October 6, 2021

A Different Way To Treat Neck Pain at Imagine PT


Erin Kelm, SPT and Kaylee Bumpus, SPT

Read Time

5 minutes

How is my neck pain related to my upper back (thoracic spine)?

The bones and muscles in your upper back are all connected to your neck. If your upper back is stiff or not moving properly, it can affect how your neck moves and potentially contribute to pain.1 

What can we do to help your thoracic spine move better?

Thoracic Manipulation:

A physical therapist may perform a thoracic manipulation if they feel that you have stiff segments in your spine.2 A manipulation is a quick thrust motion that may or may not cause a “pop” sound. It may help your spine move the way that it is supposed to, usually feels good, and has been shown in several studies to provide neck pain relief.2,3,4 Our physical therapists at Imagine PT are experts in thoracic manipulation, and are willing to try various techniques to determine the most effective method to provide neck pain relief to our patients. 

Thoracic Mulligan Technique: 

This technique, known as a SNAG (sustained natural apophyseal glide) may be performed on the thoracic spinal segments if there is a restriction in motion or if pain is brought on by movement.⁵ During this technique, a physical therapist will provide a glide to the restricted spinal segment while the patient performs the painful movement (bending or rotation).⁶ SNAGs are most effective when the movement is pain free, provides immediate relief, and is long lasting.⁵ Research has shown that thoracic mulligan techniques can provide relief for individuals with neck or back pain that is brought on by movement.7,8,9  At Imagine PT, our physical therapists are trained in thoracic mulligan techniques to create pain free movements in patients experiencing neck pain. 

What happens after these techniques?

Thoracic manipulations or thoracic mulligan techniques provided by a physical therapist have been proven to provide pain relief, but it is important to work on strength and proper movement to maintain that relief.⁹ Here at Imagine PT, your physical therapist can perform these techniques and will work with you to come up with a personalized strengthening and stretching program to ensure that you are strong and moving correctly. 

If you or someone you know is experiencing neck pain, come to Imagine Physical Therapy and our therapists can use these non-invasive techniques to help you get back to living a pain free life!


  1. Aimie L. Peek, Caroline Miller & Nicola R. Heneghan (2015) Thoracic manual therapy in the management of non-specific shoulder pain: a systematic review, Journal of Manual & Manipulative Therapy, 23:4, 176-187 
  2. González-Iglesias J, Fernández-de-las-Peñas C, Cleland JA, Gutiérrez-Vega Mdel R. Thoracic spine manipulation for the management of patients with neck pain: a randomized clinical trial. J Orthop Sports Phys Ther. 2009 Jan;39(1):20-7. doi: 10.2519/jospt.2009.2914. PMID: 19209478.
  3. Cross KM, Kuenze C, Grindstaff TL, Hertel J. Thoracic spine thrust manipulation improves pain, range of motion, and self-reported function in patients with mechanical neck pain: a systematic review. J Orthop Sports Phys Ther. 2011 Sep;41(9):633-42. doi: 10.2519/jospt.2011.3670. Epub 2011 Aug 31. PMID: 21885904.
  4. Lam, T. et al. The effectiveness of Thoracic Spine Manipulation on patients with chronic mechanical neck pain - a randomized clinical trial. Manual Therapy 16 (2011). 141-147.
  5. Exelby L. (2002). The Mulligan concept: its application in the management of spinal conditions. Manual therapy, 7(2), 64–70. https://doi.org/10.1054/math.2001.0435
  6. Crowell R. (2016) The Mulligan Concept: Upper quarter course. (based on Brian R. Mulligan techniques)
  7. Andrews, Dawn & Odland-Wolf, Kari & May, James & Baker, Russell & Nasypany, Alan & Dinkins, Eric. (2018). Immediate and short-term effects of mulligan concept positional sustained natural apophyseal glides on an athletic young-adult population classified with mechanical neck pain: an exploratory investigation. Journal of Manual & Manipulative Therapy. 26. 1-9. 10.1080/10669817.2018.1460965 
  8. Nakamaru K., Aizawa J., Kawarada K., Uemura Y., Koyama T., Nitta O. (2019) Immediate effects on thoracic spine self-mobilization in patients with mechanical neck pain: A randomized controlled trial. Journal of Bodywork & Movement Therapies, 23(2), 417-424. https://doi.org/10.1016/j.jbmt.2018.05.008.
  9. Ain, S. Q. T., Rehman, S. S. U., Maryam, M., & Kiani, S. K. (2019). Effects of Sustained Natural Apophyseal Glides with and without thoracic posture correction techniques on mechanical back pain: a randomized control trial. JPMA.