Shoulder pain is a problem remarkably common in the general population, with some experts claiming it lies second only to low back pain in terms of prevalence [1]. Risks for shoulder impingement injuries/syndromes include repetitive activities at or above the shoulder line, making this a problem particularly poignant for sportspeople or manual labourers among others. While many treatments for shoulder impingement syndrome are available, and manual therapies are included in this number, the mechanisms by which spinal manipulative therapy improves pain and mobility for this condition have not yet been established.
A preliminary randomised clinical trial appearing in the Journal of Chiropractic Medicine has put this very issue to the test, producing an initial piece of evidence that cervicothoracic manipulation plus mobilisation, in addition to exercise therapy, can improve the intensity of pain and the patient’s range of motion more-so than exercise alone[2].
The combination of modalities is not an uncommon approach for shoulder pain, given the widely accepted notion that “Combined treatments of exercise and other therapies tended to yield better effects than single intervention therapies [2].”
Still, the cervicothoracic spinal manipulation approach had not yet been put to the test. In order to achieve this, the researchers took 41 patients who were suffering from unilateral shoulder pain compatible with a medical diagnosis of SIS (Shoulder impingement syndrome). All patients in the trial suffered SIS within the dominant right side. They all had a relatively recent onset of pain, having first experience symptoms the last 12 months.
At the beginning of the study, patients filled out a self-reported questionnaire (on disabilities of the arm, shoulder and hand) rating their pain and the level of interference SIS caused in their daily life. They were randomly assigned to either the cervicothoracic manipulation therapy plus exercises therapy group, or a home exercise program and were observed over a course of 10 sessions in 5 weeks.
The results, though preliminary, indicate that the cervicothoracic spinal manipulative therapy intervention had a significant bearing on pain and mobility at the end of five weeks.
Results included the following findings:
- “Both modalities of treatment reduce disability and had positive results on clinical tests for subacromial impingement syndrome in patients with shoulder impingement [2].”
- Cervicothoracic manipulative treatment plus exercise therapy improved intensity of pain as well as range of motion compared with the home exercise group.
- The home exercise group saw significant changes for flexion, extension, adduction and abduction but not for external and internal rotation movement.
These findings appear to back up existing literature which reports that manual therapy is more effective in reducing pain than exercise alone [3,4]. The results of this study stand in contrast to other studies which “have reported that mobilizations in addition to exercise were not more effective in pain and disability than exercise alone [2].” Previous work looking at home exercise vs supervised exercise for shoulder pain also showed “no differences in the intensity of pain, disability, physical activity and work, and active range of motion.”
These contrasts indicate that the addition of cervicothoracic spinal manipulation could indeed be a significant factor in improvements of pain and range of motion. More work is required in order to fully examine the effectiveness of spinal manipulative therapy for this particular issue, but this initial study is surely a step in the right direction.
References
[1] Simons S, Kruse D, Dixon J, (Fields K and Grayzel J (eds)), “Shoulder Impingement Syndrome” Up to Date, https://www.uptodate.com/contents/shoulder-impingement-syndrome retrieved 19 May 2017
[2] Vinuesa-Montoya S, Aguilar-Ferrandiz M, Matara n-Penarrocha G, Fernandez-Sanchez M, Fernandez-Espinar E, Castro-Sanchez A (2016), “A Preliminary Randomized Clinical Trial on the Effect of Cervicothoracic Manipulation Plus Supervised Exercises vs a Home Exercise Program For The Treatment of Shoulder Impingement,” Journal Chiropractic Medicine, Vol. 16 No. 2 2016, pp. 85-93
[3] Kaya DO, Baltaci G, Toprak U, Atay AO. The clinical and sonographic effects of kinesiotaping and exercise in compar- ison with manual therapy and exercise for patients with subacromial impingement syndrome: a preliminary trial. J Manipulative Physiol Ther. 2014;37(6):422-432.
[4] Senbursa G, Baltaci G, Atay A. Comparison of conservative treatment with and without manual physical therapy for patients with shoulder impingement syndrome: a prospective, randomized clinical trial. Knee Surg Sports Traumatol Arthrosc. 2007;15(7):915-921.
