Thoracic Manipulations and Mechanical Neck Pain: Exploring the CPR. By Greg Banks

Transcription

1 Thoracic Manipulations and Mechanical Neck Pain: Exploring the CPR By Greg Banks

2 Theories of Thoracic Manipulation -Picker et. al: changes in mechanoreceptor discharge. -Analgesic response from descending pathways -Possible muscle activation in muscles adjacent to and opposite of the manipulation site. -Herzog et al: EMG responses from TSM in back muscles extending to the deltoid of the upper extremity of the side of the spine that was manipulated.

3 CPR: Thoracic Manips. for Mechanical Neck Pain The biomechanical link between the cervical spine and the thoracic spine suggest that disturbances in joint mobility in the thoracic spine may serve as an underlying contributor to the development of neck disorders.

4 CPR: Mechanical Neck Pain Con t Treatment: -6 thoracic manipulations using 3 techniques -Cervical AROM exercises for both groups

5 CPR: Mechanical Neck Pain Con t Results: -Used GROC (-7 to +7) where >/= +5 considered successful outcome -Maximum 2 sessions, results collected 2 to 4 days later -42 successful outcomes and 36 non-successful outcomes -Change in pain: 2.2 with 95% CI= NDI Score: 18.6% with 95% CI=

6 CPR: Mechanical Neck Pain Con t 6 Variables Forming parsimonious CPR: 1) Symptoms <30 days 2) No symptoms distal to the shoulder 3) Looking up does not aggravate symptoms 4) FABQPA score <12 5) Diminished upper thoracic spine kyphosis 6) Cervical extension ROM <30 deg.

7 CPR: Mechanical Neck Pain Con t Crunching Numbers: -32 out of 37 successful outcomes positive for at least 3 factors. -Of 41 patients <2 positive factors, 31 were non-successful -For 3 factors: posttest probability of success 86%

8 Problems with Study 1)How often are inclusion factors met in clinical practice? 2)Did CPR pick out correct factors or patients that would benefit from any treatment? 3)What about the longterm?

9 Examination of the CPR

10 Examination of the CPR (con t) Experimental Groups (n=70 each) 1)Manipulation + Exercise Group 2)Stretching + Strengthening Group Data Collection: At one week, 4 weeks, and 6 months

11 Examination of the CPR (con t) 6 Variables Forming parsimonious CPR: 1) Symptoms <30 days 2) No symptoms distal to the shoulder 3) Looking up does not aggravate symptoms 4) FABQPA score <12 5) Diminished upper thoracic spine kyphosis 6) Cervical extension ROM <30 deg. -CPR didn t hold water.

12 Examination of the CPR (con t) Regardless of their status on the rule, patients who received manipulation and exercise experienced greater improvements in disability and pain across time than patients who received exercise alone.

13 Examination of the CPR (con t) GROC: -Manipulation group experienced significant changes at 4 weeks and 6 months. Disability: -Manipulation group experienced significantly lower scores for disability at 1 week, 4 weeks, and 6 months.

14 Examination of the CPR (con t)

15 Examination of the CPR (con t)

16 Citations Walser, Ronald F., Brent B. Meserve, and Thomas R. Boucher. "The Effectiveness of Thoracic Spine Manipulation for the Management of Musculoskeletal Conditions: A Systematic Review and Meta-Analysis of Randomized Clinical Trials." Journal of Manual & Manipulative Therapy 17.4: Web. 28 July <file:///c:/users/greg/desktop/classes/second Year/Summer Clinical/Manip In-Service/Systematic Review Thoracic Manips.pdf>. Cleland, J. A, J. D Childs, J. M Fritz, J. M Whitman, and S. L Eberhart. "Development of a Clinical Prediction Rule for Guiding Treatment of a Subgroup of Patients With Neck Pain: Use of Thoracic Spine Manipulation, Exercise, and Patient Education." Physical Therapy 87.1 (2006): Web. 28 July < Cleland, J. A., P. E. Mintken, K. Carpenter, J. M. Fritz, P. Glynn, J. Whitman, and J. D. Childs. "Examination of a Clinical Prediction Rule to Identify Patients With Neck Pain Likely to Benefit From Thoracic Spine Thrust Manipulation and a General Cervical Range of Motion Exercise: Multi-Center Randomized Clinical Trial." Physical Therapy 90.9 (2010): Web. 28 July <