The EMU manipulation study: A randomized trial investigating the efficacy of matched or unmatched cervical/thoracic manipulations on neck pain

Introduction

Neck pain is common, and cervical and thoracic thrust joint manipulation are recommended treatments. The Cervical Thoracic Differentiation Test (CTDT) is proposed to differentiate pain of cervical or thoracic origin, but its value in guiding choice of manipulation remains unclear. This study aimed to evaluate the utility of the CTDT in selecting treatment for non-specific mechanical neck pain.

Methods

A quadruple-blinded, two-arm randomized trial enrolled adults aged 18–65 with neck pain ≥3/10. Forty participants completed the Neck Disability Index (NDI), cervical ROM (ROM), VAS for pain (rest and movement), and CTDT. They were equally allocated to a single session of either matched or unmatched manipulation based on CTDT results. Pain and ROM were assessed immediately post-manipulation and 38 participants were assessed at a one-week follow-up.

Results

Forty participants (mean age 24.8 ± 9.9 years, 51.2 % female) were included. Significant differences in the primary outcome of pain with movement were found across all time points (F_{2, 72} = 60.455, p < 0.001). Significant pain reductions were observed from pre-manipulation to immediately post-manipulation and continued at one-week. There were no differences between matched/unmatched manipulations at either time point (p > 0.05). There were no significant differences in pain at rest, NDI scores, or ROM changes between groups.

Conclusions

Both matched and unmatched manipulations significantly reduced pain with movement, with no differences based on CTDT results. In the context of a rigorously blinded trial, cervical and thoracic manipulations appear to be equally efficacious for managing neck pain regardless of CTDT outcomes, although clinical outcomes may differ.