REGIONAL INTERDEPENDENT EFFECTS OF THORACIC SPINE MANUAL THERAPY COMPARED TO STANDARD LOCALIZED CERVICAL THERAPY IN PATIENTS WITH CHRONIC MECHANICAL NECK PAIN: A RANDOMIZED CONTROLLED TRIAL

Abstract

Background

Chronic mechanical neck pain is a prevalent and often recurrent musculoskeletal condition. The regional interdependence model proposes that impairments distant from the primary symptoms, such as restricted thoracic spine mobility, may contribute to the persistence of cervical dysfunction, suggesting that treatment directed at the thoracic spine could enhance outcomes beyond localized cervical care alone.

Objective

To compare the effectiveness of thoracic spine manual therapy (mobilization and manipulation) combined with standard cervical care against standard localized cervical care alone, on pain, disability, and cervical range of motion in adults with chronic mechanical neck pain.

Methods

In this parallel-group, single-blind randomized controlled trial, 160 adults with chronic mechanical neck pain and clinically restricted thoracic mobility were randomized 1:1 to an experimental group (thoracic mobilization/manipulation plus standard cervical care) or a control group (standard localized cervical care alone). Both groups received 16 sessions over 8 weeks. The primary outcome was change in Neck Disability Index (NDI) score from baseline to week 8. Secondary outcomes included the Numeric Pain Rating Scale (NPRS) and cervical range of motion (CROM), assessed at baseline, week 4, week 8, and at 4-month follow-up by a blinded assessor.

Results

A total of 160 randomized participants, 137 (85.6%) completed the week-8 assessment and 128 (80.0%) completed the 4-month follow-up. At week 8, the experimental group demonstrated significantly greater improvement in NDI compared with the control group (between-group mean difference approximately 7.4 points, 95% CI 4.9 to 9.9, p < .001), with a similar pattern favoring the experimental group for NPRS (mean difference approximately 1.3 points, 95% CI 0.8 to 1.8, p < .001) and cervical rotation range of motion. These between-group differences were attenuated but remained statistically significant at the 4-month follow-up.

Conclusion

The addition of thoracic spine manual therapy to standard cervical care produced greater short- and medium-term improvements in pain, disability, and cervical mobility than localized cervical care alone in this sample of patients with chronic mechanical neck pain, lending clinical support to the regional interdependence model.