Effect of Upper Thoracic Manipulation on Neck Pain and Selected Muscle Activities

Inclusion Criteria:

1. Male and female subjects diagnosed and classified as having chronic non-specific NPwith mobility disorders based on clinical guidelines of NP:

• Having NP for at least 3 months that may be associated with referred shoulderor upper extremity pain (Blanpied et al., 2017; Erdem et al., 2021;Puntumetakul et al., 2015).

• Present with a limitation of cervical ROM and their pain can be provoked bysustained end-range spinal movements or positions will be included (Blanpied etal., 2017).

• Patients present with unilateral or bilateral symptoms will be included (Blanpied et al., 2017; Yang et al., 2015).

2. Age between 18-40 (J. Dunning & Rushton, 2009)

3. Negative four tests of the Wainner cluster to exclude NP with radiating pain (Wainner et al., 2003).

4. Hypomobility of at least one of the upper thoracic vertebrae (T1-T4) duringsegmental mobility assessment (Ssavedra-Hernández et al., 2011).

Exclusion Criteria:

1. Subjects diagnosed as cervical radiculopathy or myelopathy (Ssavedra-Hernández etal., 2011).

2. A history of whiplash injury, past cervical or thoracic surgery, rheumatoidarthritis, spinal fracture, heart disease, a recent significant trauma, andmeningitis (Joshi et al., 2020; Puntumetakul et al., 2015).

3. The presence of contraindications of spinal manipulation as spinal infection andspinal osteoporosis(Ssavedra-Hernández et al., 2011).