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Thoracic spine manipulation in individuals with subacromial impingement syndrome does not immediately alter thoracic spine kinematics, thoracic excursion, or scapular kinematics: a randomized controlled trial [with consumer summary]
Kardouni JR, Pidcoe PE, Shaffer SW, Finucane SD, Cheatham SA, Sousa CO, Michener LA
The Journal of Orthopaedic and Sports Physical Therapy 2015 Jul;45(7):527-538
clinical trial
7/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: Yes; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

STUDY DESIGN: Randomized controlled trial. OBJECTIVES: To determine if thoracic spinal manipulative therapy (SMT) alters thoracic kinematics, thoracic excursion, and scapular kinematics compared to a sham SMT in individuals with subacromial impingement syndrome, and also to compare changes in patient-reported outcomes between treatment groups. BACKGROUND: Prior studies indicate that thoracic SMT can improve pain and disability in individuals with subacromial impingment syndrome. However, the mechanisms underlying these benefits are not well understood. METHODS: Participants with shoulder impingement symptoms (n = 52) were randomly assigned to receive a single session of thoracic SMT or sham SMT. Thoracic and scapular kinematics during active arm elevation and overall thoracic excursion were measured before and after the intervention. Patient-reported outcomes measured were pain (numeric pain-rating scale), function (Penn Shoulder Score), and global rating of change. RESULTS: Following the intervention, there were no significant differences in changes between groups for thoracic kinematics or excursion, scapular kinematics, and patient-reported outcomes (p > 0.05). Both groups showed an increase in scapular internal rotation during arm raising (mean 0.9 degrees; 95% confidence interval (CI) 0.3 degrees to 1.6 degrees; p = 0.003) and lowering (0.8 degrees; 95% CI 0.0 degrees to 1.5 degrees; p = 0.041), as well as improved pain reported on the numeric pain-rating scale (1.2 points; 95% CI 0.3 to 1.8; p < 0.001) and function on the Penn Shoulder Score (9.1 points; 95% CI 6.5 to 11.7; p < 0.001). CONCLUSION: Thoracic spine extension and excursion did not change significantly following thoracic SMT. There were small but likely not clinically meaningful changes in scapular internal rotation in both groups. Patient-reported pain and function improved in both groups; however, there were no significant differences in the changes between the SMT and the sham SMT groups. Overall, patient-reported outcomes improved in both groups without meaningful changes to thoracic or scapular motion. LEVEL OF EVIDENCE: Therapy, level 1b-.

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