STUDY DESIGN: Randomized clinical trial. OBJECTIVES: To compare the effects of cervical versus thoracic thrust manipulation in patients with bilateral chronic mechanical neck pain on pressure pain sensitivity, neck pain, and cervical range of motion. BACKGROUND: Evidence suggests that spinal interventions can stimulate descending inhibitory pain pathways. To our knowledge, no study has investigated the neurophysiological effects of thoracic thrust manipulation in individuals with bilateral chronic mechanical neck pain, including widespread changes on pressure sensitivity. METHODS AND MEASURES: Ninety patients (51% females) were randomly assigned to 1 of 3 groups: cervical thrust manipulation on the right, cervical thrust manipulation on the left, or thoracic thrust manipulation. Pressure pain thresholds (PPTs) over the C5-C6 zygapophyseal joint, lateral epicondyle, and tibialis anterior muscle, neck pain (11-point numeric pain rating scale (NPRS)), and cervical spine range of motion were collected at baseline and 10 minutes after the intervention by an assessor blinded to the treatment allocation of the patients. Mixed-model ANCOVAs were used to examine the effects of the treatment on each outcome variable with group as the between subject variable, time and side as the within subjects variables, and gender as covariate. The primary analysis was the group x time interaction. RESULTS: No significant interactions were found with the mixed model ANCOVAs for any PPT level (C5-C6 p > 0.210; lateral epicondyle p > 0.186; tibialis anterior muscle p > 0.268), neck pain intensity (p = 0.923), or cervical range of motion (flexion p = 0.700; extension p = 0.387; lateral-flexion p > 0.672; rotation p > 0.192) as dependent variables: all groups exhibiting similar changes in PPT, neck pain and, cervical range of motion (all p < 0.001). Gender did not influence the main effects or the interaction effects in the analyses that were performed for the outcomes (p > 0.10). CONCLUSIONS: The results of the current randomized clinical trial suggest that cervical and thoracic thrust manipulation induce similar changes in PPT, neck pain intensity, and cervical range of motion in individuals with bilateral chronic mechanical neck pain. However, changes in PPT and cervical range of motion were small and did not surpass their respective minimal detectable change values. Further, because we did not include a control group, we cannot rule out the placebo effect of either thrust intervention on the outcomes. LEVEL OF EVIDENCE: Therapy, level 1b.

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