CASE REPORTS CHANGES IN NECK PAIN AND ACTIVE RANGE OF MOTION AFTER A SINGLE THORACIC SPINE MANIPULATION IN SUBJECTS PRESENTING WITH MECHANICAL NECK PAIN: ACASE SERIES Ce ´sar Ferna ´ndez-de-las-Pen ˜as, PT, CO, PhD, a,b Luis Palomeque-del-Cerro, PT, DO, a Cleofa ´s Rodrı ´guez-Blanco, PT, DO, a,c Antonia Go ´ mez-Conesa, PT, PhD, d and Juan C. Miangolarra-Page, MD, PhD b ABSTRACT Objective: Our aim was to report changes in neck pain at rest, active cervical range of motion, and neck pain at end-range of cervical motion after a single thoracic spine manipulation in a case series of patients with mechanical neck pain. Methods: Seven patients with mechanical neck pain (2 men, 5 women), 20 to 33 years old, were included. All patients received a single thoracic manipulation by an experienced manipulative therapist. The outcome measures of these cases series were neck pain at rest, as measured by a numerical pain rating scale; active cervical range of motion; and neck pain at the end of each neck motion (eg, flexion or extension). These outcomes were assessed pre treatment, 5 minutes post manipulation, and 48 hours after the intervention. A repeated-measures analysis was made with parametric tests. Within-group effect sizes were calculated using Cohen d coefficients. Results: A significant ( P b .001) decrease, with large within-group effect sizes (d N 1), in neck pain at rest were found after the thoracic spinal manipulation. A trend toward an increase in all cervical motions (flexion, extension, right or left lateral flexion, and right or left rotation) and a trend toward a decrease in neck pain at the end of each cervical motion were also found, although differences did not reach the significance ( P N .05). Nevertheless, medium to large within-group effect sizes (0.5 b d b 1) were found between preintervention data and both postintervention assessments in both active range of motion and neck pain at the end of each neck motion. Conclusions: The present results demonstrated a clinically significant reduction in pain at rest in subjects with mechanical neck pain immediately and 48 hours following a thoracic manipulation. Although increases in all tested ranges of motion were obtained, none of them reached statistical significance at either posttreatment point. The same was found for pain at the end of range of motion for all tested ranges, with the exception of pain at the end of forward flexion at 48 hours. More than one mechanism likely explains the effects of thoracic spinal manipulation. Future controlled studies comparing spinal manipulation vs spinal mobilization of the thoracic spine are required. (J Manipulative Physiol Ther 2007;30:312Q320) Key Indexing Terms: Neck Pain; Manipulation; Spinal; Thoracic Vertebrae M echanical neck pain affects 45 to 54% of the general population at some time during their lives 1 and can result in severe pain and disability. 2 Further, the economic expense caused by neck disorders is extremely high, second only to low back pain costs in the United States. 3 The source of symptoms in mechanical neck pain is not completely understood, but has been purported to be related to various anatomical structures, particularly zygapophyseal or uncovertebral joints of the cervical spine. 4,5 Spinal manipulation or mobilization is commonly used in the management of mechanical neck disorders. 6,7 Furthermore, several studies have demonstrated that spinal manipulation aimed at the cervical spine is an effective intervention for patients with mechanical neck pain. 8-13 However, clinicians 312 a Professor, Escuela de Osteopatı ´a de Madrid, Madrid, Spain. b Professor, Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, Alcorco ´ n, Spain. c Professor, Department of Physical Therapy, Universidad de Sevilla, Sevilla, Spain. d Professor, Department of Physical Therapy, Universidad de Murcia, Murcia, Spain. Submit requests for reprints to: Ce ´sar Ferna ´ndez-de-las-Pen ˜as, PT,CO, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos Avenida de Atenas s/n Alcorco ´ n, 28922 Madrid, Spain (e-mails: cesarfdlp@yahoo.es, cesar.fernandez@urjc.es). Paper submitted October 20, 2006; in revised form December 9, 2006; accepted January 2, 2007. 0161-4754/$32.00 Copyright D 2007 by National University of Health Sciences. doi:10.1016/j.jmpt.2007.03.007