Purpose: Identify patients with neck pain who are likely to experience early success from thoracic spine thrust manipulation, exercise, and patient education.


1. Symptoms < 30 days
2. No symptoms distal to the shoulder
3. Looking up does not aggravate symptoms
4. FABQ-PA score < 12
5. Diminished upper thoracic spine kyphosis
6. Cervical extension ROM < 30 degrees


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1. Cleland JA, et al. Development of a clinical prediction rule for guiding treatment of a subgroup of patients with neck pain: use of thoracic spine manipulation, exercise, and patient education. Phys Ther. 2007; 87(1): 9-23.

2. Cleland JA, et al. Examination of a Clinical Prediction Rule to Identify Patients With Neck Pain Likely to Benefit From Thoracic Spine Thrust Manipulation and a General Cervical Range of Motion Exercise: Multi-Center Randomized Clinical Trial. Phys Ther. 2010; 90(9): 1239-1250.

2 thoughts on “Thoracic Manipulation for Neck Pain

  1. It should be pointed out that this particular CPR was found to be NOT VALID… The second reference details how the rule did not help determine which subjects would do better with thoracic manipulation. Instead, ALL subjects who got thoracic manipulation did better. This had led to the belief that all subjects with neck pain who do not have any contraindications to thoracic manipulation should receive it…. The leafy green vegetable analogy…

    Liked by 1 person

    1. Louie,

      Thanks for your comment! The next phase of this resource is to include level of evidence and validation/invalidation as the evidence currently stands. The specific emphasis will be on those CPRs that have failed to hold up under further investigation (i.e. stabilization for LBP, lumbopelvic manipulation for PFPS, ect.).


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