Author Names
Haleema B, Riaz H
Reviewer Name
Paige Dewalt
Reviewer Affiliation(s)
Duke University School of Medicine, Doctor of Physical Therapy Division
Paper Abstract
Objective: To determine the effects of thoracic spine manipulation on pain pressure sensitivity of rhomboid muscles and thoracic spine mobility. Method: The randomized controlled trial was conducted at the Women Institute of Rehabilitation Sciences, Abbottabad, Pakistan, from July to December 2019, and comprised subjects aged 18-30 years having active trigger points in the rhomboid muscle. The subjects were randomized into experimental group A and control group B. The experimental group received thoracic manipulation along with conventional physical therapy, while the control group only received conventional physical therapy. The intervention lasted 2 sessions per week for 3 weeks. Pre- and post-intervention assessment was done with the numeric pain rating scale, algometry, inclinometer, and the neck disability index. Data was analyzed using SPSS 20. Results: Of the 60 subjects, there were 30(50%) in each of the two groups. There were 21(70%) females and 9(30%) males in group A with an overall mean age of 23.86±4.56 years. In group B, there were 18(60%) females and 12(40%) males, with an overall mean age of 23.93±3.96. There was a significant improvement in terms of pain (p<0.01) and pain pressure sensitivity (p<0.05). All outcome measures showed significant intra-group differences (p<0.000). Conclusion: Upper thoracic spine manipulation was found to be more effective in treating interscapular pain and pain pressure threshold of trigger points in rhomboid muscles.
NIH Risk of Bias Tool
Quality Assessment of Controlled Intervention Studies
- Was the study described as randomized, a randomized trial, a randomized clinical trial, or an RCT
- Yes
- Was the method of randomization adequate (i.e., use of randomly generated assignment)?
- Yes
- Was the treatment allocation concealed (so that assignments could not be predicted)?
- Yes
- Were study participants and providers blinded to treatment group assignment?
- No
- Were the people assessing the outcomes blinded to the participants’ group assignments?
- No
- Were the groups similar at baseline on important characteristics that could affect outcomes (e.g., demographics, risk factors, co-morbid conditions)?
- Cannot Determine, Not Reported, or Not Applicable
- Was the overall drop-out rate from the study at endpoint 20% or lower of the number allocated to treatment?
- Yes
- Was the differential drop-out rate (between treatment groups) at endpoint 15 percentage points or lower?
- Yes
- Was there high adherence to the intervention protocols for each treatment group?
- Yes
- Were other interventions avoided or similar in the groups (e.g., similar background treatments)?
- Yes
- Were outcomes assessed using valid and reliable measures, implemented consistently across all study participants?
- Yes
- Did the authors report that the sample size was sufficiently large to be able to detect a difference in the main outcome between groups with at least 80% power?
- Yes
- Were outcomes reported or subgroups analyzed prespecified (i.e., identified before analyses were conducted)?
- No
- Were all randomized participants analyzed in the group to which they were originally assigned, i.e., did they use an intention-to-treat analysis?
- Yes
Key Finding #1
A significant difference was found in pain (p=0.004) and PPT (p=0.048) post-treatment between the groups (p<0.05), while the difference was non-significant for thoracic flexion, thoracic extension, and NDI.
Key Finding #2
Intra-group analysis showed significant differences for pain, PPT, thoracic flexion, thoracic extension, and NDI in both the control and experimental group, with better results shown in the experimental group.
Key Finding #3
Further analysis showed there was a significant change (p<0.05) from baseline values in all variables except NDI (p>0.05).
Please provide your summary of the paper
This study shows that upper thoracic spine manipulation is more effective in treating interscapular pain and pain pressure sensitivity of myofascial trigger points (MTrPs) in the rhomboid muscle. Compared to manual pressure release (MPR) and general exercises (GEx) alone, the screw manipulation technique combined with MPR and GEx showed greater improvements in thoracic flexion/extension, pain pressure threshold (PPT), and the numeric pain rating scale (NPRS). MRPS and GEx included pressure applied over the identified Trp in the rhomboid until the release of tissue barrier; stretching of pectoral muscles, levator scapula, and upper trapezius; and strengthening of rotator cuff muscles and rhomboids. The screw manipulation technique used required a low amplitude, high-velocity thrust directed at the target joint to correct joint dysfunctions in the thoracic spine. It is suggested that neurophysiologic mechanisms are mainly responsible for the observed pain-modulatory effects of spinal manipulation. However, the study is not without limitations. This study was single-blind, single-center, and only the most active Trp of the rhomboid muscle was treated.
Please provide your clinical interpretation of this paper. Include how this study may impact clinical practice and how the results can be implemented.
This study shows that upper thoracic spine manipulation may be beneficial in treating interscapular pain and pain pressure sensitivity MTrPs of the rhomboid muscle. In individuals with upper back pain, a little less than half Trp are found in the rhomboids. Individuals with abnormal/poor posture, altered body biomechanics, or joint dysfunction have higher odds of myofascial pain. The above populations could show improvements in pain rating, thoracic flexion/extension, and PPT through the implementation of upper spine manipulation. Further research is needed as this was a small-scale study and may lack the external validity required to support widespread changes in practice.
