Short-Term Response of Thoracic Spine Manipulation With or Without Trigger Point Dry Needling for Mechanical Neck Pain

Neck pain is common, and return to duty rates after medical evacuation from theater for
spinal pain is low. Muscles comprise the majority of the stability for the cervical spine,
yet neck muscle function can be altered in the presence of pain. Research has consistently
shown the benefit of including thoracic spine manipulation (SMT) in the treatment of patients
with mechanical neck pain. Emerging evidence is now also showing promising benefit of
including trigger point dry needling (TDN) for the treatment of mechanical neck pain.
Treatment regimens commonly address anterior cervical stabilizing musculature, but little is
known regarding the response to treatment of the deep posterior stabilizing musculature.

This study will assess the short term response of thoracic SMT with or without TDN in 58
subjects with a primary complaint of mechanical neck pain. Subjects will be randomized to
receive 2 treatment visits approximately 2-3 days apart of either SMT+sham TDN or SMT+TDN.
TDN will be directed to the upper trapezius and deep cervical extensor muscles of the neck.
Outcomes of interest will be changes in function and pain. Assessments will be made at
baseline, immediately after the first treatment, at the 2nd treatment, and approximately 5-7
days after the 2nd treatment visit. A subgroup of 20 subjects (10 per group) will also have
the upper trapezius and deep cervical extensor muscle activation assessed via shear wave
elastography, and deep cervical flexor activation assessed via the craniocervical flexion
test.

Inclusion Criteria:

1. Age 18-64 years and eligible for military health care

2. Primary complaint of mechanical neck pain provoked by posture, movement or palpation
of neck musculature, with or without unilateral upper extremity symptoms.

3. Presence of active trigger points in either the upper trapezius or deep cervical
extensor muscles.

4. Able to make one initial appointment at the Army Medical Department Center and School
at Fort Sam Houston, one treatment visit approximately 2-3 days after the initial
visit, and then a final outcome visit approximately 5-7 days after 2nd visit.

5. No less than 10 points (0-50 range) on the Neck Disability Index.

Exclusion Criteria:

1. Prior history of whiplash injury resulting in neck pain which required medical
treatment.

2. Any prior physical therapy, chiropractic, acupuncture treatment or injections for neck
pain within the past 3 months.

3. History of cervical spine surgery.

4. History of any systemic disorder in which thoracic spine manipulation and TDN would be
contraindicated (i.e. osteoporosis, bleeding disorders or anticoagulant medication
use)

5. Signs and symptoms consistent with nerve root compression (i.e. diminished upper
extremity strength, sensation or reflexes), cervical artery insufficiency (i.e.
nystagmus, gait disturbances, Horner Syndrome) or upper cervical ligament instability
(i.e. Sharp-Purser, alar ligament, transverse ligament tests).

6. Current primary complaint of headaches

7. Pending legal action regarding their neck pain

8. Inability to read and understand English

9. Females known or thought to be pregnant