2.3. Intervention
pain
The experimental group received thoracic spinal manipulation consisting of a high velocity and low amplitude thrust in the prone position. Manipulation was applied to hypomobile spinal segments with joint-play restriction identified by palpation with posterior-anterior and transverse pressure. This technique was considered successful when an auditory or palpable release was perceived by a therapist. Manipulation maneuver was administered by a physiotherapist with high thrust and low amplitude force, with more than 10 years of clinical experience. The control group only received thoracic spinal muscle exercises with three sets of 10 repetitions and a rest period of 1 minute between the intervals. The position of subjects for exercises was sitting and prone lying, and medium resistance TheraBand was used. Scapular retraction exercises were performed in a sitting position with elbows bent at 90 degrees, and the subjects pulled the TheraBand backwards to move shoulder blades towards each other [If the subject improved in the follow-up session so that there was no pain, and the motion was normal, then, only the exercises were performed in the follow-up visits. During the treatment, patients were not allowed to take care from other clinics or health care providers for this musculoskeletal condition.Participants were treated 2 times per week for four weeks, and a total of 8 sessions were given. Measurements for pain were taken at baseline, after 1st session of 4 weeks and after the 8th session. Measurements for SF 36 were taken at baseline and after the 8th session. Patients were followed up at the 12th week after randomization (3rd month) to check the long-term effects.