Great study demonstrating the benefit of mid back or thoracic spine treatment for mechanical neck pain. Potentially an argument for having the entire spine treated even though only one area is affected. You don't go to the dentist to get one tooth cleaned, do you?
from Physical Therapy current issue by Cleland, J. A., Mintken, P. E., Carpenter, K., Fritz, J. M., Glynn, P., Whitman, J., Childs, J. D.
Background
A clinical prediction rule (CPR) purported to identify patients with neck pain who are likely to respond to thoracic spine thrust manipulation has recently been developed, but has yet to be validated.
Objective
The purpose of this study was to examine the validity of this CPR.
Design
This was a multi-center randomized clinical trial.
Methods
One hundred forty patients with a primary report of neck pain were randomly assigned to receive either 5 sessions of stretching and strengthening exercise (exercise-only group) or 2 sessions of thoracic spinemanipulation and cervical range of motion exercise followed by 3 sessions of stretching and strengthening exercise (manipulation + exercise group). Data on disability and pain were collected at baseline, 1 week, 4 weeks, and 6 months. The primary aim (treatment group x time x status on the prediction rule) was examined using a linear mixed model with repeated measures. Time, treatment group, and status on the rule, as well as all possible 2-way and 3-way interactions, were modeled as fixed effects, with disability (and pain) as the dependent variable. Effect sizes were calculated for both pain and disability at each follow-up period.
Results
There was no 3-way interaction for either disability or pain. A 2-way (group x time) interaction existed for both disability and pain. Pair-wise comparisons of disability demonstrated that significant differences existed at each follow-up period between the manipulation + exercise group and the exercise-only group. The patients who received manipulation
Limitations
Different exercise approaches may have resulted in a different outcome.
Conclusions
The results of the current study did not support the validity of the previously developed CPR. However, the results demonstrated that patients with mechanical neck pain who received thoracic spine manipulation and exercise exhibited significantly greater improvements in disability at both the short- and long-term follow-up periods and in pain at the 1-week follow-up compared with patients who received exercise only.
Joshua M. Brooks, D.C.
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ABC Clinics
Rosa Family Chiropractic
2750 Prosperity Ave, Suite 550
Fairfax, VA 22031
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