The difference in effectiveness between cervical manipulation and thoracic manipulation in the management of non-specific neck pain and disability

Item

Title
The difference in effectiveness between cervical manipulation and thoracic manipulation in the management of non-specific neck pain and disability
Author(s)
Deman, A
Abstract
Background Non-specific neck pain (NSNP) is generally a diagnosis given to neck pain in the absence of features of a specific, underlying condition and affects about two thirds of the population at some stage in their lives. Spinal manipulation is widely researched and is a non-invasive medium to treat musculoskeletal pain and disability. Both cervical- and thoracic manipulation have been subject to research in the past, a differentiation between the two in terms of effectiveness however, has yet to be clarified. Objective The objective of this study was to review randomized control trials published in the last six years regarding cervical- and thoracic manipulation in order to establish what location of manipulation, if any, is more favourable in improving pain and/or disability levels in patients suffering from NSNP. Design A structured literature review. Methods A comprehensive search of nine electronic databases was conducted in September 2019 for the years 2014 to 2019. These results were then screened for eligibility and compliancy with set in-/exclusion criteria before their data was extracted. Information like effect sizes and p-values were retrieved or calculated where possible. Additionally, a quality assessment was performed by two independent assessors using the Physiotherapy Evidence Database (PEDro) scale. Results In total, ten studies were identified as eligible of which four were cervical- and six were thoracic manipulation studies. Their approximate mean PEDro scores, per group, were respectively 8.25/10 and 5.66/10. Concretely, this meant that all cervical, and three thoracic studies were of ‘moderate to high’ quality whereas the remaining three thoracic studies were graded as ‘fair to moderate’. Effect sizes were generally given or calculable but very inconsistent within-group and seldom statistically relevant at the same time. Discussion Interpretation of the data was limited due to heterogeneity in sample sizes and within-group population characteristics, and fair to moderate methodological quality. Other important variables such as adverse events, limited medium- / long-term follow-up and practitioner/subject bias were generally unaccounted for and might have played a significant role. The results were overall inconclusive, although dissimilar to the review used as guidance for this study. Conclusion Even though the findings lean towards CM for short-term disability relief and towards TM for short-term pain relief, these remain inconclusive as adverse side effects (ASE’s) were seldomly accounted for. Furthermore, these findings should be interpreted with great care as only a handful of studies had both statistically and clinically relevant findings to back this up. Further studies that directly compare both interventions and report ASE’s are warranted.
presented at
European School of Osteopathy
Date Accepted
2020
Date Submitted
28.10.2020 18:08:19
Type
osteo_thesis
Language
English
Submitted by:
62
Pub-Identifier
16657
Inst-Identifier
1229
Keywords
Cervical manipulation, Mechanical neck pain, Non-specific neck pain, Thoracic manipulation.
Recommended
0
Item sets
Thesis

Deman, A, “The difference in effectiveness between cervical manipulation and thoracic manipulation in the management of non-specific neck pain and disability”, Osteopathic Research Web, accessed May 4, 2025, https://www.osteopathicresearch.org/s/orw/item/198