Effectiveness of cervicothoracic and thoracic manual physical therapy in managing upper quarter disorders – a systematic review

ABSTRACT

Study Design

Systematic review.

Background

Physical therapists often use cervicothoracic and thoracic manual techniques to treat musculoskeletal disorders of the upper quarter ,however, the overall effectiveness of this approach remains to be elucidated.

Objective

This systematic review explored studies that examined the short- and long-term effectiveness of manual physical therapy directed at the cervicothoracic and thoracic region in the management of upper quarter musculoskeletal conditions.

Methods

The electronic databases MEDLINE, AMED, CINAHL, and Embase were searched from their inception through 30 October 2020. Eligible clinical trials included those where human subjects treated with cervicothoracic and/or thoracic manual procedures were compared with a control group or other interventions. The methodological quality of individual studies was assessed using the PEDro scale.

Results

The initial search returned 950 individual articles. After the screening of titles and abstracts, full texts were reviewed by two authors, with 14 articles determined to be eligible for inclusion. PEDro scores ranged from 66 to 10 (out of a maximum score of 10). In the immediate to 52-week follow-up period, studies provided limited evidence that cervicothoracic and thoracic manual physical therapy may reduce pain and improve function when compared to control/sham or other treatments.

Conclusions

Evidence provides some support for the short-termeffectiveness of cervicothoracic and thoracic manual physical therapy in reducing pain and improving function in people experiencing upper quarter musculoskeletal disorders. Evidence is lacking for long-term effectiveness as only two studies explored outcomes beyond 26 weeks and this was for patient-perceived improvement.

Prospero ID

CRD42020219456

KEYWORDS:

• Thoracic spine
• Manipulation
• Upper quarter

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Notes on contributors

Ronald Schenk

Ron Schenk PT, PhD, OCS, Dip MDT, FAAOMPT, is a clinical professor and serves as core faculty in the Doctor of Physical Therapy Program at Tufts University School of Medicine where he coordinates and teaches in the musculoskeletal curricular track. His clinical research is in the area of spine pain examination and management. Dr. Schenk received his bachelor's and master's degrees from Ithaca College and his PhD from the University at Buffalo. Ron is a Fellow of the AAOMPT and is a Diplomat in Mechanical Diagnosis and Therapy. He has taught musculoskeletal examination and intervention in professional and post-professional physical therapy programs for 30 years on a full-time basis and his scholarship includes 33 peer-reviewed publications, a book chapter, and 68 professional presentations delivered at national and international conferences. He has received the American Academy of Orthopaedic Manual Physical Therapists’ Freddy Kaltenborn “Teach I Must” Award, the Mike Hage Lecture Award from the Rehabilitation Institute of Chicago, and the McKenzie Institute International Extension Award.

Megan Donaldson

Megan Donaldson PT, PhD, FAAOMPT, serves as the Program Director for the Doctor of Physical Therapy Program at Tufts University School of Medicine. She completed her bachelor’s and master's degrees at D’Youville College and her PhD from Nova Southeastern University and is a Fellow American Academy of Orthopaedic Manual Physical Therapists. She has been a faculty member for 13 years and has 25 peer-reviewed publications, two book chapters, over 50 presentations musculoskeletal health and manual therapy related topics nationally. She serves nationally as the Conference Coordinator/Chair and Executive Board member of the American Academy of Orthopaedic Manual Physical Therapists (AAOMPT), and the American Physical Therapy Association (APTA) as an Ohio Delegate. Dr. Donaldson has earned numerous awards for research, education, and professional service to include being named Ohio Physical Therapy Association Outstanding PT Award, and Chamber of Commerce Award Top 20 under 40.

Jennifer Parent-Nichols

Jennifer Parent-Nichols, DPT, EdD, is a physical therapist and is certified as a Pediatric Clinical Specialist by the American Board of Physical Therapy Specialties, where she also serves a Council member. She has earned certification as a brain injury specialist and provides educational series for the Brain Injury Association of New Hampshire. She has worked extensively in pediatrics with experience in early intervention, school-based and outpatient therapy, and adolescent sports medicine. Dr. Parent-Nichols has taught in higher education since 2012, is a Clinical Associate Professor, and currently serves as Director of Student Affairs for the Doctor of Physical Therapy Program at Tufts University School of Medicine. Her areas of research include neurology, pediatrics, and education.

Mark Wilhelm

Mark Wilhelm PT, DPT, PhD, serves as the Director of Admissions and core faculty in the Doctor of Physical Therapy Program at Tufts University School of Medicine. He completed his Bachelor of Science in Exercise Science from the University of Akron, and his Doctor of Physical Therapy from Walsh University in Ohio. Dr. Wilhelm completed his Doctor of Philosophy in Rehabilitation Sciences from Texas Tech University Health Sciences Center. He received the Dean’s Excellence in Research Award for the School of Health Professions for his clinical musculoskeletal rehabilitation research and support area of clinical biomechanics research. Dr. Wilhelm’s scholarship includes over 20 peer reviewed journal articles and he has co-authored two book chapters.

Alexis Wright

Alexis A. Wright PT, PhD, DPT, OCS, FAAOMPT, serves as the Director of Curriculum and Assessment and core faculty in the Doctor of Physical Therapy Program at Tufts University School of Medicine. Dr. Wright received her BS in Kinesiology from the University of Illinois at Urbana-Champaign in 2003, a Doctorate of Physical Therapy from Duke University in 2006, and a PhD in physical therapy clinical research from the University of Otago, New Zealand in 2010. Dr. Wright was recognized as a Fellow of the American Academy of Orthopaedic Manual Physical Therapists in 2011 and achieved APTA board certified orthopedic specialization in 2015. Dr. Wright is also a 2019 graduate of the Education Leadership Institute Fellowship through the APTA. Dr. Wright is a frequent research presenter at state, national, and international meetings and a productive author with over 45 peer-reviewed manuscripts in the areas of orthopedics and manual therapy. Dr. Wright currently serves as the Deputy Editor of Physical Therapy Reviews as well as two journal editorial boards and acts as a reviewer for a number of other international and national peer-reviewed journals. Dr. Wright currently serves as a content expert item writer for the Orthopaedic Speciality Council of the American Board of Physical Therapy Specialties. She also currently serves on the APTA Lecture Awards Subcommittee and previous roles included APTA Awards Committee and Nominating Committee Chair of the American Academy of Orthopaedic Manual Physical Therapists. Dr. Wright is a 2007 recipient of the Emerging Leader Award for the American Physical Therapy Association and a 2012 recipient of the Dorothy Briggs Memorial Scientific Inquiry Award for the American Physical Therapy Association.

Joshua A. Cleland

Josh ClelandPT, PhD, FAAOMPT, FAPTA, serves as the Director of Research and Faculty Development and core faculty in the Doctor of Physical Therapy Program at Tufts University School of Medicine. Dr. Cleland earned a Master of Physical Therapy degree from Notre Dame College and a Doctor of Physical Therapy degree from Creighton University. He received a PhD from Nova Southeastern University. He also received board certification from the American Physical Therapy Association as an Orthopaedic Clinical Specialist and completed a fellowship in manual therapy through Regis University in Denver, CO. Dr. Cleland has received over $700,000 in grant funding for clinical trials investigating the effectiveness of manual physical therapy and exercise in the management of spine and extremities disorders. He has published over 280 manuscripts in peer-reviewed journals and is an Editor for the Journal of Orthopaedic and Sports Physical Therapy. He is currently an author/editor on four textbooks, one of which has been published in nine different languages. Dr. Cleland is a well-known speaker at both the national and international levels and has delivered more than 225 keynote lectures and presentations in over 25 different countries. He is the recipient of numerous awards from the American Physical Therapy Association including the Jack Walker Award, the Eugene Michels New Investigator Award, the Chattanooga Research Award, the Rothstein Golden Pen Award for Scientific Writing, the Dorothy Baethke-Eleanor J. Carlin Award for Excellence in Academic Teaching and the Catherine Worthingham Fellowship Award. Additionally, he also received the 2013, 2014 and 2015 Rose Excellence in Research Award from the Academy of Orthopaedic Physical Therapy.