Seventy-eight patients with a mean age of 42 (SD 11.3) years participated in the study. Repeated measures analyses of variance were used to examine whether achievement of >3 pops resulted in improved outcome. Individuals were then categorized as having received ≤3 or >3 pops. The relationship between the number of pops and change scores for pain, disability, and CROM was first examined using Pearson correlation coefficients. Outcomes were assessed at a 2–4 day follow-up with an 11-point numeric pain rating (NPRS), the Neck Disability Index, the patient Global Rating of Change (GROC), and measurements of cervical range of motion (CROM). The treating clinician recorded the presence or absence of a pop during each manipulation. All patients were treated with a total of 6 thrust manipulation techniques directed to the thoracic spine followed by a basic cervical range of motion exercise. In this prospective cohort study, 78 patients referred to physical therapy with mechanical neck pain underwent a standardized examination and thoracic spine manipulation treatment protocol. The purpose of this study was to determine the relationship between the number of audible pops with thoracic spinal manipulation and improvement in pain and function in patients with mechanical neck pain. Clinicians routinely consider the success of a thrust manipulation technique based on the presence or absence of an audible pop despite the lack of evidence suggesting that this pop is associated with improved outcomes.
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