PEDro). We adhered to Preferred Reporting Items for Systematic reviews and Meta-analysis (PRISMA). The methodological quality was assessed by the PEDro scale, and the level of evidence rated by Grading of Recommendations Assessment, Development, and Evaluation (GRADE) software. Finally, a meta-analysis was done using RevMan 5.3 with a random-effects model to calculate the mean difference (MD) and 95% confidence intervals for pain and disability. Eight eligible randomized controlled trials were identified with a total of 457 participants. The quality assessment of the included studies was found to be fair in quality (mean PEDro score of 6.63/10). The overall GRADE of the review showed low to moderate level of evidence. Effect size estimates of the studies showed modest differences in pain reduction, as it revealed a significant effect in Visual Analog Scale ((VAS) 0-100mm) (MD -12.46; 95% CI: -17.29, -7.64), and Pain Numeric Rating Scale ((PNRS) 0-10 pts) (MD -0.8; 95% CI: -1.60, -0.10). The thoracic manipulation also resulted in a significant effect in decreasing neck disability, in which the mean difference in Neck disability index (NDI) showed (MD -6.46; 95% CI: -10.43 -2.50). This review suggested that thoracic spine manipulation was effective in reducing pain and neck disability in all adults with chronic mechanical neck pain compared to other interventions.
|Rehab Clinician (OT/PT)|
This conclusion is not newsworthy for practitioners in rehabilitation medicine.
This review suggests that thoracic spinal manipulation (TSM) thrust is effective in immediate/short-term reduction of pain and neck disability in adults with mechanical neck pain lasting more than 12 weeks, either alone or in combination with other treatments. The main limitations of the review are that the PEDro scale is not ideal to assess the methodologic quality of the articles and the overall GRADE-quality of evidence ranges from low to moderate due to the lack of consistency among the included studies. Additionally, the review does not provide information on potential risks or side effects associated with TSM.
This review suggests that thoracic spine manipulation is effective in reducing pain and neck disability in all adults with chronic mechanical neck pain compared with other interventions. Clinicians need to review the authors' results cautiously. Between-group mean differences for pain intensity and neck disability are not clinically relevant. The comparison interventions also demonstrate pain and disability improvement that are only slightly less compared with thoracic manipulation. As a physical therapist, the take-away message is to add thoracic manipulation to your toolbox and to use manipulation selectively for appropriate patients.
As a manual physical therapist, I find this information has been discussed in the past. However, this review concludes with meaningful information to confirm what many practitioners are performing regularly.