- Systematic review
A systematic review of thrust manipulation for non-surgical shoulder conditions
Chiropractic & Manual Therapiesvolume 25, Article number: 1 (2017)
Although 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.
A 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.
The 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.
No 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.
Shoulder pain is the 3rd most common musculoskeletal complaint behind low back and neck pain  and a frequent cause of missed work days . Estimates from a systematic review in 2004 place the point prevalence between 7 and 26% of adults who suffer from conditions causing any shoulder pain . Lifetime prevalence is reported at approximately 70% , and 40–60% of individuals with shoulder pain experience it for a duration of a year or more [5, 6]. Direct treatment costs for shoulder dysfunction totaled $7 billion in the United States alone in 2000 .
Shoulder diagnoses can be broadly classified into 1 or more of the following categories: 1) soft tissue disorders, 2) articular injury or instability, and 3) arthritis . Soft tissue disorders of the rotator cuff are frequently the cause of shoulder pain and disability  with diagnoses reaching as high as 85% . Shoulder disorders treated by manual therapists, such as doctors of chiropractic, include rotator cuff injury/disease, acromioclavicular joint disease, tendinopathy, impingement syndrome, adhesive capsulitis, and sternoclavicular dysfunction. An Australian survey reported approximately 12% of patients present to chiropractic practitioners with shoulder pain .
The shoulder is a region comprised of several disparate joints, numerous muscles, and other soft tissue structures spanning the anterior, superior, lateral, and posterior aspects of the upper thoracic region. Musculoskeletal shoulder conditions can present a diagnostic and treatment challenge due to the complex biomechanical characteristics and interrelationships between the associated joints and soft tissue structures [12–14]. Musculo-ligamentous connections between the scapulae, ribs, and the cervico-thoracic spine create the potential for symptom production from nearby structures. Likewise, shoulder pain can develop from dysfunction in adjacent anatomical regions [15–19].
Thrust manipulation is a treatment option for shoulder pain and is a procedure most often performed by chiropractors. Spinal or extremity-directed thrust manipulations are varyingly referred to as Grade V mobilizations or high-velocity low-amplitude (HVLA) manipulations in the peer-reviewed literature [21–23]. Thrust manipulation to the spine is also called spinal manipulative therapy (SMT). SMT may exert a therapeutic effect through several potential and sometimes overlapping mechanisms. SMT has been shown to alter brain and spinal cord sensory processing and contribute to reduced pain sensitivity in the extremities . Thrust manipulation to the spine and extremity joints is thought to disrupt fibrous adhesions arising from disuse, injury, or degenerative conditions . Disruption may help restore motion and augment rehabilitative exercise performance, which leads to increased proprioceptive signaling. Pain perception is also potentially altered by the inhibitive effect of increased proprioceptive signaling leading to a gating phenomenon and altered reflex activity or firing patterns within autonomic circuits [26, 27].
Systematic reviews have been conducted investigating multi-modal conservative treatments for shoulder pain [28–32]. However, drawbacks exist in their findings. For example, several reviews found mostly case reports or case series and lacked specificity in reporting statistically significant outcomes. Additionally, none of the reviews narrowed the focus to thrust manipulation. The purpose of this study was to systematically review the scientific literature and evaluate evidence regarding thrust-type manipulative therapy as a solitary treatment for non-surgical shoulder conditions.
The following electronic databases were searched from inception to March 2016: PubMed, PEDro, Index to Chiropractic Literature (ICL), Cumulative Index to Nursing and Allied Health Literature (CINAHL), and the Allied and Complementary Medicine Database (AMED). The search strategies were planned and tested in collaboration with a health sciences librarian and the detailed strategy for PubMed is included as Additional file 1. No limits were placed on language for the search; however, non-English language articles were excluded. Also, the reference lists of the included articles and previously published reviews were hand-searched to identify potentially relevant articles.
This review was conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. For the purpose of this study, shoulder conditions were defined as those involving the major anatomical regions of the shoulder complex including the proximal humerus, clavicle, scapula, sternoclavicular, glenohumeral, and acromioclavicular joints.
Articles published as manuscripts in peer-reviewed journals were included regardless of study design; systematic reviews were excluded. Table 1 displays inclusion and exclusion criteria. Thrust manipulation was defined as HVLA, or Grade V mobilization, characterized by a single thrust (lasting 100–500 milliseconds) directed at a target joint, often resulting in audible cavitation .
Eligibility determination was performed independently by two reviewers (AM and KD). During title and abstract screening, clearly irrelevant articles were excluded. Full-text versions of remaining articles were retrieved and reviewed to determine final eligibility. A final, full-text inclusive list was generated independently by reviewers and compared. A third reviewer (RV) was available for consult if concordant eligibility could not be reached.
The Physiotherapy Evidence Database (PEDro) scale was employed to assess methodological quality, internal validity, and statistical results of clinical trials . The tool uses an 11-point scale based on items from the Delphi list developed by Verhagen et al . Trials not reporting specific criterion were scored as if the criterion was not met. The PEDro scale is only applicable to appraise clinical trials including randomly allocated groups. PEDro scores were assigned (AM) to the 4 studies with random allocation designs included in this review. After scoring, methodological interpretation was performed using the following ranking: 9 to 10 is considered excellent, 6 to 8 is good, 4 to 5 is fair, and 3 or below represents poor quality . A second internal validity assessment was performed on all 6 studies using the Cochrane risk-of-bias tool . The Cochrane tool can be applied to studies with or without random allocation as part of the study design, and 2 additional biases (attrition and reporting) are evaluated that are not included in the PEDro scale. The tool can also highlight the heterogeneity of studies and inform analysis. It assesses 5 different areas (selection, performance, attrition, detection, and reporting bias). Individual items were scored (AM) according to the risk of bias (high, unclear, and low) where 0 = high risk of bias, 1 = unclear risk, and 2 = low risk.
Data extraction and analysis
Data from included studies were extracted by a primary reviewer (AM) and evaluated by a second reviewer (CH) with differences resolved by consensus discussion. A priori, we defined the primary outcomes of interest as pain and disability for studies including any length of follow-up period. These outcomes were most likely to be consistently reported across studies and are applicable to clinical practice.
Selection of studies
Figure 1 is the PRISMA flowchart of the search process. Our search strategy produced 5041 citations. After title review, 93 articles met inclusion criteria. Following abstract review, 36 articles remained and underwent full-text evaluation. Six studies met all criteria and were included [38–43]. Four [38–41] of the 6 included studies were randomized controlled trials (RCTs), and 2 [42, 43] were uncontrolled clinical studies without a comparison group. All articles included studies of interventions for subacromial impingement syndrome. Key characteristics of included studies are listed in Table 2. Studies excluded at full-text review and reasons for exclusion are included in Table 3.
The PEDro scores for the clinical trials [38–41] included in the analysis are reported in Table 4. Two studies were not scored using this instrument because they were not RCTs [42, 43]. The PEDro scores indicated the overall methodological quality of the included articles ranged from fair to good.
All included articles were evaluated with the Cochrane risk-of-bias tool. Results are reported in Table 5. No study had low risk of bias for all 8 methodological items. Reporting bias was either present or unclear in all studies because none provided trial registration numbers or had published protocols. Because all studies involved manual therapies, provider blinding did not occur and this category was marked as high risk for all studies. Participant blinding was adequately reported in 2 [38, 39] of the 4 RCTs. Three [40, 42, 43] of 6 studies were scored high risk pertaining to the blinding of outcome assessments and the other 3 were scored as unclear. The highest score was 11/16 for 2 [38, 39] studies indicating an overall moderate to low risk of bias. The remaining 4 studies’ scores indicated an overall high risk of bias.
A variety of self-reported outcome measures were assessed in this review. All 6 studies [38–43] used a numeric pain rating scale or a visual analog scale to measure pain-related outcomes. One  study used the short-form McGill pain questionnaire as an additional pain measure. Pain reduction was shown to be statistically significant following the intervention in the uncontrolled studies [42, 43]. In 3 of the RCTs [38, 39, 41], a statistically significant improvement in pain was found within both the active and sham groups but the between-group differences were not statistically significant. One RCT found statistical significance within and between the treatment and control (detuned ultrasound) groups . The clinical relevance of mean changes in pain was inconsistent across the studies. Three [38–40] found improvements that met the minimum clinically important difference, 1 study’s  findings did not meet the threshold, and 2 were unclear [39, 41]. Four studies, 2 RCTs and 2 uncontrolled trials [38, 39, 42, 43], used validated disability outcome measures. The RCTs [38, 39] reported statistically significant within-group differences, and the uncontrolled trials [42, 43] reported statistical significance in pre to post measurements. Differences in disability between the active and sham groups were not statistically significant in the RCTs.
Included studies used different tools to measure objective clinical outcomes. One RCT reported small statistically significant improvements in scapular internal and upward rotation, but improvements were not clinically relevant and the change in upward rotation occurred following both the active and sham interventions . An uncontrolled study also reported a small significant improvement in scapular upward rotation following thrust manipulation. However, there were generally no statistically significant findings in the 3 studies that assessed scapular kinematic changes [39, 41, 43]. One study  reported small statistically significant improvements in middle trapezius surface electromyographic activity and force production with elevation in the scapular plane. One RCT  reported no statistically significant changes within either treatment group for pain pressure threshold, while another found a statistically significant between-group difference supporting the thrust manipulation group .
The purpose of this study was to systematically review the scientific literature and evaluate the effectiveness of thrust manipulation for non-surgical shoulder conditions. All studies included in this review reported treatments for a single common shoulder diagnosis, subacromial impingement syndrome, thought to be caused by abnormal mechanical compression and/or inflammation of subacromial structures (e.g., supraspinatus tendon, subacromial bursa) .
In this systematic review, 5 [38, 39, 41–43] of 6 studies assessed thoracic SMT during a single treatment session. The other study  involved thrust manipulation directed to the acromioclavicular or glenohumeral joint, ribs, and/or scapula. In terms of pain and disability, all 6 studies reported positive outcomes following manipulation. Four [38, 39, 42, 43] of the 6 studies did not report adverse events (AEs). Of the 2 studies that reported AEs, 1  reported no adverse reactions to treatment and the other  reported 5 incidents of minor and temporary soreness post-treatment. Overall, little AE reporting occurred, and there is more to be learned regarding safety. What was reported (minor and temporary soreness) is consistent with AEs for spinal manipulation applied to patients with back and neck pain [45–47].
Previously, a systematic review of chiropractic treatment for upper extremity conditions  and a systematic review expanding on that work  investigated several manual therapies for shoulder pain. Both reviews concluded there was low-level to fair evidence supporting the use of manual therapy (including thrust manipulation) techniques and other therapies such as manual muscle procedures, ultrasound, and exercises treating diverse shoulder complaints. Another study published in 2013  aimed to expand upon prior reviews of manipulative, mobilization, and multi-modal therapies for upper extremity problems. This review  found very limited updated information pertaining to the shoulder, and the treatments were mainly multi-modal therapies. Similarly, a 2010 systematic review of chiropractic management for the treatment of shoulder pain reported limited evidence for the efficacy of multi-modal methods for shoulder girdle dysfunction and subacromial impingement . Lastly, a recent systematic review and meta-analysis evaluated the efficacy of manual therapy for rotator cuff tendinopathy, a condition associated with impingement syndrome . Fourteen of the 21 included studies investigated manual therapy interventions that did not use thrust manipulation. The authors concluded, based on low- to moderate-level evidence, that manual therapy alone or combined with another conservative intervention (e.g., mobilization with ultrasound) resulted in a statistically significant decrease in pain; however, the reductions were small and the clinical significance was unclear. This review also concluded, based on low-level evidence, that it is uncertain whether using manual therapy alone can improve shoulder disability. Generally, these reviews suggest that performing multiple treatments in varying combinations to the shoulder and/or spine is of some clinical benefit for non-surgical conditions causing shoulder pain. However, knowledge that an undefined set of therapies regularly results in improvement is not particularly useful to clinicians formulating evidence-based management plans.
This systematic review has limitations. Only 6 studies were included with relatively small participant sample sizes. Due to the heterogeneity of the included studies’ designs and outcome measurements, results could not be pooled. Also, the quality scores were assessed by a single author. All but one of the included studies investigated only a single treatment session. In clinical settings, manipulation is typically delivered over several visits [49–51]. This factor limits conclusions regarding the effect of thrust manipulation for shoulder impingement syndrome as used pragmatically. Another potential limitation was that a grey literature search was not performed, and it is possible that available studies did not appear in our search results. However, abstracts, conference proceedings and professional projects usually lack the reporting detail necessary to comprehensively assess study methodology using validated appraisal tools as was executed during this study. A final limitation is that manual therapy studies are unable to blind practitioners, thus the potential scores using the PEDro and Cochrane risk-of-bias tool are limited. Nevertheless, for the included studies, no substantial change in methodological ratings would have occurred if practitioners were blinded to treatment group. Consequently, there is insufficient evidence to fully interpret the effectiveness of thoracic, cervical or shoulder thrust manipulation as a solitary treatment for subacromial impingement syndrome and results of this study should be interpreted cautiously.
No clinical trials of thrust manipulation for non-surgical shoulder conditions other than subacromial impingement syndrome were found. This systematic review reports there is limited evidence to support or refute thrust manipulation as a solitary treatment for shoulder pain or disability associated with subacromial impingement syndrome. Studies consistently reported a reduction in pain and improvement in disability following thrust manipulation. In RCTs, active treatments were comparable to shams suggesting that addressing impingement issues by manipulation alone may not be effective. Thrust manipulative therapy appears not to be harmful, but AE reporting was not robust. Higher-quality studies with safety data, longer treatment periods and follow-up outcomes are needed to develop a stronger evidence-based foundation for thrust manipulation as a treatment for shoulder conditions.
Allied and Complementary Medicine Database
Cumulative Index to Nursing and Allied Health Literature
Index to Chiropractic Literature
Numeric pain rating scale
Physiotherapy Evidence Database
Preferred Reporting Items for Systematic Reviews and Meta-Analyses
Penn shoulder score
Randomized controlled trial
Range of motion
Short-form McGill pain questionnaire
Spinal manipulative therapy
Shoulder pain and disability index
Visual analog scale
May S, Chance-Larsen K, Littlewood C, Lomas D, Saad M. Reliability of physical examination tests used in the assessment of patients with shoulder problems: a systematic review. Physiotherapy. 2010;96:179–90.
House J, Mooradian A. Evaluation and management of shoulder pain in primary care clinics. South Med J. 2010;103:1129–35.
Luime JJ, Koes BW, Hendriksen IJ, Burdorf A, Verhagen AP, Miedema HS, et al. Prevalence and incidence of shoulder pain in the general population; a systematic review. Scand J Rheumatol. 2004;33:73–81.
Saltychev M, Aarimaa V, Virolainen P, Laimi K. Conservative treatment or surgery for shoulder impingement: systematic review and meta-analysis. Disabil Rehabil. 2015;37:1–8.
van den Dolder PA, Ferreira PH, Refshauge KM. Effectiveness of soft tissue massage and exercise for the treatment of non-specific shoulder pain: a systematic review with meta-analysis. Br J Sports Med. 2014;48:1216–26.
Marinko LN, Chacko JM, Dalton D, Chacko CC. The effectiveness of therapeutic exercise for painful shoulder conditions: a meta-analysis. J Shoulder Elbow Surg. 2011;20:1351–59.
Meislin RJ, Sperling JW, Stitik TP. Persistent shoulder pain: epidemiology, pathophysiology, and diagnosis. Am J Orthop (Belle Mead NJ). 2005;34:5–9.
Dinnes J, Loveman E, McIntyre L, Waugh N. The effectiveness of diagnostic tests for the assessment of shoulder pain due to soft tissue disorders: a systematic review. Health Technol Assess. 2003;7:iii, 1-iii166.
Lenza M, Buchbinder R, Takwoingi Y, Johnston RV, Hanchard NC, Faloppa F. Magnetic resonance imaging, magnetic resonance arthrography and ultrasonography for assessing rotator cuff tears in people with shoulder pain for whom surgery is being considered. Cochrane Database Syst Rev. 2013;(9):CD009020.
Ostor AJ, Richards CA, Prevost AT, Speed CA, Hazleman BL. Diagnosis and relation to general health of shoulder disorders presenting to primary care. Rheumatology (Oxford). 2005;44:800–05.
Pribicevic M, Pollard H, Bonello R. An epidemiologic survey of shoulder pain in chiropractic practice in australia. J Manipulative Physiol Ther. 2009;32:107–17.
Mitchell C, Adebajo A, Hay E, Carr A. Shoulder pain: diagnosis and management in primary care. BMJ. 2005;331:1124–28.
Hughes PC, Taylor NF, Green RA. Most clinical tests cannot accurately diagnose rotator cuff pathology: a systematic review. Aust J Physiother. 2008;54:159–70.
Hegedus EJ, Goode A, Campbell S, Morin A, Tamaddoni M, Moorman III CT, et al. Physical examination tests of the shoulder: a systematic review with meta-analysis of individual tests. Br J Sports Med. 2008;42:80–92.
Cools AM, Witvrouw EE, Mahieu NN, Danneels LA. Isokinetic scapular muscle performance in overhead athletes with and without impingement symptoms. J Athl Train. 2005;40:104–10.
Chester R, Smith TO, Hooper L, Dixon J. The impact of subacromial impingement syndrome on muscle activity patterns of the shoulder complex: a systematic review of electromyographic studies. BMC Musculoskelet Disord. 2010;11:45.
Andersen CH, Andersen LL, Zebis MK, Sjogaard G. Effect of scapular function training on chronic pain in the neck/shoulder region: a randomized controlled trial. J Occup Rehabil. 2014;24:316–24.
Santos MJ, Belangero WD, Almeida GL. The effect of joint instability on latency and recruitment order of the shoulder muscles. J Electromyogr Kinesiol. 2007;17:167–75.
Sergienko S, Kalichman L. Myofascial origin of shoulder pain: a literature review. J Bodyw Mov Ther. 2015;19:91–101.
Cooperstein R, Perle SM, Gatterman MI, Lantz C, Schneider MJ. Chiropractic technique procedures for specific low back conditions: characterizing the literature. J Manipulative Physiol Ther. 2001;24:407–24.
Evans DW, Lucas N. What is ‘manipulation’? A reappraisal. Man Ther. 2010;15:286–91.
Evans DW. Why do spinal manipulation techniques take the form they do? Towards a general model of spinal manipulation. Man Ther. 2010;15:212–19.
American Physical Therapy Association. Physical therapists and direction of mobilization/manipulation: an educational resource paper. 2013.
Coronado RA, Gay CW, Bialosky JE, Carnaby GD, Bishop MD, George SZ. Changes in pain sensitivity following spinal manipulation: a systematic review and meta-analysis. J Electromyogr Kinesiol. 2012;22:752–67.
Cramer GD, Henderson CN, Little JW, Daley C, Grieve TJ. Zygapophyseal joint adhesions after induced hypomobility. J Manipulative Physiol Ther. 2010;33:508–18.
Pickar JG. Neurophysiological effects of spinal manipulation. Spine J. 2002;2:357–71.
Audette J, Bailey A. Integrative Pain Medicine. 1st ed. Humana Press; 2008.
Brantingham JW, Cassa TK, Bonnefin D, Pribicevic M, Robb A, Pollard H, et al. Manipulative and multimodal therapy for upper extremity and temporomandibular disorders: a systematic review. J Manipulative Physiol Ther. 2013;36:143–201.
Pribicevic M, Pollard H, Bonello R, de Luca K. A systematic review of manipulative therapy for the treatment of shoulder pain. J Manipulative Physiol Ther. 2010;33:679–89.
Brantingham JW, Cassa TK, Bonnefin D, Jensen M, Globe G, Hicks M, et al. Manipulative therapy for shoulder pain and disorders: expansion of a systematic review. J Manipulative Physiol Ther. 2011;34:314–46.
McHardy A, Hoskins W, Pollard H, Onley R, Windsham R. Chiropractic treatment of upper extremity conditions: a systematic review. J Manipulative Physiol Ther. 2008;31:146–59.
Ho CY, Sole G, Munn J. The effectiveness of manual therapy in the management of musculoskeletal disorders of the shoulder: a systematic review. Man Ther. 2009;14:463–74.
American Physical Therapy Association. Position on Thrust Joint Manipulation provided by Physical Therapists. VA: Alexandria; 2009.
de Morton NA. The PEDro scale is a valid measure of the methodological quality of clinical trials: a demographic study. Aust J Physiother. 2009;55:129–33.
Verhagen AP, de Vet HC, de Bie RA, Kessels AG, Boers M, Bouter LM, et al. The Delphi list: a criteria list for quality assessment of randomized clinical trials for conducting systematic reviews developed by Delphi consensus. J Clin Epidemiol. 1998;51:1235–41.
Teasell RW, Foley NC, Bhogal SK, Speechley MR. An evidence-based review of stroke rehabilitation. Top Stroke Rehabil. 2003;10:29–58.
Higgins JPT. Cochrane Handbook for Systematic Reviews of Interventions. Version 5.1.0 [updated March 2011]. The Cochrane Collaboration. 2011. Available from www.handbook.cochrane.org. Accessed Mar 2016.
Kardouni JR, Shaffer SW, Pidcoe PE, Finucane SD, Cheatham SA, Michener LA. Immediate changes in pressure pain sensitivity after thoracic spinal manipulative therapy in patients with subacromial impingement syndrome: a randomized controlled study. Man Ther. 2015;20:540–46.
Kardouni JR, Pidcoe PE, Shaffer SW, Finucane SD, Cheatham SA, Sousa CO, et al. 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. J Orthop Sports Phys Ther. 2015;45:527–38.
Munday S, Jones A, Brantingham J, Globe G, Jensen M, Price J. A randomized, single-blinded, placebo-controlled clinical trial to evaluate the efficacy of chiropractic shoulder girdle adjustment in the treatment of shoulder impingement syndrome. JACA Online. 2007;44(6):6–15.
Haik MN, Alburquerque-Sendin F, Silva CZ, Siqueira-Junior AL, Ribeiro IL, Camargo PR. Scapular kinematics pre- and post-thoracic thrust manipulation in individuals with and without shoulder impingement symptoms: a randomized controlled study. J Orthop Sports Phys Ther. 2014;44:475–87.
Boyles RE, Ritland BM, Miracle BM, Barclay DM, Faul MS, Moore JH, et al. The short-term effects of thoracic spine thrust manipulation on patients with shoulder impingement syndrome. Man Ther. 2009;14:375–80.
Muth S, Barbe MF, Lauer R, McClure PW. The effects of thoracic spine manipulation in subjects with signs of rotator cuff tendinopathy. J Orthop Sports Phys Ther. 2012;42:1005–16.
Braman JP, Zhao KD, Lawrence RL, Harrison AK, Ludewig PM. Shoulder impingement revisited: evolution of diagnostic understanding in orthopedic surgery and physical therapy. Med Biol Eng Comput. 2014;52:211–19.
Walker BF, Hebert JJ, Stomski NJ, Clarke BR, Bowden RS, Losco B, et al. Outcomes of usual chiropractic. The OUCH randomized controlled trial of adverse events. Spine (Phila Pa 1976). 2013;38:1723–29.
Hurwitz EL, Morgenstern H, Vassilaki M, Chiang LM. Frequency and clinical predictors of adverse reactions to chiropractic care in the UCLA neck pain study. Spine (Phila Pa 1976). 2005;30:1477–84.
Cagnie B, Vinck E, Beernaert A, Cambier D. How common are side effects of spinal manipulation and can these side effects be predicted? Man Ther. 2004;9:151–56.
Desjardins-Charbonneau A, Roy JS, Dionne CE, Fremont P, MacDermid JC, Desmeules F. The efficacy of manual therapy for rotator cuff tendinopathy: a systematic review and meta-analysis. J Orthop Sports Phys Ther. 2015;45:330–50.
Souza T. Shoulder Girdle Complaints. Differential Diagnosis and Management for the Chiropractor. 5th edition. Jones & Bartlett Learning. 2014;237–302.
Bryans R, Decina P, Descarreaux M, Duranleau M, Marcoux H, Potter B, et al. Evidence-based guidelines for the chiropractic treatment of adults with neck pain. J Manipulative Physiol Ther. 2014;37:42–63.
Globe G, Farabaugh RJ, Hawk C, Morris CE, Baker G, Whalen WM, et al. Clinical practice guideline: chiropractic care for Low back pain. J Manipulative Physiol Ther. 2016;39:1–22.
Atkinson M, et al. A randomized controlled trial to assess the efficacy of shoulder manipulation vs. placebo in the treatment of shoulder pain due to rotator cuff tendinopathy. JACA Online. 2008;45(9):11–26.
Bang MD, Deyle GD. Comparison of supervised exercise with and without manual physical therapy for patients with shoulder impingement syndrome. J Orthop Sports Phys Ther. 2000;30:126–37.
Bialoszewski D, Zaborowski G. Usefulness of manual therapy in the rehabilitation of patients with chronic rotator cuff injuries. Preliminary report. Ortop Traumatol Rehabil. 2011;13:9–20.
Buchbinder R, Youd JM, Green S, Stein A, Forbes A, Harris A, et al. Efficacy and cost-effectiveness of physiotherapy following glenohumeral joint distension for adhesive capsulitis: a randomized trial. Arthritis Rheum. 2007;57:1027–37.
Coombes BK, Vicenzino B. Pragmatic study of corticosteroid injections and manual physical therapy for the shoulder impingement syndrome. Ann Intern Med. 2014;161:224–25.
Crowell MS, Tragord BS. Orthopaedic manual physical therapy for shoulder pain and impaired movement in a patient with glenohumeral joint osteoarthritis: a case report. J Orthop Sports Phys Ther. 2015;45:453.
Dunning J, Mourad F, Giovannico G, Maselli F, Perreault T, Fernandez-de-Las-Penas C. Changes in shoulder pain and disability after thrust manipulation in subjects presenting with second and third rib syndrome. J Manipulative Physiol Ther. 2015;38:382–94.
Foster NE. Similar clinical outcomes but more healthcare use in shoulder impingement patients following corticosteroid injection compared with physical therapy. Evid Based Med. 2015;20:67.
Ha SM, Kwon OY, Yi CH, Jeon HS, Lee WH. Effects of passive correction of scapular position on pain, proprioception, and range of motion in neck-pain patients with bilateral scapular downward-rotation syndrome. Man Ther. 2011;16:585–89.
Harris KD, Deyle GD, Gill NW, Howes RR. Manual physical therapy for injection-confirmed nonacute acromioclavicular joint pain. J Orthop Sports Phys Ther. 2012;42:66–80.
Howe DH, Newcombe RG, Wade MT. Manipulation of the cervical spine--a pilot study. J R Coll Gen Pract. 1983;33:574–79.
Jewell DV, Riddle DL, Thacker LR. Interventions associated with an increased or decreased likelihood of pain reduction and improved function in patients with adhesive capsulitis: a retrospective cohort study. Phys Ther. 2009;89:419–29.
Johnson G. Physical therapy management of a patient with cervicothoracic dysfunction and shoulder impingement syndrome: a case report. Orthop Phys Ther Pract. 2011;23(3):133–38.
Kazemi M. Adhesive capsulitis: a case report. J Can Chiropr Assoc. 2011;44(3):169–76.
Kukkonen J, Joukainen A, Lehtinen J, Mattila KT, Tuominen EK, Kauko T, et al. Treatment of non-traumatic rotator cuff tears: a randomised controlled trial with one-year clinical results. Bone Joint J. 2014;96-B:75–81.
Kukkonen J, Joukainen A, Lehtinen J, Mattila KT, Tuominen EK, Kauko T, et al. Treatment of nontraumatic rotator cuff tears: a randomized controlled trial with Two years of clinical and imaging follow-up. J Bone Joint Surg Am. 2015;97:1729–37.
Michener LA, Kardouni JR, Sousa CO, Ely JM. Validation of a sham comparator for thoracic spinal manipulation in patients with shoulder pain. Man Ther. 2015;20:171–75.
Negahban H, Behtash Z, Sohani SM, Salehi R. Responsiveness of two Persian-versions of shoulder outcome measures following physiotherapy intervention in patients with shoulder disorders. Disabil Rehabil. 2015;37:2300–04.
Pribicevic M, Pollard H. A multi-modal treatment approach for the shoulder: a 4 patient case series. Chiropr Osteopat. 2005;13:20.
Rhon DI, Boyles RB, Cleland JA. One-year outcome of subacromial corticosteroid injection compared with manual physical therapy for the management of the unilateral shoulder impingement syndrome: a pragmatic randomized trial. Ann Intern Med. 2014;161:161–69.
Riley SP, Bialosky J, Cote MP, Swanson BT, Tafuto V, Sizer PS, et al. Thoracic spinal manipulation for musculoskeletal shoulder pain: Can an instructional set change patient expectation and outcome? Man Ther. 2015;20:469–74.
Riley SP, Cote MP, Leger RR, Swanson BT, Tafuto V, Sizer PS, et al. Short-term effects of thoracic spinal manipulations and message conveyed by clinicians to patients with musculoskeletal shoulder symptoms: a randomized clinical trial. J Man Manip Ther. 2015;23:3–11.
Senbursa G, Baltaci G, Atay A. Comparison of conservative treatment with and without manual physical therapy for patients with shoulder impingement syndrome: a prospective, randomized clinical trial. Knee Surg Sports Traumatol Arthrosc. 2007;15:915–21.
Vermeulen HM, Obermann WR, Burger BJ, Kok GJ, Rozing PM, van Den Ende CH. End-range mobilization techniques in adhesive capsulitis of the shoulder joint: a multiple-subject case report. Phys Ther. 2000;80:1204–13.
Wassinger CA, Rich D, Cameron N, Clark S, Davenport S, Lingelbach M, et al. Cervical & thoracic manipulations: acute effects upon pain pressure threshold and self-reported pain in experimentally induced shoulder pain. Man Ther. 2016;21:227–32.
Winters JC, Sobel JS, Groenier KH, Arendzen HJ, Meyboom-de JB. Comparison of physiotherapy, manipulation, and corticosteroid injection for treating shoulder complaints in general practice: randomised, single blind study. BMJ. 1997;314:1320–25.
Yang JL, Jan MH, Chang CW, Lin JJ. Effectiveness of the end-range mobilization and scapular mobilization approach in a subgroup of subjects with frozen shoulder syndrome: a randomized control trial. Man Ther. 2012;17:47–52.
Yilmaz ATS. The effectiveness of conservative treatment on subacromial shoulder pain: a prospective and observational study for functional outcome. J Phys Med Rehabil Sci. 2015;18(3):146–55.
The authors would like to thank Roseann Erwin, Branch Manager Librarian at Palmer College of Chiropractic, for her support with the generation of the literature search.
This project was supported by a graduate research assistantship funded in part by the Palmer Center for Chiropractic Research. The funding body did not have a role in the design of the study, analysis, interpretation of data or in writing the manuscript.
Availability of data and materials
AM and KD performed the literature search and the screening and selection of the included articles. AM completed the data extraction as the primary reviewer and CH evaluated the data extraction as secondary reviewer. AM, RV, KD and CL prepared the manuscript. RV, CL, and CH oversaw the design of the study. All authors read and approved the final manuscript.
The authors declare that they have no competing interests.
Consent for publication
Ethics approval and consent to participate
PubMed literature search strategy. (DOCX 13 kb)