Widespread Pressure Pain Sensitivity in Patients with Bilateral Chronic Mechanical Neck Pain: a Randomized Controlled Trial of Thoracic Thrust Manipulation Vs Non–thrust Mobilization

Objective: The purpose of this study was to compare the effects of thoracic thrust manipulation vs thoracic non–thrust mobilization in patients with bilateral chronic mechanical neck pain on pressure pain sensitivity and neck pain intensity. Methods: Fifty-two patients (58% were female) were randomly assigned to a thoracic spine thrust manipulation group or of thoracic non–thrust mobilization group. Pressure pain thresholds (PPTs) over C5-C6 zygapophyseal joint, second metacarpal, and tibialis anterior muscle and neck pain intensity (11-point Numerical Pain Rate Scale) were collected at baseline and 10 minutes after the intervention by an assessor blinded to group allocation. Mixed-model analyses of variance (ANOVAs) were used to examine the effects of the treatment on each outcome. The primary analysis was the group * time interaction. Results: No significant interactions were found with the mixed-model ANOVAs for any PPT (C5-C6: P N .252; second metacarpal:P N .452; tibialis anterior:P N .273): both groups exhibited similar increases in PPT (all, P b .01), but withingroup and between-group effect sizes were small (standardizedmean score difference [SMD] b 0.22). TheANOVA found that patients receiving thoracic spine thrust manipulation experienced a greater decrease in neck pain (between-groupmean difference: 1.4; 95% confidence interval, 0.8-2.1) than did those receiving thoracic spine non–thrust mobilization (P b .001). Within-group effect sizes were large for both groups (SMD N 2.1), and between-group effect size was also large (SMD = 1.3) in favor of the manipulative group. Conclusions: The results of this randomized clinical trial suggest that thoracic thrust manipulation and non–thrust mobilization induce similar changes in widespread PPT in individuals with mechanical neck pain; however, the changes were clinically small. We also found that thoracic thrust manipulation was more effective than thoracic non–thrust mobilization for decreasing intensity of neck pain for patients with bilateral chronic mechanical neck pain. (J Manipulative Physiol Ther 2014;37:312-319) Key Indexing Terms: Manual Therapy; Neck Pain; Spine; Pressure