Effects of Manipulating the Midback on the NeckYou may have heard the statistic that 80 per cent of all adults will experience back pain sometime in their life. Would it surprise you to know neck pain affects up to half of all adults? In both cases (back and neck pain), the condition is referred to as mechanical pain.
Mechanical back or neck pain describes pain that usually occurs with movement and is not caused by fracture, inflammation, tumors, nerve problems, or other known systemic causes. Most of the time the underlying cause remains unknown. Whether it's a ligamentous problem, muscle tension, an issue with spinal alignment, or some other factor, no one knows for sure.
Even when we don't know what is causing the neck pain, treatment can still be effective. The usual treatment goals are to reduce pain and increase neck motion. The natural result of achieving both these outcomes is improved function.
So the question naturally arises, what treatment works best? That's the rub -- we don't know yet. Neck pain is one condition for which there is no gold standard treatment. Gold standard treatment refers to the best known treatment with best results based on evidence from clinical research.
But all is not lost! Research is ongoing to compare current treatments against each other. In a recent systematic review, the results of thoracic spine thrust manipulation was compared to some other type of treatment. Neck pain and neck motion were used in all studies to measure the outcomes.
Thoracic spine thrust manipulation refers to a hands-on treatment of the mid-back (thoracic spine). A physical therapist or chiropractor places the patient's body in a specific position and then applies a force through the joint. This type of thrust manipulation helps realign the spinal joints, takes pressure off the discs, and allows the nearby muscles to relax.
When researchers conduct a systematic review, it means they look at all the studies already published on a single topic, condition, or treatment. They choose the studies with the highest quality that are consistent with one another and then combine all the results.
In the case of this topic, there were six studies that met the test for high-quality. A total of 173 patients were included. The thoracic spine manipulations were all done by physical therapists trained in this type of manipulative treatment referred to as manual therapy.
After examining all of the data, it seems that thrust manipulation of the midback can help improve the neck. The benefits of manipulating the upper-mid back to reduce neck pain were observed right away but the results may not last. The studies only followed patients for six months, so there isn't a long-term effect reported.
The studies contained in this systematic review did not compare the results of manipulation against multiple treatment techniques (exercise, manipulation, neck brace, stretching and so forth). It is possible that patients would get better faster and stay well longer if treatment consisted of two or more treatment techniques combined together.
It is also possible that there is one type of thrust manipulation (i.e., specific technique) that works better than another. In addition, the differences in treatment outcomes may be based on the location of the problem within the spine. Perhaps the position the patient is in (sitting, lying down) when the manipulation is done makes a difference.
The authors of this systematic literature review on thoracic manipulation to treat neck pain say the results can't be applied to everyone. There are too many missing variables and different factors to take into consideration. Further investigation is recommended.
K. M. Cross, PT, PhD, ATC, et al. Thoracic Spine Thrust Manipulation Improves Pain, Range of Motion, and Self-Reported Function in Patients with Mechanical Neck Pain: A Systematic Review. In Journal of Orthopaedic & Sports Physical Therapy. September 2011. Vol. 41. No. 9. Pp.633-643.
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