Effect of Upper Thoracic Manipulation on Neck Pain and Selected Muscle Activities

Inclusion Criteria: 1. Male and female subjects diagnosed and classified as having chronic non-specific NP with mobility disorders based on clinical guidelines of NP: * Having NP for at least 3 months that may be associated with referred shoulder or upper extremity pain (Blanpied et al., 2017; Erdem et al., 2021; Puntumetakul et al., 2015). * Present with a limitation of cervical ROM and their pain can be provoked by sustained end-range spinal movements or positions will be included (Blanpied et al., 2017). * Patients present with unilateral or bilateral symptoms will be included (Blanpied et al., 2017; Yang et al., 2015). 2. Age between 18-40 (J. Dunning \& Rushton, 2009) 3. Negative four tests of the Wainner cluster to exclude NP with radiating pain (Wainner et al., 2003). 4. Hypomobility of at least one of the upper thoracic vertebrae (T1-T4) during segmental mobility assessment (Ssavedra-Hernández et al., 2011). Exclusion Criteria: 1. Subjects diagnosed as cervical radiculopathy or myelopathy (Ssavedra-Hernández et al., 2011). 2. A history of whiplash injury, past cervical or thoracic surgery, rheumatoid arthritis, spinal fracture, heart disease, a recent significant trauma, and meningitis (Joshi et al., 2020; Puntumetakul et al., 2015). 3. The presence of contraindications of spinal manipulation as spinal infection and spinal osteoporosis(Ssavedra-Hernández et al., 2011).