Many people think of Chiropractic care for neck and back issues. As a Chiropractor, I also work on extremities such as the shoulder joint by using manipulative therapy. Sometimes the best results occur when you treat a health problem from several different aspects, as we do in this clinic. Today I will share the results of a study published recently in the Annals of Internal Medicine that found “manual therapy” in conjunction with “usual medical care” to be much more effective for shoulder dysfunction and pain than usual medical care alone.

Researchers in The Netherlands noted significant improvements in recovery, severity of complaint, shoulder pain and shoulder disability with the addition of a 12-week course of manual therapy. Usual medical care (control group) included “information, advice, and therapy.” During the first two weeks of care, patients in the control group “were given information about the nature and course of shoulder symptoms, along with advice on daily use of the affected shoulder” with prescriptions for “oral analgesics or nonsteroidal anti-inflammatory drugs (NSAIDs) if necessary.” Control group patients who did improve could receive another two weeks of analgesics or NSAIDs; if this approach was ineffective, they could be given “up to 3 corticosteroid injections.” If improvement remained insufficient two weeks after injections were administered, the injections could be repeated, or patients could be referred for physiotherapy consisting of shoulder exercises, massage, and physical applications.

Patients in the intervention group received usual care and manipulative therapy that included specific manipulations (low-amplitude, high-velocity thrust techniques) and specific mobilizations (high-amplitude, low-velocity thrust techniques) “to improve overall joint function and decrease any restrictions in movement at single or multiple segmental levels in the cervical spine and upper thoracic spine and adjacent ribs.” (emphasis added)This is an important point, as this study provides evidence that by utilizing spinal manipulation to address shoulder pain and dysfunction, problems in the shoulder (and other extremities) can be addressed through manipulation of the spine.

Almost all of the control patients (92%) “were treated with a wait-and-see policy, 28% were treated with corticosteroid injections, and 27% were referred to a physical therapist for a maximum of 9 treatment sessions.” Patients in the manipulative therapy group received similar care, but in addition, they received an average of 3.8 “treatment sessions from a manual therapist.”

The differences in results showed substantial improvement for those patients receiving manipulative therapy. 



The authors made several important comments regarding their study: 



“We demonstrated that manipulative therapy for the shoulder girdle in addition to usual medical care by a general practitioner accelerated recovery of shoulder symptoms and reduced their severity. These effects were sustained at 52 weeks of follow-up.”

“We believe that general practitioners should include a short physical examination of the shoulder girdle in their structured medical examinations. For patients with shoulder symptoms in whom dysfunction of the cervicothoracic spine and adjacent ribs is found, referral to a manual
therapist (Chiropractor) should be considered.”


Reference
Bergman GJD, Winters JC, Groenier KH, et al. Manipulative therapy in addition to usual medical care for patients with shoulder dysfunction and pain. Ann Intern Med2004;141:4320439.

Dr. Jason Kart D.C.