The evidence to guide use of spinal
manipulative therapy (SMT) for patients with
shoulder pain is limited. A validated
sham comparator is needed to ascertain the unique effects of SMT. We investigated the plausibility of a thoracic
sham-SMT comparator for SMT in patients with
shoulder pain. Participants (n = 56) with
subacromial impingement syndrome were randomized to thoracic SMT or a
sham-SMT. An examiner blinded to group assignment took measures pre- and post-treatment of shoulder active range of motion (AROM) and perceived effects of the assigned intervention. Treatment consisted of six upper, middle and lower thoracic SMT or
sham-SMT. The
sham-SMT was identical to the SMT, except no thrust was applied. Believability as an active treatment was measured post-treatment. Believability as an active treatment was not different between groups (χ(2) = 2.19; p = 0.15). Perceptions of effects were not different between groups at pre-treatment (t = 0.12; p = 0.90) or post-treatment (t = 0.40; p = 0.69), and demonstrated equivalency with 95% confidence between groups at pre- and post-treatment. There was no significant change in shoulder flexion in either group over time, or in the
sham-SMT for internal rotation (p > 0.05). The SMT group had an increase of 6.49° in internal rotation over time (p = 0.04). The thoracic
sham-SMT of this study is a plausible comparator for SMT in patients with
shoulder pain. The
sham-SMT was believable as an active treatment, perceived as having equal beneficial effects both when verbally described and after familiarization with the treatment, and has an inert effect on shoulder AROM. This comparator can be considered for used in clinical trials investigating thoracic SMT. IRB number: HM 13182.