I am sure all of you have heard the phrase that clinical practice is ~13-18 yrs  behind what research shows is effective.  Meaning, it takes this amount of time for changes to occur clinically based on sound evidence.  This may shorten with the access to relevant research (blogs, Twitter, Pedro, etc.), but to be realistic, it probably will not.  This is like kicking a dead horse, but hasn’t ultrasound been proven to be ineffective but still in use in clinics?

On the flip side, as I am hustling out here in clinical practice, I know there is a lot of what we do that has not been documented in the research.  I think everyone who practices will agree.  Where would we be if we just relied on relevant research?

In the recent JOSPT, Dr. Salvatori and company presented a case report entitled, “Use of Thoracic Spine Manipulation on Neck Pain and Headache in a Patient Following Multiple-Level Anterior Cervical Discectomy and Fusion: A Case Report“.

The following is a quote from the introduction section (emphasizing bold),

A high percentage of patients may experience neck pain 1 year following ACDF surgical intervention.53 Previous studies evaluating the effectiveness of thoracic spine thrust manipulation have not included individuals post-ACDF, primarily due to study exclusion criteria.16,19,20,35,36,43,65 Consequently, utilization of this manual therapy technique may not be considered as routine physical therapy care, based on either postoperative protocols or lack of empirical studies to support its clinical effectiveness in this specific patient population. Therefore, the purpose of this case report was to describe the physical therapy management, which included thoracic spine thrust manipulation, and outcomes in a patient referred to physical therapy with neck pain and headache following an ACDF surgical procedure.

I am very surprised that there is no research on the use of thoracic manipulation for this subgroup of patients.  Haven’t we all performed a technique similar to this with great outcomes following ACDF?  Now granted this is low level evidence (I do like case reports), but this is what we really need in the literature.  I applaud the authors for putting this case together.  Finally, research has caught up with clinical practice.




  1. Thank you for the encouraging comments and for sharing our study. As you said, it is time for us to take a better look at the interventions we all know provide good results day in and day out. Stay tuned, we are working on a larger study on this topic!

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