Melina N. Haik
Journal of Orthopaedic & Sports Physical Therapy, Ahead of Print Pages: 1-38 doi:10.2519/jospt.2014.4760

Study Design
Randomized controlled trial with immediate follow-up.

Objective
To evaluate the immediate effects of a low-amplitude high-velocity (thrust) thoracic spine manipulation (TSM) on pain and scapular kinematics during elevation and lowering of the arm in individuals with shoulder impingement syndrome (SIS). The secondary objective was to evaluate the immediate effects of TSM on scapular kinematics during elevation and lowering of the arm in individuals without symptoms.

Background
Considering the regional interdependence among shoulder, thoracic, and cervical spine, TSM may be effective to improving pain and function in individuals with SIS. Comparison with individuals without shoulder pathology would provide information on the effects being specific to those with SIS.

Methods
Fifty subjects (mean ± SD: 31.8 ± 10.9 years old) with SIS and 47 subjects (25.8 ± 5.0 years old) asymptomatic for shoulder dysfunction were randomly assigned to 1 of 2 interventions: manipulation or sham. Scapular kinematics was analyzed during elevation and lowering of the arm in the sagittal plane and a numeric pain rating scale was used to assess shoulder pain during arm movement at pre- and post-intervention.

Results
For those in the SIS group, shoulder pain was reduced immediately after TSM and sham intervention (mean ± SD, 2.9 ± 2.5 pre-intervention; 2.3 ± 2.5 post-intervention; P<.01; moderate effect size; d-Cohen=0.2). Scapular internal rotation increased 0.5 ± 0.02 degrees (P=.04; small effect size; d-Cohen<0.1) during elevation of the arm after TSM and sham intervention in the SIS group only. Subjects with and without SIS who received TSM and asymptomatic subjects who received sham intervention had a significant increase (1.6 ± 2.7 degrees) in scapular upward rotation post-intervention (P<.05; small size effect; d-Cohen<0.2) which was not considered clinically significant. Scapular anterior tilt increased (1.0 ± 4.8 degrees) during elevation and lowering of the arm post-manipulation (P<0.05; small effect size; d-Cohen<0.2) in the asymptomatic subjects who received TSM.

Conclusion
Shoulder pain in individuals with SIS immediately decreased after a TSM. The observed changes in scapular kinematics following TSM were not considered clinically important.

Level of Evidence
Therapy, level 4. J Orthop Sports Phys Ther, Epub 22 May 2014. doi:10.2519/jospt.2014.4760

Read More: http://www.jospt.org.ezproxy.ttuhsc.edu/doi/abs/10.2519/jospt.2014.4760