Regional interdependence and manual therapy directed at the thoracic spine
Open accessAbstract
Thoracic spine manipulation is commonly used by physical therapists for the management of patients with upper quarter pain syndromes. The theoretical construct for using thoracic manipulation for upper quarter conditions is a mainstay of a regional interdependence (RI) approach. The RI concept is likely much more complex and is perhaps driven by a neurophysiological response including those related to peripheral, spinal cord and supraspinal mechanisms. Recent evidence suggests that thoracic spine manipulation results in neurophysiological changes, which may lead to improved pain and outcomes in individuals with musculoskeletal disorders. The intent of this narrative review is to describe the research supporting the RI concept and its application to the treatment of individuals with neck and/or shoulder pain. Treatment utilizing both thrust and non-thrust thoracic manipulation has been shown to result in improvements in pain, range of motion and disability in patients with upper quarter conditions. Research has yet to determine optimal dosage, techniques or patient populations to which the RI approach should be applied; however, emerging evidence supporting a neurophysiological effect for thoracic spine manipulation may negate the need to fully answer this question. Certainly, there is a need for further research examining both the clinical efficacy and effectiveness of manual therapy interventions utilized in the RI model as well as the neurophysiological effects resulting fr…
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The link between the upper cervical spine and temporomandibular joint dysfunction has led manual therapists to evaluate the principle of regional interdependence, which implies that successful outcomes can be achieved by treating areas remote from the symptomatic site.
“The link between the upper cervical spine and TMJ dysfunction has led manual therapists to evaluate the principle of regional interdependence, implying that successful outcomes can be achieved by treating areas remote from the symptomatic site.53”
Temporomandibular dysfunction has been associated with poor quality of sleep and exposure to stressful life events, especially when pain is of muscular origin.
“Temporomandibular dysfunction has been associated with poor quality of sleep53 and exposure to stressful life events, especially when pain is of muscular origin.54”
Cites
Musculoskeletal pain in the Netherlands: prevalences, consequences and risk groups, the DMC3-study
Picavet, H. S. J., & Schouten, J. S. A. G. (2003) · Pain · doi:10.1016/s0304-3959(02)00372-x · Cited by 1,197 · see citing works
Bialosky, J. E., Bishop, M. D., Robinson, M. E., Zeppieri, G., & George, S. Z. (2009) · Physical Therapy · doi:10.2522/ptj.20090058 · Cited by 163 · see citing works
Walser, R. F., Meserve, B. B., & Boucher, T. R. (2009) · Journal of Manual & Manipulative Therapy · doi:10.1179/106698109791352085 · Cited by 98 · see citing works
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Lam, A. C., Liddle, L. J., & MacLellan, C. L. (2023) · Archives of Rehabilitation Research and Clinical Translation · doi:10.1016/j.arrct.2022.100242 · Cited by 14 · see citing works
“The link between the upper cervical spine and TMJ dysfunction has led manual therapists to evaluate the principle of regional interdependence, implying that successful outcomes can be achieved by treating areas remote from the symptomatic site.(53) Clinicians therefore often consider the cervical spine as a potential…”
Background
- Authors
- McDevitt, A., Young, J., Mintken, P., & Cleland, J.
- Affiliations
- University of Colorado Anschutz (US)
- Franklin Pierce University (US)
- Corresponding author
- McDevitt, Amy
- Venue
- Journal of Manual & Manipulative Therapy
- Publisher
- Informa UK Limited
- Published
- 2015-03-27
- Volume
- 23
- Issue
- 3
- Pages
- 139-146
- ISSN
- 1066-9817 (ISSN-L)
- 2042-6186
- PMC
- PMC4534849
- OpenAlex
- W2008058736
- Cited by
- 57
- References
- 3
- Citations by year
- 2026: 6 · 2025: 8 · 2024: 3 · 2023: 7 · 2022: 8 · 2021: 6 · 2020: 8 · 2019: 2 · 2018: 1 · 2017: 2 · 2016: 4 · 2015: 1 · 2014: 1
- FWCI
- 1.92
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Manual & Manipulative Therapy (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Cell Biology › Myofascial pain diagnosis and treatment
- Health Sciences › Medicine › Surgery › Shoulder Injury and Treatment
- Keywords
- regional interdependence, thoracic spine manipulation, manual therapy, neck pain, shoulder pain, neurophysiological mechanisms, thrust manipulation, range of motion, disability
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