Clinical Prediction Rule: Thoracic Spine Manipulation

A patient comes into your clinic complaining of neck pain…what do you do? For some patients, treating the thoracic spine may help improve their symptoms. Cleland et al published a study in 2007 in which they published a clinical prediction rule to find a subgroup of patients whom may benefit from thoracic manipulations:

  • Symptoms <30 days
  • No symptoms distal to the shoulder
  • Looking up does not aggravate symptoms
  • FABQ <12
  • Decreased thoracic kyphosis in the upper thoracic spine
  • Cervical extension range of motion <30 degrees

Cleland found that if 3 out of 6 factors were present the probability of success was nearly 86%. While this study proved to be helpful for this subgroup of patients, it was not validated. That being said, the validation study did show that patients with mechanical neck pain who received thoracic spine manipulation and exercise exhibited significantly greater improvements in disability at both the short- and long-term follow-up periods and in pain at the 1-week follow-up compared with patients who received exercise only.

So what does this mean? Take a look a the thoracic spine; if it is justified to perform a thoracic manipulation you may get your patient better faster!


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