Abstract

STUDY DESIGN: Randomized controlled trial with immediate follow-up. OBJECTIVES: 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 the shoulder and the thoracic and cervical spines, TSM may improve pain and function in individuals with SIS. Comparing individuals with SIS to those without shoulder pathology may provide information on the effects of TSM specifically in those with SIS. METHODS: Fifty subjects (mean +/- SD age, 31.8 +/- 10.9 years) with SIS and 47 subjects (age, 25.8 +/- 5.0 years) asymptomatic for shoulder dysfunction were randomly assigned to 1 of 2 interventions: TSM or a sham intervention. Scapular kinematics were 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 preintervention and postintervention. RESULTS: For those in the SIS group, shoulder pain was reduced immediately after TSM and the sham intervention (mean +/- SD preintervention, 2.9 +/- 2.5; postintervention, 2.3 +/- 2.5; P.01; moderate effect size [Cohen d = 0.2]). Scapular internal rotation increased 0.5 degrees +/- 0.02 degrees (P = .04; small effect size [Cohen d0.1]) 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 the sham intervention had a significant increase (1.6 degrees +/- 2.7 degrees) in scapular upward rotation postintervention (P.05; small effect size [Cohen d0.2]), which was not considered clinically significant. Scapular anterior tilt increased 1.0 degrees +/- 4.8 degrees during elevation and lowering of the arm postmanipulation (P.05; small effect size [Cohen d0.2]) 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.