Shoulder complaints are common, so common in fact that they constitute the third largest group of muscle and joint disorders. That correlates to 1 out of 5 people annually reporting a shoulder complaint.
These complaints are characterized by loss of function or disability (mostly due to pain), or to restricted range of motion in the shoulder. For athletes, the rate of shoulder complaints rose to greater than 30%, with anterior shoulder impingement and rotator cuff tendinitis being the most common injuries.
There are a wide variety of injuries that affect the shoulder, ranging from mild to serious. Unfortunately, only 50% of all new episodes of shoulder complaints resolve within 6 months, and over 40% of these patients are still affected during work and leisure time after 12 months.
Now, obviously a lot of the therapy used by chiropractors and other health care therapists is directed at the shoulder itself. Some techniques that are used include muscle release therapy, acupuncture, mobilizations of the shoulder joint, electrical stimulation for the joint capsule, and of course, rehabilitation exercise.
However, other options exist to get results for shoulder injuries. The topic of this blog will examine several of these and how they are useful.
1) Thoracic Spine (Mid-back) Manipulation
Three large, high quality studies have shown that adding thoracic manipulation for shoulder pain treatment reduces pain and disability after 6 weeks, 6 months, and 1 year post-injury. It is well established that proper mid-back function is needed for optimum use of the shoulders,
Another benefit from mid-back manipulation an increase in the lower trapezius muscle strength immediately following a manipulation. This muscle is important in proper control of the shoulder blade (scapula), which explains the increase in shoulder range of motion immediately after mid-back mobilization.
2) Upper Rib Manipulation
There is also immediate effects of upper rib manipulation in patients with a primary complaint of shoulder pain. A study found that after only a single treatment of rib manipulation, patients had a 51% reduction in shoulder pain, an increase in shoulder range of motion (increasing by 38 degrees) and a positive patient-perceived rating of change.
Another finding is the pain blocking effect that is a result of upper rib manipulation which may contribute to the reduction of shoulder pain and an increase in shoulder range of motion. The true mechanism for the pain and motion changes observed for these patients is still poorly understood, but the results that are beneficial and fascinating.
These two interventions are based on the relationship of the thoracic spine, ribs and shoulder. This means that injuries respond more favourably to an examination and treatment approach that includes treating all of these areas.
3) Neck Adjustments
Manipulation of the neck has been found to be beneficial for shoulder pain as well. When medical doctors and chiropractors work together to co-manage patients with shoulder pain, the effects are accelerated recovery versus patients treated by only their medical doctor. The studies have found that neck manipulation was especially effective for those stubborn shoulder complaints, those lasting more than 12 weeks, or for very severe cases of pain or disability.
4) Scapular Motion
For the shoulder joint to have full and pain-free motion, the shoulder blade needs to be moving properly and fully.
A majority of the population have over-active upper trapezius muscles (muscles between the neck and shoulder) and under-developed or even inhibited lower traps. This simplified muscle imbalance can cause a whole host of shoulder issues including pain in the front of the shoulder and extra strain on the rotator cuff, just to name a few.
There are a variety of ways to get proper motor control of your shoulder blade, but each technique varies based on the underlying issue of the individual. Individualized treatments include decreasing tone to upper traps, strengthening lower traps, and increasing control of the scapula are used, depending on the assessment findings.
References
Bergman JG, et al. (2010). Manipulative therapy in addition to usual medical care accelerates recovry of shoulder complaints at higher costs: economic outcomes of a randomized trial, BMC Musculoskelet Disord 11:200
Peek AL, et al. (2015). Thoracic manual therapy in the management of non-specific shoulder pain: a systematic review, Journal of Manual and Manipulative Therapy; 23(4): 176-87
Strunce JB, et al. (2009). The immediate effects of thoracic spine and rib manipulation on subjects with complaints of shoulder pain, J Man Manip Ther 17(4): 230-6Labels: adjustments, Champion Chiropractic, exercise, injury, neck, rehab, ribs, scapula, shoulder, shoulder pain
