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Effectiveness of Thoracic Spine Manipulation for Upper Quadrant Musculoskeletal Disorders: A Systematic Review
Erik J Thoomes1, Gus Tilborghs2, Nicola R Heneghan1
1Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham. United Kingdom.
Objective:
Thoracic high-velocity low-amplitude thrust (Tx-HVLAT) manipulation is a form of conservative management recommended as an effective treatment option for patients with upper quadrant musculoskeletal disorders (UQMD). This systematic review aimed to update the current evidence on the effectiveness of Tx-HVLAT for patients with UQMD on pain, disability, and performance outcome measures.
Methods:
Electronic libraries of the Cochrane Controlled Trials Register, MEDLINE, EMBASE, CINAHL, PEDro, and Index to Chiropractic Literature were searched from inception. Two review authors independently assessed the risk of bias using the Cochrane Back Review Group's recommended RoB2 tool, extracted data, and evaluated the quality of the evidence using the GRADE method. For continuous data, standardized mean differences with 95% CI were calculated. For pooling, a random-effects model was used.
Results:
Eighteen of the 26 included studies were of low RoB. The effectiveness of TxHVLAT on pain and disability for patients with neck pain, shoulder pain, cervical radiculopathy, cervicogenic headache, and temporomandibular disorders was compared to sham manipulation, thoracic mobilization, cervical HVLAT, deep neck flexor training or general conservative therapy at different follow-up times. Methodological similarities between several studies allowed meta-analysis, but statistical heterogeneity was high.
Conclusions:
There is very low to low quality evidence that TxHVLAT manipulation is more effective than sham TxHVLAT, thoracic mobilization, general conservative therapy or deep neck flexor training on pain and disability in patients with neck pain, cervical radiculopathy, cervicogenic headache, and temporomandibular disorders. TxHVLAT was also more effective than general conservative therapy in patients with shoulder pain, but not more effective than sham manipulation.
