Immediate and Short-term Effects of Thoracic Spine Manipulation in Patients with Cervical Radiculopathy: A Randomized Controlled Trial

by Sarah Voelkel Feierstein PT, DPT, OCS, CMPT


The use of thoracic spine manipulation is supported in literature for use on patients with neck pain. However, there is limited evidence for its use in patients with neck and arm pain due to cervical radiculopathy. The authors in the study, Immediate and Short-term Effects of Thoracic Spine Manipulation in Patients with Cervical Radiculopathy: A Randomized Controlled Trial, observed the immediate and short-term effects of upper and mid-thoracic manipulation on neck and upper extremity pain, patient-perceived symptoms, neck disability, cervical active range of motion (AROM), deep neck flexor muscle endurance, upper extremity numbness and tingling, and symptom distribution.


Patients who were clinically diagnosed with cervical radiculopathy and who had a neck disability index (NDI) score of 10/50 or greater were recruited for the study. Patients were randomized into either a treatment (manipulation) group or a control group (sham manipulation). A total of 22 patients were placed in the treatment group and 21 in the control group. The manipulation group received a high-velocity, low-amplitude thrust manipulation bilaterally to the upper thoracic and mid thoracic spine. The sham manipulation was performed with a slightly different technique where the therapist’s fingers were extended on the thoracic segment and no thrust manipulation was performed. Both groups were instructed to resume normal activities until the next visit, with no home exercise or advice.

The primary outcomes were self-reported pain on the numeric pain-rating scale and changes in perceived improvement on the global rating of change scale (GROC). The secondary outcomes were disability using the neck disability index (NDI), cervical AROM, deep neck flexor muscle endurance, and patient-reported numbness, tingling, and distribution of symptoms.


There was a significant reduction in neck and upper extremity pain at 24- and 72-hours post-treatment in the intervention group. There was moderate improvement in the manipulation group of GROC scores at both time points. Improvements in secondary outcomes in the manipulation group were also evident on the NDI, deep neck flexor endurance test, and active cervical ROM in all motions except sidebending to the opposite side.


Patients who received thoracic manipulation as compared to the sham manipulation had greater improvements in neck pain, neck-related disability, and cervical impairments (ROM and deep neck flexor endurance) immediately and up to 48 to 72 hours after treatment. Fourteen (64%) of the participants in the manipulation group reported centralization of symptoms at 48 to 72 hours.


Patients that received the manipulation experienced improved pain, disability, cervical ROM, and deep neck flexor endurance compared to those patients in the control group.

Physical Therapy First Implications

Physical Therapy First therapists are highly trained in clinically diagnosing cervical radiculopathy in the presence of neck and arm pain. Our therapists are also proficient at performing thrust manipulations of the upper and mid thoracic spine in the treatment of cervical radiculopathy. If you are experiencing neck pain, arm pain, numbness, or tingling, physical therapy is a great option for diagnosis, management, and treatment of your symptoms.


Young, I., Pozzi, F., Dunning, J., Linkonis, R., Michener, L (2019). Immediate and Short-term Effects of Thoracic Spine Manipulation in Patients With Cervical Radiculopathy: A Randomized Controlled Trial. Journal of Orthopedic and Sports Physical Therapy. Vol 49, No 5, Pages 299-309.