Short-Term Effects of Thoracic Spine Manipulation on Shoulder Impingement Syndrome – A Randomized Controlled Trial

Publication date: Available online 1 March 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Melina N. Haik, Francisco Alburquerque-Sendín, Paula R. Camargo
ObjectiveTo investigate the short-term effects of thoracic spine manipulation (TSM) on pain, function, scapular kinematics and scapular muscle activity in individuals with shoulder impingement syndrome (SIS).DesignBlinded assessor and patient, randomized controlled trial.SettingLaboratory.ParticipantsSixty-one patients with SIS.Intervention.Participants were randomly allocated to TSM (n=30) or sham-TSM group (n=31) and attended 2 intervention sessions over a 1-week period.Main Outcome MeasurementsScapular kinematics and muscle activity were measured at day 1 (baseline, before first intervention), day 2-pre (before second intervention), day 2-post (after second intervention) and day 3 (follow-up). Shoulder pain and function were assessed by the Disability of the Arm, Shoulder and Hand (DASH) questionnaire and Western Ontario Rotator Cuff (WORC) index at baseline, day 2-pre and follow-up. An assessor blinded to group assignment measured all outcomes.ResultsPain decreased 0.7 points (1.3-0.1 95%Confidence Interval - CI) at day 2-pre and 0.9 points (1.5-0.3 95%CI) at day 2-post in the TSM group. DASH (p=0.01) and WORC (p=0.02) scores improved in both groups. Scapular upward rotation increased during arm lowering (p<0.01) at day 2-post (5.3º) and follow-up (3.5º) in the TSM group. Upper trapezius activity increased (p<0.05) in the sham-TSM group. Middle and lower trapezius and serratus anterior decreased activation in both groups during elevation and lowering of the arm.ConclusionTSM may increase scapular upward rotation during arm lowering. TSM does not seem to influence activity of the scapular muscles. Results concerning shoulder pain, function, scapular tilt and internal rotation are not conclusive.



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