Short-term effects of spinal thrust joint manipulation on postural sway in patients with chronic mechanical neck pain: a randomized controlled trial.

Intervention: Upper cervical spine manipulation; A single high velocity low amplitude (HVLA) thrust manipulation directed to the upper cervical spine (C1-C2) with the patient supine will be performed. For this technique, the patient’s left posterior arch of the atlas is contacted with the lateral aspect of the proximal phalanx of the therapist’s left second finger using a “cradle hold.” To localize the forces to the left C1-C2 articulation, secondary movements of extension, posterior-anterior shift, ipsilateral side-bend, and contralateral side-shift are used. While maintaining the secondary movements, the therapist perform a single HVLA thrust manipulation to the left atlanto-axial joint, using the combined thrusting primary movements of right rotation in an arc toward the underside eye and translation toward the table. This will be repeated using the same procedure but directed to the right C1-C2 articulation. All the interventions will be carried out by an experienced physiotherapist with a five-year certification in spinal manipulation therapy, a degree in physiotherapy, and more than 9 years of clinical experience with patients. The application of the techniques will take no longer than 5 minutes and they will be supervised by another experienced physiotherapist. Prior to the intervention, all participants will sign the informed consent.