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Should We Be Performing Thoracic Manipulation for Shoulder Pain?

5/4/2019

5 Comments

 
There is belief among the manual therapy-trained that thoracic manipulation may be beneficial for almost any condition due to its effect on the nervous system. With the nervous system being connected from head to toe physically and the input to the central system, a manipulation to the thoracic spine may potentially impact the patient peripherally and/or centrally. Take any individual and measure their SLR ROM. Perform a thoracic manipulation and then remeasure the SLR mobility. Often, you will see a change that appears like we are facilitating.

There have been many studies showing that thoracic manipulation does not show any difference between sham manipulation in improving shoulder pain and muscle activation (Bizzarri et al, 2018 & Grimes et al, 2019). Studies like these contribute to the heavy anti-manual therapy rhetoric by some practitioners and academians. However, can/should we ignore the fact that we can get some sore of change in something like SLR mobility with the technique? Maybe we should consider that the manual contact or verbiage we use in the sham manipulation to get the change as there is no difference compared to thoracic manipulation. 
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While some are completely against incorporating manual therapy in treatment and others are heavy manual therapy-biased, I try to fall somewhere in the middle. It's clear that manipulation doesn't have the biomechanical effect we once thought it had. However, it is not clear that manual therapy, placebo or not, doesn't have some sort of impact on the nervous system. The contact of the hand is still an input to the system. It would appear that further research is needed to determine what exactly that impact is.

​-Dr. Fox, PT, DPT, OCS
References:
Bizzarri P1, Buzzatti L2, Cattrysse E3, Scafoglieri A4.  Thoracic manual therapy is not more effective than placebo thoracic manual therapy in patients with shoulder dysfunctions: A systematic review with meta-analysis.  Musculoskelet Sci Pract. 2018 Feb;33:1-10.

Grimes JK1,2, Puentedura E2,3, Cheng MS2, Seitz AL4. The Comparative Effects of Upper Thoracic Spine Thrust Manipulation Techniques in Individuals With Subacromial Pain Syndrome: A Randomized Clinical Trial. J Orthop Sports Phys Ther. 2019 Mar 12:1-28.

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Should We Be Performing Thoracic Manipulation for Shoulder Pain? This question has sparked much debate in the healthcare community. While some practitioners argue that thoracic manipulation can provide relief and improve shoulder function, others raise concerns about potential risks and lack of evidence. It is crucial to carefully assess individual patients and consider alternative treatments before resorting to manipulation.

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The debate over whether thoracic manipulation should be employed for alleviating shoulder pain is a contentious one within the medical community. Advocates argue that thoracic manipulation can address underlying biomechanical issues contributing to shoulder pain by improving thoracic mobility and reducing stress on the shoulder joint. Proponents highlight studies demonstrating short-term improvements in pain and function following thoracic manipulation interventions. However, detractors raise concerns about the potential risks associated with such interventions, including vertebral artery dissection and exacerbation of existing conditions.

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  • Home
  • About Us
  • TSPT Academy
  • Resources
    • Newsletter
    • Orthopedic Blog
    • Featured Articles
    • Research Articles
    • Residency Corner
  • Special Tests
    • Cervical Spine >
      • Alar Ligament Test
      • Bakody's Sign
      • Cervical Distraction Test
      • Cervical Rotation Lateral Flexion Test
      • Craniocervical Flexion Test (CCFT)
      • Deep Neck Flexor Endurance Test
      • Posterior-Anterior Segmental Mobility
      • Segmental Mobility
      • Sharp-Purser Test
      • Spurling's Maneuver
      • Transverse Ligament Test
      • ULNT - Median
      • ULNT - Radial
      • ULNT - Ulnar
      • Vertebral Artery Test
    • Thoracic Spine >
      • Adam's Forward Bend Test
      • Passive Neck Flexion Test
      • Thoracic Compression Test
      • Thoracic Distraction Test
      • Thoracic Foraminal Closure Test
    • Lumbar Spine/Sacroiliac Joint >
      • Active Sit-Up Test
      • Alternate Gillet Test
      • Crossed Straight Leg Raise Test
      • Extensor Endurance Test
      • FABER Test
      • Fortin's Sign
      • Gaenslen Test
      • Gillet Test
      • Gower's Sign
      • Lumbar Quadrant Test
      • POSH Test
      • Posteroanterior Mobility
      • Prone Knee Bend Test
      • Prone Instability Test
      • Resisted Abduction Test
      • Sacral Clearing Test
      • Seated Forward Flexion Test
      • SIJ Compression/Distraction Test
      • Slump Test
      • Sphinx Test
      • Spine Rotators & Multifidus Test
      • Squish Test
      • Standing Forward Flexion Test
      • Straight Leg Raise Test
      • Supine to Long Sit Test
    • Shoulder >
      • Active Compression Test
      • Anterior Apprehension
      • Biceps Load Test II
      • Drop Arm Sign
      • External Rotation Lag Sign
      • Hawkins-Kennedy Impingement Sign
      • Horizontal Adduction Test
      • Internal Rotation Lag Sign
      • Jobe Test
      • Ludington's Test
      • Neer Test
      • Painful Arc Sign
      • Pronated Load Test
      • Resisted Supination External Rotation Test
      • Speed's Test
      • Posterior Apprehension
      • Sulcus Sign
      • Thoracic Outlet Tests >
        • Adson's Test
        • Costoclavicular Brace
        • Hyperabduction Test
        • Roos (EAST)
      • Yergason's Test
    • Elbow >
      • Biceps Squeeze Test
      • Chair Sign
      • Cozen's Test
      • Elbow Extension Test
      • Medial Epicondylalgia Test
      • Mill's Test
      • Moving Valgus Stress Test
      • Push-up Sign
      • Ulnar Nerve Compression Test
      • Valgus Stress Test
      • Varus Stress Test
    • Wrist/Hand >
      • Allen's Test
      • Carpal Compression Test
      • Finkelstein Test
      • Phalen's Test
      • Reverse Phalen's Test
    • Hip >
      • Craig's Test
      • Dial Test
      • FABER Test
      • FAIR Test
      • Fitzgerald's Test
      • Hip Quadrant Test
      • Hop Test
      • Labral Anterior Impingement Test
      • Labral Posterior Impingement Test
      • Long-Axis Femoral Distraction Test
      • Noble Compression Test
      • Percussion Test
      • Sign of the Buttock
      • Trendelenburg Test
    • Knee >
      • Anterior Drawer Test
      • Dial Test (Tibial Rotation Test)
      • Joint Line Tenderness
      • Lachman Test
      • McMurray Test
      • Noble Compression Test
      • Pivot-Shift Test
      • Posterior Drawer Test
      • Posterior Sag Sign
      • Quad Active Test
      • Thessaly Test
      • Valgus Stress Test
      • Varus Stress Test
    • Foot/Ankle >
      • Anterior Drawer
      • Calf Squeeze Test
      • External Rotation Test
      • Fracture Screening Tests
      • Impingement Sign
      • Navicular Drop Test
      • Squeeze Test
      • Talar Tilt
      • Tarsal Tunnel Syndrome Test
      • Test for Interdigital Neuroma
      • Windlass Test