Research Review by Dr. Shawn Thistle©


Aug. 2005

Study Title:

Immediate effects of thoracic manipulation in patients with neck pain: a randomized clinical trial


Cleland JA et al.

Publication Information:

Manual Therapy 2005; 10: 127-135.


Neck pain is a common condition, second only to low back pain in annual workers' compensation costs in the United States. Although the benefits of manual medicine techniques such as cervical spine mobilization and manipulation have been well documented, there are small inherent risks to these procedures.

Further, many patients state specifically that they do not want manual techniques performed on their neck. This has led some to suggest that manipulation of the thoracic spine - generally regarded as safer than neck manipulation - may be a more prudent approach to those with mechanical neck pain.

This study investigated the effect of thoracic spine manipulation on pain levels in patients with mechanical neck pain. 36 patients (average age 36 years) were divided into two groups. 19 patients received thoracic spine manipulation with the patient supine (an "anterior" manipulation for those familiar with this terminology) at segments deemed to be restricted by the treating therapist.

The remaining 17 patients received placebo manipulation - involving an open-hand contact with no low-amplitude, high-velocity thrust (and hence, no joint cavitation or "popping").

Patients were asked to rate their pain levels on a visual analogue scale before and directly after treatment. The visual analogue scale is a 100mm line with zero at one end representing "no pain" and 100 at the other representing "the worst pain imaginable". Patients simply place a mark on the line which they feel corresponds to their pain level.

Immediate reduction in pain was the primary outcome in this study. Statistical analysis revealed that patients receiving thoracic spine manipulation experienced a significant, immediate decrease in pain levels - 15.5mm improvement on the VAS versus only 4.2mm improvement in the placebo group.

Conclusions & Practical Application:

Although the risk of serious complications from neck manipulation is extremely low, this study provides some evidence that thoracic spine manipulation can provide immediate pain relief in patients with mechanical neck pain.

Larger studies are needed to confirm this finding, but this study suggests that we as clinicians have the option to treat the thoracic spine in patients with neck pain who choose not to undergo neck manipulation, and still achieve an effective pain relief outcome.