Award Date


Degree Type


Degree Name

Doctor of Physical Therapy (DPT)


Physical Therapy

First Committee Member

Kai Yu Ho

Second Committee Member

Emilio Puentedura

Third Committee Member

Merrill Landers

Fourth Committee Member

Kathryn Hausbeck Korgan

Number of Pages



Background and Purpose: Myofascial pain may be considered one of the most common clinical findings in patients with neck pain (NP). Motor aspects of myofascial pain include disturbed motor function and muscle weakness secondary to motor inhibition, muscle stiffness, and restricted range of motion (ROM). Currently, it is unclear which interventions may have the greatest immediate impact on pressure pain sensitivity and ROM. Several studies have demonstrated improved pressure pain thresholds (PPT) after cervical manipulation; however, it is not clear if manipulation targeted to the cervicothoracic (CT) junction will have a similar effect. Others recommend stretching as a method to reduce muscle soreness; however, the immediate effects of passive stretching to the upper trapezius on PPT and ROM have not been studied. The purpose of this project was to evaluate the influence of CT manipulation and passive stretching to the upper trapezius on PPT and ROM in individuals without recent complaint of NP.

Subjects: Ninety (90) subjects without current complaint of NP were enrolled into the study.

Methods: PPT was assessed on both the right and left upper trapezius musculature. Cervical range of motion (CROM) was assessed in the frontal, sagittal, and transverse planes. Subjects were randomized into one of three groups for intervention (CT manipulation, passive upper trapezius stretching, or control). CROM was reassessed immediately after the intervention. PPT levels were reassessed at 5 and 10 minutes post intervention by a blinded examiner. Mean and standard deviations for PPT and ROM were calculated. Repeated measures two-way ANOVA was used to assess within group (pre- and post- treatment) differences as well as difference among treatment conditions (Control, CT Manip, and Stretch groups). Post-hoc one-way ANOVA tests were used to examine the effects of group assignment/time points in the event of significant interactions between time and group assignment. Statistical significant was set at p <0.05.

Results: The two-way ANOVA test showed that there was a significant interaction between time and group assignment for CROM in the sagittal and transverse planes, however the post-hoc comparisons did not reveal a significant difference among 3 treatment group or among 3 time points. ANOVA also showed that there was not a difference in frontal plane CROM between time and group assignment. Similarly, although the two-way ANOVA test revealed a significant interaction between time and group assignment for PPT, post-hoc analyses showed that there was no difference between the 3 groups or among 3 time points for either side of the upper trapezius.

Discussion: No significant difference in any plane of motion CROM or PPT pre-treatment to post-treatment between treatment groups brings into question the cause of the improved measures with time. Trends found with increased CROM and PPT over time are clouded by increased measures in the control group. The need for further research exists to better understand the relationship between CT manipulation and upper trapezius stretching and their effects on pain pressure thresholds and CROM.

Conclusion: Upper trapezius stretching and CT manipulation may both be viable options for treatment by improving CROM and increasing PPT. Further high powered studies focusing on reducing the learning effects between measures and lowering participant uneasiness with research methods could produce clearer results.


Motor ability; Myofascial pain syndromes; Myofascial pain syndromes--Physical therapy; Neck pain; Physical therapy


Applied Statistics | Physical Therapy | Rehabilitation and Therapy | Statistics and Probability