PRAGMATICALLY APPLIED CERVICAL AND THORACIC NONTHRUST MANIPULATION VERSUS THRUST MANIPULATION FOR PATIENTS WITH MECHANICAL NECK PAIN: A MULTICENTER RANDOMIZED CLINICAL TRIAL

BACKGROUND & OBJECTIVE

It has been reported that both NTM and TM produce comparable physiological effects that facilitate pain reduction, change neuromuscular input and alter the inflammatory state caused by injury, yet these two interventions have not been compared in a pragmatically applied clinical setting. Research has demonstrated that the neurophysiological effects of manual therapy (MT) occur locally where the MT is applied, segmentally, and at the supraspinal level. However, due to the temporary nature of the treatment effects of MT, it has been recommended that both NTM or TM not be utilized in isolation and instead should be combined with therapeutic exercise to attain longer-term benefits. To date, there have been no studies conducted to examine the impact of a pragmatically applied TM versus NTM approach to both the cervical and thoracic spines in patients with neck pain. The purpose of this study was to compare the effectiveness of pragmatically applied TM to that of NTM, targeting the symptomatic level of both the cervical and thoracic spines in patients with mechanical neck pain.

METHODS

This study was designed as a multicenter RCT. Patients were eligible if they presented with mechanical neck pain, were between the ages of 18 and 70 years, scored a minimum of 20% on the Neck Disability Index, and reported 2/10 or greater on the 24-hour NPRS. All participating clinicians were OMT (orthopedic manual therapy) advanced practitioners as defined by AAOMPT. In clinical studies, clinical equipoise can often be a confounding factor influencing the outcomes and confounding data. In this study, a 2-part control was placed for measuring the impact of clinical equipoise. First, global belief of overall technique effectiveness was measured at the beginning of the clinical trial. Second, following the examination of each patient, the treating clinicians rated their clinical opinion of which OMT technique they felt would be more effective for that patient.

The techniques and dosage parameters for the MT interventions were determined pragmatically. The experimental groups received either NTM or TM, targeting the symptomatic level, to both the cervical and thoracic spines. The treating clinician performed either graded oscillatory technique or a high-velocity, low-amplitude thrust to the most symptomatic segment of both the cervical and thoracic spines. The type of NTM/TM, direction of thrust/grade and direction of oscillation of NTM were at the discretion of the clinician. Additionally, a HEP was provided to both groups that included AROM exercises for both the cervical and thoracic spines and deep cervical flexor (DCF) exercises.

RESULTS

The final analysis included 103 patients – 48 randomized to receive TM and 55 to receive NTM. The results of this study found no between-group differences in disability, pain, or motor performance among patients with mechanical neck pain who received

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