A Comparison of Two Thoracic Manipulation Techniques to Improve Neck Pain

The study will be conducted at the Musculoskeletal clinical facility in the Dept. of Physical
Therapy and Athletic Training, Northern Arizona University, Flagstaff AZ. The investigators
aim to test a maximum of 76 participants in this study. A phone screening will determine
initial eligibility. If the participant meets the inclusion criteria and is not excluded
after the phone screen, an appointment will be scheduled. Final eligibility will be
determined in the initial session after the participant completes the outcome measures and is
evaluated by a licensed physical therapist.

Participants will be involved in the study over a 4 week period. Each participant will be
asked to attend 4 sessions, with one week in between each session as follows: Week 0 =
baseline assessment and treatment 1; Week 1= treatment 2; Week 2 = treatment 3; and week 4 =
follow-up assessment.

After completion of the baseline assessment, qualified participants will be randomly assigned
to either a supine or prone thoracic spine thrust manipulation intervention.

Inclusion Criteria:

- Between 20 and 50 years of age (inclusive)

- Primary complaint of neck pain with or without symptoms that spread down into one arm

- Overall rating of neck pain intensity is at least 3/10; the overall rating is the
average of the participant's rating of current, least, and worst pain experienced over
the previous 24 hours on separate numeric pain rating scales where 0 corresponds to
"no pain" and 10 corresponds to "worst possible pain"

- Neck Disability Index (NDI) score > 10 points (measure of self-reported disability
with a 0 to 50-point scale where higher scores indicate higher levels of disability)

- Proficient in speaking and reading English to complete outcome questionnaires

Exclusion Criteria:

- Neck pain related to a motor vehicle accident or other trauma within the previous 6
weeks

- Neck pain that spreads down into both arms

- Low back pain or thoracic origin of pain

- Nerve root involvement; defined as the presence of two or more neurological findings
(e.g., decreased strength, diminished deep tendon reflex, or decreased sensation) at
the same nerve root level

- Diagnosis of cervical spinal stenosis (narrowing of the central canal that contains
the spinal cord)

- History of spinal tumors, spinal infection, cervical spine fracture, or previous neck
surgery

- Pending legal action related to current episode of neck pain

- Contraindications to thoracic spine thrust manipulation

1. serious pathologies or conditions (tumor, fracture, metabolic diseases,
rheumatoid arthritis, osteoporosis, history of prolonged steroid use)

2. hyperreflexia

3. unsteadiness during gait

4. nystagmus

5. loss of visual acuity

6. impaired sensation of the face

7. altered taste

8. the presence of pathological reflexes

9. pregnancy or considering pregnancy