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Effects of Spinal Manipulation on Thoracic Range of Motion, Chest Expansion, and Functional Status in Patients with Thoracic Spinal Pain: A Randomized Controlled Trial

. Muhammad Sharif Waqas, Hossein Karimi , Ashfaq Ahmad, Danish Hassan, Shazia Rafiq & Amna Zia


Abstract

Purpose: To compare immediate and long-term effects of thoracic spine manipulation on thoracolumbar range of motion, functional status, and chest expansion in patients with thoracic pain.

Methods: A double-blind randomized clinical trial was conducted at Services Hospital, Lahore, Pakistan. There were 100 patients with an age range of 40–60 years included in the study after obtaining their consent. In the experimental group (n = 50), thoracic spinal manipulation was applied. The control group (n = 50) performed thoracic muscles exercises only. Thoracic mobility was measured with an inclinometer, functional status was measured by the Oswestry Disability Index, and chest expansion was measured by tape measure. Measurements were taken at baseline, after the first session, after the eighth session, and at later follow-ups after 8 and 12 weeks. Repeated measure ANOVA for in-group comparisons and the independent sample t-test for between-group comparisons were used. Intention-to-treat analysis was used to analyze the missing data due to loss of follow-up.

Results: Of the 100 enrolled patients, there were 35 male (70%) subjects in the control group and 34 males (68%) in the experimental group. The mean age of patients in the control group was 38.56±12.44 and 36.02±11.32 in the experimental group. Both groups demonstrated significant improvement in functional status, chest expansion, and thoracolumbar mobility compared to the baseline (p < 0.05) but an in-group comparison of the eighth session and results at the first and second follow-ups showed that effects of exercise persist while functional status and thoracolumbar mobility in the spinal manipulation group were significantly reduced after discontinuing treatment. The difference between both protocols was found to be a function of time. After the first and eighth sessions, spinal manipulation showed notable results, but at week 8 at the follow-up and week 12 at the second follow-up, no significant difference was observed between the study groups.

Conclusion:

Spinal manipulation and thoracic exercise together were more effective in comparison to thoracic exercises only in thoracic spine pain patients for improving their thoracic range of motion, chest expansion, and functional status at the end of 8th session of care. The addition of spinal manipulation to thoracic exercises was not advantageous or effective at the 12-week of follow-up because improvement was not sustained.

 

Keywords: Health status, Manual therapy, Range of motion, Spinal manipulation, Spinal column

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