Cervicothoracic manual therapy: effective in shoulder pain?
Up until today, exercise seems to be the most effective treatment for pain and disability in the shoulder region. Shoulder pain is often recurrent within the same year. Recent research has shown that exercise is as effective as a costicosteroid injection in non-specific shoulder pain and impingement.
On top of that, it has been shown that 40% of all patients with shoulder pain also present with movement disorders of the cervicothoracic spine.
A clinical prediction rule has been developed which can determine whether manual therapy of the cervicothoracic spine is effective in patients with shoulder pain (at least 3 positive). This prediction rule includes shoulder flexion less than 127, shoulder internal rotation les than 53 in 90 degrees abduction, negative Neer test, less than 90 days symptoms and no medication use.
The aim of this study was to compare cervicothoracic manual therapy plus exercise and exercise alone in the treatment of patients with shoulder pain.
Patients received treatment twice a week during 4 weeks. The manual therapy group received cervicothoracic manual therapy for the first 2 sessions.
There were no significant differences between the 2 groups. Both groups improved by 81,4% after 6 months on the NPRS and SPADI, The only difference found between the groups was a greater improvement in the patient perceived success and acceptability of symptoms in the manual therapy group,
One of the possible reasons for not finding a difference, is the fact that the patients included in the study had chronic shoulder pain, which may very well include a certain degree of central sensitization. The manual therapy group only received 2 treatment sessions and it is unknown the amount of sessions required for a successful outcome.
> From: Mintken et al., J Orthop Sports Phys Ther 46 (2016) 617-628(Epub ahead of print). All rights reserved to Journal of Orthopaedic & sports physical therapy. Click here for the Pubmed summary.