Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India.
Chiropr Man Therap. 2020 Aug 7;28(1):38. doi: 10.1186/s12998-020-00327-4.
Cervicothoracic (CT) junction hypomobility has been proposed as a contributing factor for neck pain. However, there are limited studies that compared the effect of CT junction mobilization against an effective intervention in neck pain. Thoracic spine manipulation is a nonspecific intervention for neck pain where remote spinal segments are treated based on the concept of regional interdependence. The effectiveness of segment-specific spinal mobilization in the cervical spine has been researched in the last few years, and no definite conclusions could be made from the previous studies. The above reasons warrant the investigation of the effects of a specific CT junction mobilization against a nonspecific thoracic manipulation intervention in neck pain. The present study aims to compare the immediate effects of C7-T1 Maitland mobilization with thoracic manipulation in individuals with mechanical neck pain presenting with CT junction dysfunction specifically.
A randomized clinical trial is conducted where participants with complaints of mechanical neck pain and CT junction dysfunction randomly assigned to either C7-T1 level Maitland mobilization group or mid-thoracic (T3-T6) manipulation group (active control group). In both the groups, the post graduate student (SJ) pursuing Master's in orthopedic physiotherapy delivered the intervention. The outcomes of cervical flexion, extension, side flexion & rotation range of motion (ROM) were measured before & after the intervention with a cervical range of motion (CROM) device. Self-reported pain intensity was measured with the numerical pain rating scale (NPRS). The post-intervention between-group comparison was performed using a one-way ANCOVA test.
Forty-two participants with mean age CT junction group: 35.14 ± 10.13 and Thoracic manipulation group: 38.47 ± 11.47 were recruited for the study. No significant differences in the post-intervention baseline adjusted outcomes of cervical ROM & self-reported pain intensity were identified between the groups after the treatment (p = 0.08, 0.95, 0.01, 0.39, 0.29, 0.27for flexion, extension, bilateral lateral flexion & rotations respectively) & neck pain intensity (p = 0.68). However, within-group, pre, and post comparison showed significant improvements in cervical ROM and pain in both groups.
This preliminary study identified that CT junction mobilization is not superior to thoracic manipulation on the outcomes of cervical ROM and neck pain when level-specific CT junction mobilization was compared with remote mid-thoracic manipulation in individuals with mechanical neck pain and CT junction dysfunction.
CTRI: 2018/04/013088, Registered 6 April 2018, http://ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=24418.
颈椎-胸（CT）交界处活动度降低被认为是导致颈部疼痛的一个因素。然而，目前很少有研究比较 CT 交界处活动度与有效的颈部疼痛干预措施的效果。胸椎脊柱推拿是非特异性干预颈部疼痛的方法，根据区域相互依存的概念，对远程脊柱节段进行治疗。近年来，对颈椎节段特异性脊柱活动度的有效性进行了研究，但之前的研究没有得出明确的结论。基于上述原因，有必要调查特定 CT 交界处活动度与颈部疼痛的非特异性胸椎推拿干预措施的效果。本研究旨在比较机械性颈部疼痛患者 CT 交界处功能障碍患者 C7-T1 迈特兰德（Maitland）活动度与胸椎推拿的即刻效果。
这是一项随机临床试验，参与者为患有机械性颈部疼痛和 CT 交界处功能障碍的患者，随机分配至 C7-T1 水平迈特兰德（Maitland）活动组或中胸椎（T3-T6）推拿组（主动对照组）。两组均由攻读骨科物理治疗硕士学位的研究生（SJ）实施干预。使用颈椎活动度（CROM）设备在干预前后测量颈椎前屈、后伸、侧屈和旋转活动度（ROM）的结果。用数字疼痛评分量表（NPRS）测量自我报告的疼痛强度。使用单向方差分析（ANCOVA）检验进行组间比较。
共招募了 42 名平均年龄为 CT 交界处组：35.14±10.13 岁和胸椎推拿组：38.47±11.47 岁的患者参与研究。治疗后，两组间的颈椎 ROM 和自我报告的疼痛强度的干预后调整后的基线结果无显著差异（p=0.08，0.95，0.01，0.39，0.29，0.27，分别为前屈、后伸、双侧侧屈和旋转）和颈部疼痛强度（p=0.68）。然而，组内比较显示，两组的颈椎 ROM 和疼痛均有显著改善。
本初步研究表明，在机械性颈部疼痛和 CT 交界处功能障碍患者中，与远程中胸椎推拿相比，当对特定 CT 交界处进行水平特异性活动度与非特异性中胸椎推拿进行比较时，CT 交界处活动度并不优于胸椎推拿。
临床试验印度注册中心：2018/04/013088，2018 年 4 月 6 日注册，http://ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=24418。
