Abstract: Thoracic manual therapy in the management of non-specific shoulder pain
“Non-specific shoulder pain (NSSP) is often persistent and disabling leading to high socioeconomic costs. Cervical manipulation has demonstrated improvements in patients with NSSP, although risks associated with thrust techniques are documented. Thoracic manual therapy (TMT) may utilise similar neurophysiological effects with less risk. The current evidence for TMT in treating NSSP is limited to systematic reviews of manual therapy (MT) applied to the upper quadrant. These reviews included trials that used shoulder girdle manual therapy (SG-MT) in the TMT group. This limits the scope of their conclusions with regard to the exclusive effectiveness of TMT for NSSP.”
“Over 912 articles were retrieved: three RCTs, one single-arm trial and three pre–post test studies were eligible. Studies varied from poor to high quality. Three RCTs demonstrated that TMT reduced pain and disability at 6, 26 and 52 weeks compared with usual care. Two pre–post test studies found between 76% and 100% of patients experienced significant pain reduction immediately post-TMT. An additional pre–post test study and a single-arm trial showed reductions in pain and disability scores 48 hours post-TMT.”
How many times do you treat the thoracic spine when you have a patient with a shoulder problem? The thoracic spine plays a major part in the function of both the upper and lower quadrants during functional activities. Raising our arm overhead in the flexion/abduction plane is a very functional movement that we can perform multiple times per day when reaching overhead for items. This activity requires movement and coordination between the SC joint, the AC joint, the glenohumeral joint, as well as the thoracic spine. If our thoracic spine is “stuck” and cannot extend/rotate/sidebend during overhead activities, this can lead to compensatory movement strategies being employed in the shoulder girdle which can lead to pain and shoulder dysfunction. Your thoughts?
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**Abstract of the week shared by NAIOMT Instructor Stacy Soappman, PT, DSc, COMT, FAAOMPT.
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