This study aimed to compare the effects of thoracic thrust manipulation vs thoracic non-thrust mobilization in patients with bilateral chronic mechanical neck pain on pressure pain sensitivity and neck pain intensity. Fifty-two patients (58% were female) were placed at random into either a thoracic spine thrust manipulation group or a thoracic non-thrust mobilization group. Pressure pain thresholds (PPTs) over C5-C6 zygapophyseal joint, second metacarpal, and tibialis anterior muscle and neck pain intensity (11-point Numerical Pain Rate Scale) were collected at baseline and 10minutes post-intervention by an assessor blinded to group allocation. Mixed-model analyses of variance (ANOVAs) were used to examine the effects of the treatment on each outcome. The primary analysis was the group * time interaction. No significant interactions were observed with the mixed-model ANOVAs for any PPT (C5-C6: P>.252; second metacarpal: P>.452; tibialis anterior: P>.273): both groups displayed similar increases in PPT (all, P<.01), but within-group and between-group effect sizes were small (standardized mean score difference [SMD]<0.22). The ANOVA found that patients receiving thoracic spine thrust manipulation experienced a greater reduction in neck pain (between-group mean difference: 1.4; 95% confidence interval, 0.8-2.1) than did those receiving thoracic spine non-thrust mobilization (P2.1), and between-group effect size was also large (SMD = 1.3) in favor of the manipulative group.
The results of this randomized clinical trial indicated that thoracic thrust manipulation and non-thrust mobilization induce similar changes in widespread PPT in individuals with mechanical neck pain; however, the changes were clinically small. It also found that thoracic thrust manipulation was more effective than thoracic non-thrust mobilization for reducing the severity of neck pain for patients with bilateral chronic mechanical neck pain.