Posts tagged thoracic manipulation
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.