Effectiveness of cervical, thoracic and cervico-thoracic spinal manipulation on pain and spinal kinematics in non-specific neck pain : a randomised controlled trial

Abstract

Background: Neck pain is a musculoskeletal disorder that affects many people at some point in their lives. It has been demonstrated that up to 50% of adults in the general population may experience neck pain at some point during the year, with many going on to develop persistent chronic neck pain. Neck pain is associated with disability and activity impairment especially of the upper limb when performing functional movements. Spinal manipulation has been shown to help decrease pain intensity and disability and improve range of motion and the quality of life in individuals with non-specific neck pain. Few studies have examined range of motion beyond that of peak displacement and, thus, little is known if spinal manipulation therapy of the cervical and thoracic spine improves the quality of motion in those with neck pain. Aim: The aim of this study was to determine the effectiveness of cervical and thoracic spinal manipulation applied alone and in a combination. The groups were compared to a control group in terms of their effect on pain intensity, disability, cervical and thoracic kinematic outcomes during cervical range of motion and two upper extremity functional limb tasks in individuals with non-specific neck pain. Methods: The study is a quantitative, randomised, controlled, single-blinded study. Individuals with chronic non-specific neck pain between the ages of 18–50 were recruited and randomly assigned to one of four groups: control, cervical, thoracic spinal manipulation, or a combination of the two. The participants performed cervical range of motion and two upper limb tasks while motion capture technology collected cervical and thoracic spinal kinematics. A pain rating and spinal kinematics were obtained pre and post the intervention. The data were analysed using software SPSS and a p-value of 0.05 indicated significance. Results: A total of 47 participants were randomised. No significant difference was recorded for pain intensity across all four of the groups (F(3,42) = 0.41, p = 0.750). Spinal kinematics improved within the groups, with no differences between the groups during the cervical range of motion task. Between the groups, in the unilateral arm task, differences were found in the lower thoracic spine during the flexion-extension cycle for jerk, with the cervical and thoracic combination group being significantly greater than cervical manipulation group alone (F(3, 40) = 2.892, p = 0.047). In the cervical and thoracic combination group, for the bilateral arm task in the upper thoracic spine flexion extension range, it was found to be significantly greater than the control group (F(3, 40) = 3.127, p = 0.036). In the cervical and thoracic combination group, in the lower thoracic spine during the flexion-extension cycle for the jerk measure, it was found to be significantly higher than the control group (F(3, 40) = 2.902, p = 0.047). Conclusion: This study could not prove that spinal manipulation can result in a change in the spinal kinematics during cervical range of motion and two arm tasks in patients with non-specific neck pain following spinal manipulation of the cervical and thoracic spines.