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EUROPEAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE

A Journal on Physical Medicine and Rehabilitation after Pathological Events


Official Journal of the Italian Society of Physical and Rehabilitation Medicine (SIMFER), European Society of Physical and Rehabilitation Medicine (ESPRM), European Union of Medical Specialists - Physical and Rehabilitation Medicine Section (UEMS-PRM), Mediterranean Forum of Physical and Rehabilitation Medicine (MFPRM), Hellenic Society of Physical and Rehabilitation Medicine (EEFIAP)
In association with International Society of Physical and Rehabilitation Medicine (ISPRM)
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European Journal of Physical and Rehabilitation Medicine 2017 June;53(3):333-41

DOI: 10.23736/S1973-9087.17.04431-8

Copyright © 2017 EDIZIONI MINERVA MEDICA

language: English

Effect of cervical vs. thoracic spinal manipulation on peripheral neural features and grip strength in subjects with chronic mechanical neck pain: a randomized controlled trial

Francisco BAUTISTA-AGUIRRE 1, 2, Ángel, OLIVA-PASCUAL-VACA 3 , Alberto M. HEREDIA-RIZO 3, Juan J. BOSCÁ-GANDÍA 2, François RICARD 2, Cleofás RODRIGUEZ-BLANCO 3

1 Department of Physical Therapy, European University, Valencia, Spain; 2 Madrid Osteopathic School, Madrid, Spain; 3 Department of Physiotherapy, Faculty of Nursing, Physiotherapy and Podology, University of Sevilla, Sevilla, Spain


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BACKGROUND: Cervical and thoracic spinal manipulative therapy has shown positive impact for relief of pain and improve function in non-specific mechanical neck pain. Several attempts have been made to compare their effectiveness although previous studies lacked a control group, assessed acute neck pain or combined thrust and non-thrust techniques.
AIM: To compare the immediate effects of cervical and thoracic spinal thrust manipulations on mechanosensitivity of upper limb nerve trunks and grip strength in patients with chronic non-specific mechanical neck pain.
DESIGN: Randomized, single-blinded, controlled clinical trial.
SETTING: Private physiotherapy clinical consultancy.
POPULATION: Eighty-eight subjects (32.09±6.05 years; 72.7% females) suffering neck pain (grades I or II) of at least 12 weeks of duration.
METHODS: Participants were distributed into three groups: 1) cervical group (N.=28); 2) thoracic group (N.=30); and 3) control group (N.=30). One treatment session consisting of applying a high-velocity low-amplitude spinal thrust technique over the lower cervical spine (C7) or the upper thoracic spine (T3) was performed, while the control group received a sham-manual contact. Measurements were taken at baseline and after intervention of the pressure pain threshold over the median, ulnar and radial nerves. Secondary measures included assessing free-pain grip strength with a hydraulic dynamometer.
RESULTS: No statistically significant differences were observed when comparing between-groups in any of the outcome measures (P>0.05). Those who received thrust techniques, regardless of the manipulated area, reported an immediate increase in mechanosensitivity over the radial (both sides) and left ulnar nerve trunks (P<0.05), and grip strength (P<0.001). For those in the control group, right hand grip strength and pain perception over the radial nerve also improved (P≤0.025).
CONCLUSIONS: Low-cervical and upper-thoracic thrust manipulation is no more effective than placebo to induce immediate changes on mechanosensitivity of upper limb nerve trunks and grip strength in patients with chronic non-specific mechanical neck pain.
CLINICAL REHABILITATION IMPACT: A single treatment session using cervical or thoracic thrust techniques is not enough to achieve clinically relevant changes on neural mechanosensitivity and grip strength in chronic non-specific mechanical neck pain.


KEY WORDS: Brachial plexus - Hand strength - Neck pain - Pain threshold - Musculoskeletal manipulations

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Publication History

Issue published online: June 15, 2017
Article first published online: February 17, 2017
Manuscript accepted: February 15, 2017
Manuscript revised: February 6, 2017
Manuscript received: July 26, 2016

Cite this article as

Bautista-Aguirre F, Oliva-Pascual-Vaca Á, Heredia-Rizo AM, Boscá-Gandía JJ, Ricard F, Rodriguez-Blanco C. Effect of cervical vs. thoracic spinal manipulation on peripheral neural features and grip strength in subjects with chronic mechanical neck pain: a randomized controlled trial. Eur J Phys Rehabil Med 2017;53:333-41. DOI: 10.23736/S1973-9087.17.04431-8

Corresponding author e-mail

angeloliva@us.es