Thoracic manual therapy improves pain and disability in individuals with shoulder impingement syndrome compared to placebo: a randomised controlled trial with one year follow-up

Osteopathic approach to injuries of the overhead thrower's shoulder

Overhead sports place a significant amount of stress on the shoulder. There are a variety of activities and sports with overhead athletes including both throwing (baseball, softball, football, cricket) and nonthrowing (tennis, swimming, volleyball) sports. Although all of these overhead motions can lead to pathology, a large focus has been on the consequences of overhead throwing. Overhead-throwing sports place forces on the joints, muscles, tendons, and ligaments that vary through the spectrum of athletes, as does the potential injuries that may be caused by these forces. The primary joints that are commonly injured in overhead sports are the shoulder and the elbow. The goal of this article is to discuss the impact of overhead motions on the shoulder, with a primary focus on throwing, as well as to highlight the osteopathic approach to assessment, treatment, management, and prevention.

Association between kinetic chain factors and the presence of shoulder pain in the non-athletic population

Background

The proximal-distal energy transfer between body segments occurs through the kinetic chain. Although some kinetic chain aspects have been investigated in individuals not engaged in sports, their relationship with shoulder pain in this population remains unclear. This cross-sectional study aimed to verify associations between kinetic chain factors and the presence of shoulder pain in adults.

Methods

Lumbopelvic stability (single-leg bridge test); active range of motion of the shoulder, trunk, and hip; and isometric peak strength of shoulder, trunk, hip, and knee muscles were assessed. A multivariate binary logistic regression analyzed the likelihood of shoulder pain based on these clinical results.

Results

Forty individuals (26.3 ± 10.4 years, 19 with shoulder pain) were assessed. The isometric strength of trunk extensor muscles significantly influenced the regression model (odds ratio = 0.99 [0.98-1.00]; p = 0.027), indicating that each 1 N increase in strength reduced the likelihood of shoulder pain by about 1%. No significant relationships were observed between other outcomes and shoulder pain.

Discussion

Isometric strength of trunk extensor muscles may be associated with shoulder pain. No associations were observed between shoulder pain and stability, mobility, and strength of other kinetic chain segments.

Thinking outside the shoulder: A systematic review and metanalysis of kinetic chain characteristics in non-athletes with shoulder pain

INTRODUCTION

The kinetic chain is important in the proximal-distal energy transfer along body segments. Although biomechanical impairments in components of the kinetic chain have already been reported in athletes with shoulder pain, such investigations in non-athlete individuals have not yet been synthesized.

OBJECTIVE

To systematically review the literature and analyze the quality of evidence on the characteristics of the kinetic chain of non-athletes with shoulder pain compared to asymptomatic individuals.

METHODS

Studies published until February 2024 (without language restrictions) that quantitatively assessed outcomes related to the kinetic chain of non-athlete individuals were searched in five databases (MEDLINE, CINAHL, Web of Science, EMBASE, and SCOPUS). The risk of bias and quality of evidence were analyzed using the Joanna Briggs Institute Critical Appraisal Tool for Analytical Cross-Sectional Studies and the Grading of Recommendations, Assessment, Development, and Evaluation approach, respectively. To summarize the findings, meta-analyses with random-effects models were performed.

RESULTS

Six cross-sectional studies (n = 562 [282 with shoulder pain], mean age = 48.7 ± 8.1 years) with low risk of bias were included in this review. Very low-quality evidence suggests that individuals with shoulder pain may present a lower active range of motion and muscular endurance/strength in the cervical spine, thoracolumbar region, and hip, as well as deficits in neuromuscular control of the lower extremities. Findings related to thoracic spine posture were conflicting and no differences were found in cervical spine isometric muscular strength between individuals with and without shoulder pain.

CONCLUSION

Individuals with shoulder pain may present alterations in active mobility, muscular endurance, and neuromuscular control in kinetic chain segments. These findings suggest that broader physical assessments considering components of the kinetic chain may be clinically relevant in this population. However, based on the very low quality of evidence, the findings of this review should be interpreted with caution.

Efficacy of Mulligan thoracic sustained natural apophyseal glides on sub-acromial pain in patients with sub-acromial impingement syndrome: a single-blinded randomized controlled trial

PURPOSE

To investigate the effects of Mulligan thoracic sustained natural apophyseal glides (SNAGS) techniques and traditional exercises on pain, shoulder function, size of sub-acromial space, and shoulder joint range in patients with sub-acromial impingement syndrome.

METHODS

Seventy-four patients with sub-acromial impingement syndrome (25 to 40 years) joined this research and were allocated randomly into two equal groups; experimental group A (Mulligan SNAGS and exercise) and control group B (exercise only). All patients were assessed by visual analogue scale (VAS) for pain intensity, Shoulder Pain and Disability Index (SPADI) for shoulder function, plain x-ray for the size of sub-acromial space, and goniometer for shoulder range of motion (ROM). The measurements were performed at two intervals (baseline and after four weeks of intervention).

RESULTS

After 4 weeks of intervention, there were statistically significant differences between groups, in favor of Mulligan SNAGS, on sub acromial space size, pain intensity, shoulder function, and shoulder joint range of motion (p < 0.05). In within-group analysis, there were also statistically significant differences between pre- and post-treatment in all measured variables (p < 0.05).

CONCLUSION

Mulligan thoracic spine (SNAGS) mobilization into extension and traditional exercises improve sub acromial space size, pain intensity, shoulder function, and shoulder joint range of motion in patients with sub acromial impingement syndrome. It is recommended to mobilize the thoracic spine by mulligan SNAGS in the treatment of sub-acromial impingement syndrome.

Efficacy of manual therapy on shoulder pain and function in patients with rotator cuff injury: A systematic review and meta‑analysis

To critically evaluate the effects of manual therapy (MT) on pain and functional improvement in patients with rotator cuff injury (RCI), a systematic review of all randomized controlled trials (RCTs) on MT for RCI was conducted in the following databases: PubMed, Cochrane Central Register of Controlled Trials, Embase, Web of Science, Physiotherapy Evidence Database, Chinese National Knowledge Infrastructure, Wan-fang Data, Chinese Scientific Journal Database, and Chinese Biomedical Literature database from inception to March 28, 2023. A total of 1,110 participants from 24 eligible RCTs were included in the analysis. Compared with placebo, MT could not effectively relieve pain [standardized mean difference (SMD)=-0.25; 95% CI: -0.51 to 0.01; P=0.06], although its impact on functional improvement appears limited (SMD=0.20; 95% CI: -0.09 to 0.49; P=0.18). Combining MT with exercise had significant advantages over exercise alone, as combined therapy contributed to both pain reduction (SMD=0.36; 95% CI: 0.08 to 0.64; P=0.01) and functional enhancement (SMD=0.32; 95% CI: 0.11 to 0.52; P=0.002). Furthermore, MT combined with multimodal physiotherapy showed additional benefits in pain reduction (mean difference=1.57; 95% CI: 0.18 to 2.96; P=0.03) and functional improvement (SMD=0.77; 95% CI: 0.43 to 1.12; P<0.0001) compared with multimodal physiotherapy alone. These findings highlight the superior pain alleviation and functional improvement provided by MT when combined with exercise or physiotherapy. Consequently, MT has emerged as a pivotal component of therapeutic intervention for RCI.