Physical therapists utilize a number of interventions in the management of neck pain including joint manipulation (non-thrust and thrust), therapeutic exercise, traction, and a variety of modalities 5. Additionally, nearly 25% of all visits in outpatient physical therapy practice consists of patients with a primary report of neck pain 4. This results in a substantial economic burden as nearly 1/3 of patients who experience a first-time onset of neck pain will report continued healthcare utilization for their neck pain at a 10-year follow-up 3. The prevalence of neck pain is high, with nearly 70% of individuals experiencing neck pain at some point in their life and with 15–22% of individuals continuing to experience symptoms 5 years after onset 1, 2. Additionally, a greater number of audible pops experienced was not associated with a dramatic improvement with manipulation treatment. The results of this analysis provide preliminary evidence for the hypothesis that there is no relationship between the number of audible pops during thoracic spine thrust manipulation and clinically meaningful improvements in pain, disability, or CROM in patients with mechanical neck pain. The odds ratio for patients experiencing dramatic improvement was in favor of the group experiencing ≤3 pops but this was not clinically meaningful (1.3: 95% CI 0.46, 3.7). There was no significant interaction for group X time for any of the dependent measures (P>0.05). Pearson correlation coefficients revealed no significant correlation existed between the number of pops and outcomes with the exception of 3 of the 6 CROM measurements, which were inversely related. Seventy-eight patients with a mean age of 42 (SD 11.3) years participated in the study. Repeated measures analyses of variance were used to examine whether achievement of >3 pops resulted in improved outcome. Individuals were then categorized as having received ≤3 or >3 pops. The relationship between the number of pops and change scores for pain, disability, and CROM was first examined using Pearson correlation coefficients. Outcomes were assessed at a 2–4 day follow-up with an 11-point numeric pain rating (NPRS), the Neck Disability Index, the patient Global Rating of Change (GROC), and measurements of cervical range of motion (CROM). The treating clinician recorded the presence or absence of a pop during each manipulation. All patients were treated with a total of 6 thrust manipulation techniques directed to the thoracic spine followed by a basic cervical range of motion exercise. In this prospective cohort study, 78 patients referred to physical therapy with mechanical neck pain underwent a standardized examination and thoracic spine manipulation treatment protocol. The purpose of this study was to determine the relationship between the number of audible pops with thoracic spinal manipulation and improvement in pain and function in patients with mechanical neck pain. Clinicians routinely consider the success of a thrust manipulation technique based on the presence or absence of an audible pop despite the lack of evidence suggesting that this pop is associated with improved outcomes.

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