Chronic Neck PainNCT06926738
Effect of Upper Thoracic Manipulation on Neck Pain and Selected Muscle Activities
A study testing Upper Thoracic Manipulation in people with Chronic Neck Pain, run by Cairo University at 2 sites in Egypt.
Trial summary
This study will investigate the immediate and short-term effects of upper thoracic manipulation versus sham upper thoracic manipulation on Pain intensity, Cervical ROM, the myoelectric activity of the sternocleidomastoid muscle and upper trapezius muscle during Maximum voluntary isometric contraction. Read more about this study
- Who is it for?
- Ages 18 to 40 years
- Conditions the study is for
- Chronic Neck Pain
- What is being tested?
- Upper Thoracic Manipulation
- Could I receive a placebo?
- Yes, some participants may receive a placebo
- How many people
- 42 participants
- Where
- 2 sitesEgypt
- Study dates
- 15 Apr 2025to 1 Feb 2026
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 to 40 years
- All sexes
- No healthy volunteers
- Adult
Who may be able to join
- Male and female subjects diagnosed and classified as having chronic non-specific NP with mobility disorders based on clinical guidelines of NP:
- Having NP for at least 3 months that may be associated with referred shoulder or 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 by sustained end-range spinal movements or positions will be included (Blanpied et al., 2017).
- Patients present with unilateral or bilateral symptoms will be included (Blanpied et al., 2017; Yang et al., 2015).
- Age between 18-40 (J. Dunning \& Rushton, 2009)
- Negative four tests of the Wainner cluster to exclude NP with radiating pain (Wainner et al., 2003).
- Hypomobility of at least one of the upper thoracic vertebrae (T1-T4) during segmental mobility assessment (Ssavedra-Hernández et al., 2011).
Who cannot join
- Subjects diagnosed as cervical radiculopathy or myelopathy (Ssavedra-Hernández et al., 2011).
- A history of whiplash injury, past cervical or thoracic surgery, rheumatoid arthritis, spinal fracture, heart disease, a recent significant trauma, and meningitis (Joshi et al., 2020; Puntumetakul et al., 2015).
- The presence of contraindications of spinal manipulation as spinal infection and spinal osteoporosis(Ssavedra-Hernández et al., 2011).
Trial locations and contacts
2 sites in 1 country.
Egypt2 sites
CairoU
Giza, 12611
Faculty of Physical Therapy, Cairo University
Giza, 12611
About this study
Official title: Effect of Upper Thoracic Spine Manipulation on Cervical Symptoms and Selected Muscle Activities in Chronic Mechanical Neck Pain
This study will investigate the immediate and short-term effects of upper thoracic manipulation versus sham upper thoracic manipulation on Pain intensity, Cervical ROM, the myoelectric activity of the sternocleidomastoid muscle and upper trapezius muscle during Maximum voluntary isometric contraction.
Read the detailed description
This study will investigate the immediate and short-term effects of upper thoracic manipulation versus sham upper thoracic manipulation on Pain intensity measured by the visual analogue scale, Cervical ROM measured by CROM, the myoelectric activity of the sternocleidomastoid muscle and upper trapezius muscle during Maximum voluntary isometric contraction measured by Neuro-Soft using surface electrodes. All outcomes will be measured Pre-intervention, Immediately Post-Intervention, One-week Post-intervention, Two-week post-intervention.
- Conditions
- Chronic Neck Pain
- Being tested
- Upper Thoracic Manipulation, Sham Comparison
- Keywords
- Neck Pain, Thoracic manipulation, Manual Therapy, Neck pain with Mobility Deficits, Muscle activity
- Medical subject headings
- Neck Pain
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Upper Thoracic ManipulationOther
Segmental mobility will be assessed using posteroanterior central vertebral pressure and posteroanterior unilateral vertebral pressure. It will be done while the patient lies in a prone position and the examiner stands at the level of the patient's head.
Afterwards, the subjects in the thoracic manipulation group will be asked to lie in a prone position on a standard examination table and they were marked on both sides of the zygapophyseal joint of the selected segments including levels from T1- T4. Subjects will then be instructed to perform deep inhalation and exhalation and at the end of exhalation, the Clinician will perform thoracic manipulation (screw thrust technique) at the selected segmental level/s. This maneuver will be repeated for a maximum of two attempts in case of no hearing of a pop sound. It will be performed by an experienced physiotherapist with more than 10-year experience.
Sham ComparisonOther
Segmental mobility will be assessed using posteroanterior central vertebral pressure and posteroanterior unilateral vertebral pressure. It will be done while the patient lies in a prone position and the examiner stands at the level of the patient's head.
Afterwards, the subjects in the thoracic manipulation group will be asked to lie in a prone position on a standard examination table and they were marked on both sides of the zygapophyseal joint of the selected segments including levels from T1- T4. Subjects will then be instructed to perform deep inhalation and exhalation and at the end of exhalation, the Clinician will just the place the hands on the selected levels in the same hand placement of Thoracic manipulation group (screw thrust technique) without applying the manipulation. It will be performed by an experienced physiotherapist with more than 10-year experience.
| Study group | Role | What they receive |
|---|---|---|
| Upper thoracic manipulation group | Experimental | The Patients in this group will receive Upper Thoracic Manipulation. Receives: Other: Upper Thoracic Manipulation |
| Sham Upper Thoracic Manipulation | Sham comparator | The patients in this group will receive the sham upper thoracic manipulation. Receives: Other: Sham Comparison |
What is being measured
The primary outcome is the main question the study is designed to answer.
Pain intensity
A hard copy of the Visual analogue scale will be given to the patient who will be asked to mark a perpendicular line between the two borders of the scale to express his/her pain level.
It will be measured pre-treatment, post-treatment, and each week for 2 weeks. The level of pain will be measured at the end range of active extension.
Measured: Pre-intervention, Immediately Post-Intervention, One-week Post-intervention, Two-week post-intervention.
Secondary outcomes (3)
Cervical Range of Motion
The cervical ROM measurements will be performed with the participants sitting on a chair with instructions to sit in an upright posture. Prior to starting measurement, the patient will be asked to do these movements 5 times in each direction for familiarization and as a warm-up.
The participant will sit erect with the thoracic spine away from the back of the chair, arms hanging at the sides, and feet flat on the floor. The participants were instructed to stare at a spot marked on a wall in front of them.
Flexion, Extension, right and left side bending and rotation will be measured. Each measurement will be repeated for total three times.
Measured: Pre-intervention, Immediately Post-Intervention, One-week Post-intervention, Two-week post-intervention.
Sternocleidomastoid muscle activity
Regarding EMG measurement of the sternocleidomastoid, the electrodes will be positioned over the sternocleidomastoid muscle at half the distance between the mastoid process of the temporal bone and the jugular notch of the sternum, slightly posterior to the center of the belly of the muscle, and parallel to the muscle fibers. The reference electrode will be attached to the proximal portion of the sternum with tape.
Each participant will perform three 5-s MVIC for each muscle. Each subject will be asked to increase the force against the assessor's hand, reach the maximum effort, and hold it for EMG recording. The mean value of the three trials for the maximal contraction in each muscle will be taken.
The patient will be supine lying and fully rested for the measurement of the SCM activity. To measure the MVIC of the Sternocleidomastoid muscle, the patient will be asked to flex the cervical spine against maximal resistance from the examiner on the forehead area while supine lying
Measured: Pre-intervention, Immediately Post-Intervention, One-week Post-intervention, Two-week post-intervention.
Upper trapezius muscle activity
The Patient will be sitting in a chair with erect posture, hands supported on the thighs, feet parallel and supported on the floor, and eyes open for measurement of the upper trapezius muscle activity. The active and the reference electrodes will be placed 2 cm lateral to the midpoint between C7 and posterior acromion with 2 cm inter-electrode distance and ground placed on C7.
Each participant will perform three 5-s MVIC for each muscle. Each subject will be asked to increase the force against the assessor's hand, reach the maximum effort, and hold it for EMG recording. The mean value of the three trials for the maximal contraction in each muscle was taken as the MVIC. The rest time between each maximum contraction will be 30 seconds. To measure the MVIC of the upper trapezius muscle, the patient will be asked to abduct his/her shoulder to 90 degrees with the elbow fully extended against maximum resistance which will be applied superior to the elbow to resist abduction.
Measured: Pre-intervention, Immediately Post-Intervention, One-week Post-intervention, Two-week post-intervention.
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted15 Apr 2025
- Study start15 Apr 2025
- Primary completion1 Feb 2026
- Study completion1 Feb 2026
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Chronic Neck PainStudies of the same condition, open and under way.
- More trials run by Cairo UniversityThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind
- Who is masked
- Participant
- Enrolment
- 42 participants (actual)
Sponsor and investigators
- Lead sponsor
- Cairo University
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Mohamed Nagy Hassan Abdelhamid, Cairo University
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT06926738
- Sponsor's protocol ID
- Upper thoracic manipulation
- Status last verified
- Jan 2025
- First submitted
- 5 Apr 2025
- Last updated
- 3 Mar 2026
- Results posted
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Study at a glance
From the registry record, last updated by the sponsor on 3 Mar 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Effect of Upper Thoracic Spine Manipulation on Cervical Symptoms and Selected Muscle Activities in Chronic Mechanical Neck Pain
- ClinicalTrials.gov ID
- NCT06926738
- Acronym / sponsor ID
- Upper thoracic manipulation
- Conditions
- Chronic Neck Pain
- Keywords
- Neck Pain, Thoracic manipulation, Manual Therapy, Neck pain with Mobility Deficits, Muscle activity
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 42 participants (actual)
- Lead sponsor
- Cairo UniversityUniversity, hospital or other
- Study start
- 15 Apr 2025 (actual)
- Primary completion
- 1 Feb 2026 (actual)
- Study completion
- 1 Feb 2026 (actual)
- First posted
- 15 Apr 2025 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
This study will investigate the immediate and short-term effects of upper thoracic manipulation versus sham upper thoracic manipulation on Pain intensity, Cervical ROM, the myoelectric activity of the sternocleidomastoid muscle and upper trapezius muscle during Maximum voluntary isometric contraction.
Detailed description
This study will investigate the immediate and short-term effects of upper thoracic manipulation versus sham upper thoracic manipulation on Pain intensity measured by the visual analogue scale, Cervical ROM measured by CROM, the myoelectric activity of the sternocleidomastoid muscle and upper trapezius muscle during Maximum voluntary isometric contraction measured by Neuro-Soft using surface electrodes. All outcomes will be measured Pre-intervention, Immediately Post-Intervention, One-week Post-intervention, Two-week post-intervention.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind (participant)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Upper thoracic manipulation group | Experimental | Other: Upper Thoracic ManipulationThe Patients in this group will receive Upper Thoracic Manipulation. |
| Sham Upper Thoracic Manipulation | Sham comparator | Other: Sham ComparisonThe patients in this group will receive the sham upper thoracic manipulation. |
Who may qualify
- Ages
- 18 to 40 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult
Key inclusion criteria (7 listed)
- Male and female subjects diagnosed and classified as having chronic non-specific NP with mobility disorders based on clinical guidelines of NP:
- Age between 18-40 (J. Dunning \& Rushton, 2009)
- Negative four tests of the Wainner cluster to exclude NP with radiating pain (Wainner et al., 2003).
- Hypomobility of at least one of the upper thoracic vertebrae (T1-T4) during segmental mobility assessment (Ssavedra-Hernández et al., 2011).
Key exclusion criteria (3 listed)
- Subjects diagnosed as cervical radiculopathy or myelopathy (Ssavedra-Hernández et al., 2011).
- A history of whiplash injury, past cervical or thoracic surgery, rheumatoid arthritis, spinal fracture, heart disease, a recent significant trauma, and meningitis (Joshi et al., 2020; Puntumetakul et al., 2015).
- The presence of contraindications of spinal manipulation as spinal infection and spinal osteoporosis(Ssavedra-Hernández et al., 2011).
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Upper Thoracic ManipulationSegmental mobility will be assessed using posteroanterior central vertebral pressure and posteroanterior unilateral vertebral pressure. It will be done while the patient lies in a prone position and the examiner stands at the level of the patient's head. Afterwards, the subjects in the thoracic manipulation group will be asked to lie in a prone position on a standard examination table and they were marked on both sides of the zygapophyseal joint of the selected segments including levels from T1- T4. Subjects will then be instructed to perform deep inhalation and exhalation and at the end of exhalation, the Clinician will perform thoracic manipulation (screw thrust technique) at the selected segmental level/s. This maneuver will be repeated for a maximum of two attempts in case of no hearing of a pop sound. It will be performed by an experienced physiotherapist with more than 10-year experience. | Other | Upper thoracic manipulation group |
| Sham ComparisonSegmental mobility will be assessed using posteroanterior central vertebral pressure and posteroanterior unilateral vertebral pressure. It will be done while the patient lies in a prone position and the examiner stands at the level of the patient's head. Afterwards, the subjects in the thoracic manipulation group will be asked to lie in a prone position on a standard examination table and they were marked on both sides of the zygapophyseal joint of the selected segments including levels from T1- T4. Subjects will then be instructed to perform deep inhalation and exhalation and at the end of exhalation, the Clinician will just the place the hands on the selected levels in the same hand placement of Thoracic manipulation group (screw thrust technique) without applying the manipulation. It will be performed by an experienced physiotherapist with more than 10-year experience. | Other | Sham Upper Thoracic Manipulation |
Primary outcome
Pain intensity
Time frame: Pre-intervention, Immediately Post-Intervention, One-week Post-intervention, Two-week post-intervention.
A hard copy of the Visual analogue scale will be given to the patient who will be asked to mark a perpendicular line between the two borders of the scale to express his/her pain level. It will be measured pre-treatment, post-treatment, and each week for 2 weeks. The level of pain will be measured at the end range of active extension.
3 secondary outcomes
Cervical Range of Motion
Time frame: Pre-intervention, Immediately Post-Intervention, One-week Post-intervention, Two-week post-intervention.
Sternocleidomastoid muscle activity
Time frame: Pre-intervention, Immediately Post-Intervention, One-week Post-intervention, Two-week post-intervention.
Upper trapezius muscle activity
Time frame: Pre-intervention, Immediately Post-Intervention, One-week Post-intervention, Two-week post-intervention.
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 3 Mar 2026.
- Individual participant dataSharing planned: No
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
The record lists no contact. Use the official record to reach the sponsor.
2 sites in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Upper Thoracic Manipulation in people with Chronic Neck Pain, run by Cairo University at 2 sites in Egypt.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 7 inclusion and 3 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 3 Mar 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 2 sites in Egypt. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Pain intensity (time frame: Pre-intervention, Immediately Post-Intervention, One-week Post-intervention, Two-week post-intervention.). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 3 Mar 2026; AzTrials last refreshed its copy on 6 Nov 2026.