Evaluating the Role of Cervicothoracic Manual Therapy in Cervicogenic Pain Management: A Randomized Controlled Trial

Abstract

Introduction: Neck pain imposes a substantial physical, emotional, and financial burden worldwide. Although limited research supports the use of thoracic manual therapy in managing neck pain, clinicians often integrate upper thoracic techniques into treatment routines. This study aimed to compare the effectiveness of manual therapy applied solely to the cervical spine with that applied to both the cervical and upper thoracic regions in individuals with non-specific neck pain.

Methods: A randomized controlled trial was carried out at the Physical Therapy Department of Munir Medical Complex, Dir Lower. Participants aged 18–60 years with non-specific neck pain were randomly assigned to two groups. The control group received cervical manual therapy alone, while the experimental group underwent combined cervicothoracic manual therapy over four weeks. Pain intensity and disability were measured using the Numeric Pain Rating Scale (NPRS) and the Neck Disability Index (NDI) at baseline and after treatment. Additional treatment effects were evaluated using the Treatment Effects Questionnaire (TEQ).

Results: The participants’ mean age was 25.9 ± 9.6 years, with the majority being laborers (43.2%) and housewives (18.9%). The control group (n = 17) consisted of 82.4% males and 17.6% females, whereas the experimental group (n = 20) included 70.0% males and 30.0% females. Both groups were comparable in terms of demographic and baseline clinical characteristics (P > 0.05). Post-treatment findings revealed significant improvements in both groups; however, the experimental group demonstrated greater reductions in pain (from 5.55 ± 1.19 to 1.30 ± 0.97, P < 0.001) and disability (from 20.4 ± 7.78 to 7.50 ± 5.52, P < 0.001) compared to the control group (P = 0.02 and P = 0.03, respectively). TEQ outcomes showed no significant intergroup differences (P > 0.05), suggesting that manual therapy yields beneficial effects irrespective of the targeted spinal region.

Conclusion: Combining cervical and thoracic manual therapy provides superior improvement in pain and functional outcomes compared to cervical manual therapy alone in patients with non-specific neck pain.