Posts tagged thoracic manipulation
Benefits Of Manipulation For Patients With Neck And Arm Pain

Thoracic manipulation by Physical Therapists has previously been shown to improve pain and function in patients with elbow, shoulder, and neck pain. Authors continue to research the mechanisms behind its’ effectiveness including a beneficial cascade of events in the peripheral and central nervous system, as well as, a possible biomechanical change in the spinal joints. Clinically, thoracic manipulation is also utilized in patients with neck and arm pain (cervical radicular pain or cervical radiculopathy). This painful condition is secondary to encroachment of the spinal nerves in the neck as they pass through their respective vertebrae. Patient’s with this condition can experience pain, numbness, and/or pins and needles into their shoulder blade, arm, and hand. If left untreated patients may also notice weakness in their hands. Physical Therapy treatments including manual therapy and exercise aim to improve spacing within the bony neck canals that contain the neck nerves, as well as, optimize movement in the body regions adjacent to the neck to reduce the demands in the affected neck vertebrae. A new recent study highlights the benefits of thoracic manipulation in this patient population.

A randomized controlled trial in the Journal of Orthopedic and Sports Physical Therapy was conducted by Young and colleagues to determine the effectiveness of thoracic manipulation in patients with neck and arm pain (2019). Authors randomized patients to one of two treatment groups including a single session of thoracic manipulation or sham (placebo) manipulation. They assessed immediate and short term (48-72 hours) changes in pain, pain location (centralization), function, neck range of motion and strength. As expected, patients provided with thoracic manipulation reported decreased pain, improved function, and demonstrated improved range of motion at both time points compared to the sham manipulation group.

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Impact of Manipulation Direction on Outcomes in Patients with Neck Pain

Neck pain is a common problem affecting up to 70% of the population in their lifetime.  Cervical and thoracic manipulation remains an effective Physical Therapy treatment to restore mobility and decrease pain in patients with neck pain.  Recent research has shown no difference between one manipulation technique over another with both showing equal benefits for patients.  More importantly, the research supports choosing the right patient for the manipulation versus the right manipulation technique.  A recent study examined the impact of a Physical Therapy manipulation either matched or unmatched to a patient's restriction of motion.  

Karas and colleagues in the Journal of Manual and Manipulative Therapy examined the impact of directional specific thoracic spine manipulation in patients with neck pain (2018).  69 patients with neck pain were randomized to either a thoracic manipulation either matched or unmatched to their direction of mobility loss.  For example, patients with pain and difficulty looking toward the ceiling (cervical extension) were either manipulated to improve this direction or the opposite direction.  Consistent with our previous research, the authors reported both groups pain, range of motion, and disability improved but there was no significant difference with the matched or unmatched manipulation direction.  

This study highlights the importance of patient and clinician comfort during a manipulation technique versus a manipulation in the direction of movement loss.  


Thoracic Manipulation and Shoulder Pain
boulder physical therapy thoracic manipulation shoulder pain

Treatment of the thoracic spine utilizing joint mobilization or manipulation is a excellent treatment approach to accelerate the recovery of patients dealing with neck, elbow, and shoulder pain.  Utilizing a regional interdependence approach where areas adjacent or distant to the site of pain are treated by the physical therapist, in addition to the painful area, lead to greater outcomes in fewer visits.  The benefits of manual therapy alone often last 1-2 days but when combined with physical therapy exercises can deliver both short and long term improvements in pain and function.  In our practice, manual therapy treatments produce a valuable reduction in a patient's pain allowing them to move with less discomfort as we transition into a strengthening program.  Previous research showed patient's receiving this combined approach demonstrates better outcomes and strength development than those receiving only exercise treatments (Bang et al. 2000). 

boulder physical therapy shoulder pain treatment

Recently, a review of the available literature on manual therapy in the management of shoulder pain was published in the Journal of Manual and Manipulative Therapy (Peek et al. 2015).  The pooled results of the 7 studies found between 76-100% of patients reported significant reductions in shoulder pain immediately after the thoracic manipulation.  Some of the studies demonstrated improved shoulder outcomes up to 1 year after the treatment period.  This review article adds to our available evidence supporting the utilization of thoracic manipulation during physical therapy treatments for shoulder pain.  To learn more about how thoracic manipulation can help you reduce pain and get back to your activities contact your local physical therapist.