Short-term Effects of Mobilization and Manipulation of Thoracic Spine in Chronic Nonspecific Neck Arm Pain

Research Objectives: This study compared the immediate and 48-hour follow-up effects of thoracic spine mobilization and manipulation on improving pain and sensitization outcomes in individuals with chronic non-specific neck-arm pain (NSNAP).

Design: Randomized clinical trial

Setting: Neurosciences Center, All India Institute of Medical Sciences, New Delhi, India

Participants: Thirty-nine chronic NSNAP participants, ages 18-65, with unilateral neck and arm pain below the elbow, no evidence of spinal never-root compression, the intensity of pain on a visual analog scale (VAS) ≥ 3, and disability reported on the neck-disability index (NDI) ≥ 20%, were recruited. The participants were randomized to thoracic spine mobilization (N=20, Mage= 35.9±7.2 ) or manipulation groups (N=19, Mage=38.5±7.4).

Interventions: Mobilization involved the subject prone while the investigator performed a 30-second, grade III or IV central posterior-anterior mobilization from the T1 to T4 spinous processes, repeated 3-4 times with one-minute rests. In the manipulation group, subjects clasped hands at the neck base and pulled down for upper thoracic spine flexion while the therapist applied a high-velocity, low-amplitude thrust from T1 to T4, repeated 3-4 times.

Main Outcome Measures: Outcome measures were collected pre-intervention, immediately post-intervention, and 48 hours follow-up, including pain intensity on a VAS, elbow extension ROM during the median nerve tension test, and pressure-pain thresholds at the cubital fossa, trapezius, first webspace, and tibialis anterior to assess hyperalgesia.

Results: No significant differences in age (p=.269), sex (p=.127), or symptom duration (p=.427) were noted between the groups at baseline. Repeated-measures ANOVA revealed that both groups experienced statistically significant reductions in VAS scores from pre- to post-intervention and pre- to follow-up, with the mobilization group showing a greater decrease (η² = .434, p < 0.001). While improvements in elbow extension ROM and PPT-tibialis anterior were observed in both groups over time, no significant time x group interactions were detected (p = 0.497, p = 0.857, respectively). However, the manipulation group exhibited a more pronounced increase in PPT-hand immediately post-intervention compared to the mobilization group (p = 0.016, η² = 0.206), and a sustained increased PPT at trapezius and hand sites were observed at follow-up with manipulation.

Conclusions: This study found the short-term efficacy of both mobilization and manipulation therapies in reducing pain and sensitivity in chronic NSNAP, with mobilization yielding greater VAS score reductions and manipulation enhancing threshold sustainability at primary sites through 48-hour follow-up. Future research should investigate how manual therapies impact patients with different sensitization levels.

Author(s) Disclosures: No Conflict of interest was reported by the authors.