Thoracic manipulation for chronic neck pain: What does the evidence say?

We’ve all had patients who don’t want their neck adjusted, which is (of course) their choice. So, what do we do in these cases? Do you recommend thoracic SMT instead? This week’s Review updates us on the evidence for thoracic SMT for chronic neck pain.

The most common type of neck pain is mechanical neck pain, which has been defined as pain in the cervical spine or cervicothoracic junction that is elicited and/or exacerbated by cervical motion and/or palpation of cervical structures. The linkage between the thoracic and cervical spine suggests that disturbances in the biomechanics of the thoracic spine could contribute to neck pain. A previous systematic review reported that thoracic spine manipulation was more beneficial than thoracic mobilization, cervical mobilization, and standard care in the treatment of mechanical neck pain, but no better than cervical manipulation or placebo thoracic spine manipulation to improve pain and disability. However, research on the effect of thoracic spine manipulation on patients with chronic neck pain has been inconsistent.    

Therefore, the objective of this systematic review was to evaluate the evidence on the effectiveness of thoracic manipulation on decreasing pain intensity and neck disability in patients with chronic mechanical neck pain.

Comment from Dr. Thistle:

“This is a topic that I started seeing small studies on years ago, and then it kind of went quiet in the literature. With a few more studies to look at now and a focus on chronic neck pain patients in this review, the conclusion remains the same (always a good thing!) – thoracic manipulation is a reasonable option. This provides us with a reasonable treatment option in clinic for those patients who may not want their neck adjusted (also a good thing!). As I have said before, I think the combination of cervical and thoracic manipulation can be very effective in many patients as well, something many of you likely do already!“

RESEARCH REVIEW: Effectiveness of Thoracic Manipulation for Chronic Mechanical Neck Pain

This paper was published in the Journal of Pain Research (2023)

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