Cervical radiculopathy is when a nerve is pinched in the neck, and it radiates down into the arm(s). This paper suggests that by treating the mid back with manipulation techniques, you can get some quick relief of this problem. Good news for patients who don’t want to get their “neck cracked”. ~ Dr. Broussard
Immediate and Short Term Effects of Thoracic Spine Manipulation in Patients With Cervical Radiculopathy: A Randomized Controlled Trial
Published: Journal of Orthopaedic & Sports Physical Therapy, 2019 Volume:0 Issue:0 Pages:1–36 DOI: 10.2519/jospt.2019.8150
Study Design
Multicenter randomized controlled trial.
Background
Thoracic spine thrust manipulation has been shown to improve patient-rated outcomes for individuals with neck pain. However, there is limited evidence for effectiveness in patients with cervical radiculopathy (CRAD).
Objectives
To compare the immediate and short-term effects of thoracic manipulation to those of a sham thoracic manipulation in patients with CRAD.
Methods
Participants with CRAD were randomized to receive manipulation (N=22) or sham manipulation (N=21) of the thoracic spine. Outcomes were measured at baseline and immediately and 48-72 hours after manipulation. Repeated measures ANOVA analyzed the numeric pain rating scale (NPRS) for neck and upper extremity pain, neck disability index (NDI), cervical range of motion (ROM), and deep neck flexor endurance test. Post-hoc independent t-test assessed difference between groups at the two-follow ups. Mean changes, between group differences over time with 95% confidence intervals, and associated effect sizes were calculated. Chi-square test analyzed the score on the global rating of change scale (GROC) for neck and upper extremity pain, centralization of symptoms, and beliefs about receiving the active manipulation treatment.
Results
Neck and upper extremity pain, cervical ROM, NDI, and deep neck flexor endurance all showed significant 2-way interactions for group and time (P<.01). At both follow-up time points, the manipulation group had lower neck pain (P<.01), better cervical range of motion (P<.01), lower NDI score (P<.01), and better deep neck flexor endurance (P = .02) compared to sham manipulation group. The manipulation group had moderate to large effect size changes over time. No between group differences for upper extremity pain were found at immediate (P = .34) and 48-72hrs (P = .18) follow-ups. Following treatment at 48-72hrs, a greater proportion of participants in the manipulation group reported improvement (GROC ≥4) in neck and upper extremity symptoms (P<.01); centralization of symptoms (P<.01); and belief that they received an active manipulation (P = .01), compared to the sham manipulation group.
Conclusion
One session of thoracic manipulation may result in improvements in pain disability, CROM and deep neck flexor endurance in patients with CRAD. Patients treated with manipulation are more likely to report at least moderate change in their neck and upper extremity symptoms up to 48-72 hours following treatment.
Level of Evidence
Therapy, Level 2. J Orthop Sports Phys Ther, Epub 25 Apr 2019. doi:10.2519/jospt.2019.8150