| Summary: | 碩士 === 國立陽明大學 === 物理治療暨輔助科技學系 === 98 === Background: Neck pain is a common musculoskeletal complaint and near half of the patients may develop persistent neck pain for one year. The relationships between neck pain and abnormal posture or abnormal thoracic mobility have been postulated in the literature. Recent evidences provided in several clinical studies support the use of thoracic thrust manipulation for subjects with neck pain. Therefore, thoracic approaches become a new direction for treating patients with neck pain. Although exercises for thoracic mobility have been used to treat subjects with spinal pain in clinical practice, no studies have investigated the effects of thoracic exercises on pain reduction and/or functional improvement for subjects with neck pain. Purpose of the study: This study was to investigate the additional effects of thoracic exercises compared with the regaular physical therapy treatment program on decreasing neck pain and disability, increasing cervical and thoracic mobility, and improving posture in patients with neck pain. Methods: A single blind randomized controlled trial has been conducted. Fifty-seven patients with neck pain were randomly assigned into either the thoracic exercise (TE) group (n=28) or regular treatment (RT) group (n=29). Both groups received their regular physical therapy treatment and cervical range of motion (ROM) exercises for 12 sessions within 4 to 6 weeks. Only the TE group received additional thoracic exercises. Outcome measures included the cervical ROM, upper thoracic and thoracic ROM, static posture measurement of the forward head angle and thoracic kyphotic angle in 3 different postures (habitual posture, self-corrected posture and verbally-corrected posture), intensity of pain, perceived improvement, function, and disability. Two-way repeated measures analyses of variance with group as the between-subject variable and time as the within-subject variable were used to analyze the effects of the interventions. In order to further understand if there were patients who demonstrated better treatment effects, subgroup analyses were conducted in this study. Three types of subgroups including cervical hypomobility group, thoracic hypomoblity group and cervical and thoracic hypomobility group were identified and analyzed. Results and Discussion: The whole group analysis showed that the TE group demonstrated more improvement in cervical rotation of the restricted side and upper thoracic side-bending of the restricted side. The subgroup analysis showed that in the cervical hypomobility group the TE group showed more increase of their cervical and upper thoracic mobility than the RT group. In upper thoracic hypomobility and thoracic hypomobility subgroups, compared to the RT group, TE group showed significantly better improvement in their cervical, upper thoracic as well as thoracic mobility. Furthermore, TE group also demonstrated significantly greater reduction in pain intensity and disability and more improvement in function than the RT group. However, posture and perceived improvement were found with no significant group by time interactions in all subgroups. In summary, results of this study demonstrated that both the regular treatment program and the thoracic exercise program were effective for patients with neck pain. Patients who had more restriction of their spinal mobility benefited more from the thoracic exercise program in increasing spinal mobility, decreasing disability as well as improving function. Improvement of the upper thoracic and thoracic range of motion can help redistribute cervical joint force, and therefore, decrease neck pain and increase neck mobility. Furthermore, thoracic exercise could increase thoracic extension and side-bending mobility, and thus, contribute to the improvement of disability and function in patients with neck pain. Clinical relevance: Thoracic exercises demonstrated additional effects on improving neck pain, function and disability in patients with neck pain especially in patients who had more restriction of their spinal mobility. Physical therapists should consider adding thoracic exercises into the treatment program for neck pain when appropriate.
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