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NCT Number: NCT07063992

Effects of Thoracic Spine Manipulation With and Without Costovertebral Joint Manipulation in Patients Mid-back Pain

Mid-back pain (mbp) is defined as pain occurring within the limits of the third thoracic (T3) and ninth thoracic (T9) vertebrae, caused by the dysfunction of the musculoskeletal structures in the thoracic spine. It can present as pain and/or burning between the shoulder blades with reduced thoracic spine mobility and increased muscle tension. Congenital disorders such as scoliosis and Scheuermann's disease, or acquired disorders such as thoracic facet and costovertebral joint dysfunction may cause mid back pain.

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Key information

Conditions

Back Pain Neurologic Manifestations Pain Pathological Conditions, Signs and Symptoms Signs and Symptoms

Age range

18 year–45 year

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

Sehat Medical Complex

Lahore, Punjab Province, 54000, Pakistan

Location contact

Waseem Javaid, PhD Scholar

CONTACT

[email protected]

03457881133

About this study

Participants aged 18-45 years with non-specific mid-back pain will be randomly assigned to receive either thoracic spine manipulation alone or in combination with costovertebral joint manipulation. Primary outcomes will include pain intensity measured by the Numeric Pain Rating Scale (NPRS), while secondary outcomes will involve thoracic spine range of motion measured by Bubble Inclinometer, and functional disability assessed by the Oswestry Disability Index (ODI). Statistical analysis will be performed using the statistical software IBM SPSS Statistics SPSS 25.0 for calculations. This study aims to provide evidence-based insights into the relative benefits of these manual therapy techniques, potentially informing clinical practice and enhancing treatment outcomes for patients with non-specific mid-back pain.

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • Participants will be between 18 - 45 years of age
  • For this study, mid-back pain included all the following signs and symptoms:
  • Sharp, shooting, or aching mid-back pain
  • Mid back pain experienced during deep inspiration, sneezing, and/or coughing

Exclusion criteria

  • Individuals who did not sign or understand the letter of informed consent
  • Individuals with contraindications to manipulation in the thoracic spine (15)
  • Weakened bone due to: Osteoporosis, Infection and Neoplasm

Treatment and study plan

thoracic facet manipulations

Other

Group A will receive thoracic facet manipulations of the restricted segments between T3 to T9, in the prone position and cephalic direction. The duration of the intervention will be followed by 4 weeks 3 sessions each week and pre- and post-intervention observations will be recorded.

Bilateral hypothenar Cross bilateral hypothenar manipulationThese flexibility exercises will be targeted for

  • Rhomboid and middle trapezius stretching (2-3 times daily; 3 sets for 30 seconds))
  • Pectoralis muscle stretch in a corner (2-3 times daily; 3 sets for 30 seconds)
  • Prone on the elbow with upper thoracic extension exercise (2-3 times daily; 3 sets for 30 seconds) .

The postural exercises will be the following

  • Postural strengthening/ stabilization with back to a wall. The participant will press their arms into the wall while retracting scapulae.
  • Trunk rotation stretching in the sitting position

thoracic facet and costovertebral manipulations

Other

Group B will receive thoracic facet and costovertebral manipulations of the restricted segments between T3 to T9 and ribs 3 to 9 (costovertebral joints), in the prone position. The duration of the intervention will be followed by 4 weeks 3 sessions each week and pre and post-intervention observations will be recorded.

Hypothenar Costal Manipulative technique Ilial Hypothenar costal manipulation between T3-T9

Primary outcomes

  1. Numerical Pain Rating Scale (NPRS)

    Time frame: upto 4 weeks

    The Numeric Pain Rating Scale (NPRS) is perhaps the most frequently applied scale used to quantify pain intensity in the clinical setting. It is an 11-point numeric scale, ranging from 0 indicating no pain to 10 indicating worst pain imaginable

  2. Oswestry Disability Index

    Time frame: upto 4 weeks

    The Oswestry Disability Index (ODI) is an index derived from the Oswestry Low Back Pain Questionnaire used by clinicians and researchers to quantify disability for low back pain and quality of life. Oswestry Disability Index. Purpose. used to qualify low back pain.

  3. Bubble Inclinometer

    Time frame: upto 4 weeks

    A bubble inclinometer is a simple, handheld device used to measure the angle of inclination or tilt of a surface. In the context of thoracic spine assessments, it is particularly useful for quantifying the range of motion and curvature of the spine.

Study contacts

Contact information is provided by the study sponsor or research team.

Alishah Malik, MSPT

CONTACT

[email protected]

03064500637

Samrood Akram, PhD Scholar

CONTACT

[email protected]

03324806143

Sponsors and collaborators

Lead sponsor

Riphah International University

Other

Registry information

Official study title

Effects of Thoracic Spine Manipulation With and Without Costovertebral Joint Manipulation in Patients With Non-specific Mid-back Pain

Important dates

Study start
2025
Primary completion
2025
Study completion
2025
First posted
Jul 14, 2025
Registry last updated
Jul 14, 2025

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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