Non-surgical, conservative care to address shoulder pain, especially when caused by shoulder impingement syndrome (SIS), is one of the most common reasons patients visit a chiropractic office. Doctors of chiropractic often manage the condition with a combination of manual therapies and exercises targeted on the shoulder joint.
The scientific literature is rich with studies showing the benefits of shoulder exercises to address SIS, and a poorer outcome is more likely without exercise. Manual therapies applied to the shoulder have also been demonstrated to benefit the SIS patient, and it’s common for chiropractors to use both specific exercise and manual therapies in combination when managing the condition.
Two recent studies suggest that incorporating spinal manipulative therapy can lead to even better outcomes for the SIS patient.
In one study, researchers assigned participants (half of whom had SIS) to either a treatment (thoracic spine thrust manipulation) or a sham treatment group. Before and after treatment, participants performed an arm raise test to assess scapular kinematics and note their current pain levels. The SIS patients in the treatment group reported improvements in their shoulder pain; however, there was no observed improvement in scapular kinematics among any participants.
The other study took a similar approach, except it assessed shoulder joint range of motion in addition to shoulder pain. In this study, the research team observed that mid-back thrust manipulation led to immediate improvements in both shoulder pain and shoulder range of motion in the SIS patients.
Both studies demonstrated that spinal manipulation applied to the mid-back can lessen shoulder pain (and improve shoulder joint range of motion) without administering any treatment directly on the shoulder.
This suggests mid-back dysfunction may play a role, however small, in many cases of SIS and that patients with shoulder issues should receive a thorough examination to identify all possible contributing factors to the patient’s musculoskeletal pain and disability, even those outside the area of chief complaint, something which doctors of chiropractic are trained to do when assessing a new patient.