A systematic review of thrust manipulation for non-surgical shoulder conditions

Abstract

PurposeAlthough many conservative management options are available for patients with non-surgical shoulder conditions, there is little evidence of their effectiveness. This review investigated one manual therapy approach, thrust manipulation, as a treatment option.MethodsA systematic search was conducted of the electronic databases from inception to March 2016: PubMed, PEDro, ICL, CINAHL, and AMED. Two independent reviewers conducted the screening process to determine article eligibility. Inclusion criteria were manuscripts published in peer-reviewed journals with human participants of any age. The intervention included was thrust, or high-velocity low-amplitude, manipulative therapy directed to the shoulder and/or the regions of the cervical or thoracic spine. Studies investigating secondary shoulder pain or lacking diagnostic confirmation procedures were excluded. Methodological quality was assessed using the PEDro scale and the Cochrane risk-of-bias tool.ResultsThe initial search rendered 5041 articles. After screening titles and abstracts, 36 articles remained for full-text review. Six articles studying subacromial impingement syndrome met inclusion criteria. Four studies were randomized controlled trials (RCTs) and 2 were uncontrolled clinical studies. Five studies included 1 application of a thoracic spine thrust manipulation and 1 applied 8 treatments incorporating a shoulder joint thrust manipulation. Statistically significant improvements in pain scores were reported in all studies. Three of 4 RCTs compared a thrust manipulation to a sham, and statistical significance in pain reduction was found within the groups but not between them. Clinically meaningful changes in pain were inconsistent; 3 studies reported that scores met minimum clinically important difference, 1 reported scores did not, and 2 were unclear. Four studies found statistically significant improvements in disability; however, 2 were RCTs and did not find statistical significance between the active and sham groups.ConclusionsNo clinical trials of thrust manipulation for non-surgical shoulder conditions other than subacromial impingement syndrome were found. There is limited evidence to support or refute thrust manipulation as a solitary treatment for this condition. Studies consistently reported pain reduction, but active treatments were comparable to shams. High-quality studies of thrust manipulation with safety data, longer treatment periods and follow-up outcomes are needed.Electronic supplementary materialThe online version of this article (doi:10.1186/s12998-016-0133-8) contains supplementary material, which is available to authorized users.

A systematic review and meta-analysis on effect of spinal mobilization and manipulation on cardiovascular responses

“…The existing research literature regarding effect of spinal manipulation and mobilization on cardiovascular parameters is still ambiguous. Studies corroborate 11 , 13 , 14 , 15 , 16 , 17 , 18 , 21 , 22 , 23 , 26 , 27 , 28 as well as contradict 12 , 19 , 20 , 24 , 25 the effects of manual therapy on cardiovascular parameters. These studies also have various methodological flaws.…”

“…Most of the studies were done in USA (nine) 11 , 12 , 19 , 21 , 22 , 23 , 25 , 27 , 28 followed by Australia (two), 17 , 18 Spain (two), 13 , 24 Canada (two). 14 , 16 One study each was conducted in Brazil, 15 France 16 and Malaysia. 20 Only randomized control trials, either on healthy population or symptomatic population (such as subjects with spinal pain or hypertension), that compared the intervention to either a placebo or a control group were included.…”

“…5 out of 18 studies scored the highest score of 11. 14 , 20 , 21 , 24 , 25 6 studies scored 10, 13 , 16 , 18 , 22 , 25 , 27 3 studies scored 9 12 , 19 , 26 and 4 studies scored 8. 11 , 15 , 17 , 28 Therefore, it can be inferred that all the included studies were of good quality.…”

Immediate Effects of Spinal Manipulation on Shoulder Motion Range and Pain in Individuals With Shoulder Pain: A Randomized Trial

“…This result was also reported in a systematic review in which thrust manipulation was investigated as a treatment option for nonsurgical shoulder conditions, verifying that there was a reduction in pain, although active and sham treatments were comparable. 33 Similar to this result, the study of Kardouni et al, 11 who evaluated patients with shoulder impingement syndrome after thoracic manipulation, found that both the manipulation group and the placebo group presented a reduction in pain. Two other studies obtained the same outcome as those of the present study for pain, verifying a decrease after manipulation in participants with shoulder impingement syndrome, both in the manipulation group and placebo group.…”

Towards an integrated clinical framework for patient with shoulder pain

“…3 ). Once the painful movement is identified, the patient rates his/her pain on a numeric rating scale and then the physiotherapist attempts to modify it applying specific procedures [ 31 , 57 , 84 – 89 ] (see Table 3 ).

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