Thoracic Spine Manipulation in Individuals With Subacromial Impingement Syndrome Does Not Immediately Alter Thoracic Spine Kinematics, Thoracic Excursion, or Scapular Kinematics: A Randomized Controlled Trial.

Abstract

STUDY DESIGN:

Randomized controlled trial.

OBJECTIVES:

To determine if thoracic spinal manipulative therapy (SMT) alters thoracic kinematics, thoracic excursion, and scapular kinematics compared to a sham SMT in individuals with subacromial impingement syndrome, and also to compare changes in patient-reported outcomes between treatment groups.

BACKGROUND:

Prior studies indicate that thoracic SMT can improve pain and disability in individuals with subacromial impingment syndrome. However, the mechanisms underlying these benefits are not well understood.

METHODS:

Participants with shoulder impingement symptoms (n = 52) were randomly assigned to receive a single session of thoracic SMT or sham SMT. Thoracic and scapular kinematics during active arm elevation and overall thoracic excursion were measured before and after the intervention. Patient-reported outcomes measured were pain (numeric pain-rating scale), function (Penn Shoulder Score), and global rating of change.

RESULTS:

Following the intervention, there were no significant differences in changes between groups for thoracic kinematics or excursion, scapular kinematics, and patient-reported outcomes (P>.05). Both groups showed an increase in scapular internal rotation during arm raising (mean, 0.9°; 95% confidence interval [CI]: 0.3°, 1.6°; P = .003) and lowering (0.8°; 95% CI: 0.0°, 1.5°; P = .041), as well as improved pain reported on the numeric pain-rating scale (1.2 points; 95% CI: 0.3, 1.8; P<.001) and function on the Penn Shoulder Score (9.1 points; 95% CI: 6.5, 11.7; P<.001).

CONCLUSION:

Thoracic spine extension and excursion did not change significantly following thoracic SMT. There were small but likely not clinically meaningful changes in scapular internal rotation in both groups. Patient-reported pain and function improved in both groups; however, there were no significant differences in the changes between the SMT and the sham SMT groups. Overall, patient-reported outcomes improved in both groups without meaningful changes to thoracic or scapular motion.

LEVEL OF EVIDENCE:

Therapy, level 1b-.

• Authors: Joseph R Kardouni, Peter E Pidcoe, Scott W Shaffer, Sheryl D Finucane, Seth A Cheatham, Catarina O Sousa, Lori A Michener
• Journal: The Journal of orthopaedic and sports physical therapy (J Orthop Sports Phys Ther) Vol. 45 Issue 7 Pg. 527-38 (Jul 2015) ISSN: 1938-1344 [Electronic] United States
• PMID: 25996365 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)

Topics

• Adolescent
• Adult
• Biomechanical Phenomena
• Female
• Humans
• Male
• Manipulation, Spinal
• Middle Aged
• Pain Measurement
• Scapula (physiopathology)
• Shoulder Impingement Syndrome (physiopathology, therapy)
• Thoracic Vertebrae (physiopathology)
• Treatment Outcome
• Young Adult