Chiropractic for Shoulder Pain

EFFECTIVENESS: 4/5

Several studies have shown manipulation can be helpful for shoulder pain-sprain/strain. However, research specifically related to sprain/strain in isolation is minimal. There are many different types of shoulder pain-sprain/strain, and while manipulation may help some patients with different types of shoulder pain-sprain/strain, it is not effective for all shoulder pain-sprain/strain sufferers, including pain associated with nerve-involvement. Several studies however have shown that some patients who receive manipulation do better in the short and long term compared to usual medical care.

Bottom line: there is fair evidence that manipulation and mobilization is effective for some types of shoulder pain-sprain/strain, but more research needs to be done.

Additionally, there is some evidence related to manipulation/mobilization related to conditions other than sprain/strain, including: rotator cuff tear, adhesive capsulitis. Research is poor as it relates to neurogenic shoulder pain and osteoarthritis. More current research suggests that manipulation was at least as effective as steroid injections for frozen shoulder.[i]

Of interest: One recent study demonstrated that manipulation performed by Doctors of Chiropractic is the most frequently requested alternative medicine approach for chronic tension-type shoulder pain-sprain/strain, and slightly more than 40% reported improvement with the treatment. [ii] There are many other papers related to the treatment of shoulder sprain/strain using manipulation and/or mobilization. [iii], [iv], [v], [vi], [vii], [viii], [ix]

Sources:

[i] Brantingham JW, Cassa TK, Bonnefin D, Jensen M, Globe G, Hicks M, Korporaal C. Manipulative therapy for shoulder pain and disorders: expansion of a systematic review. J Manipulative Physiol Ther. 2011 Jun;34(5):314-46.

[ii] Rossi P, Di Lorenzo G, Faroni J, Malpezzi MG, Cesarino F, Nappi G. Use of complementary and alternative medicine by patients with chronic tension-type shoulder pain-sprain/strain: results of a shoulder pain-sprain/strain clinic survey. Shoulder pain-sprain/strain. 2006 Apr; 46(4):622-31.

[iii] Garcia JD, Arnold S, Tetley K, Voight K, Frank RA. Mobilization and Manipulation of the Cervical Spine in Patients with Cervicogenic Shoulder pain-sprain/strain: Any Scientific Evidence? Frontiers in Neurology. 2016;7:40. doi:10.3389/fneur.2016.00040.

[iv] Espí-López GV1, Zurriaga-Llorens R, Monzani L, Falla D.The effect of manipulation plus massage therapy versus massage therapy alone in people with tension-type shoulder pain-sprain/strain. A randomized controlled clinical trial. Eur J Phys Rehabil Med. 2016 Oct;52(5):606-617. Epub 2016 Mar 18.

[v] Aleksander Chaibi, Michael Bjørn Russell. Manual therapies for primary chronic shoulder pain-sprain/strain: a systematic review of randomized controlled trials. The Journal of Shoulder pain-sprain/strain and Pain201415:67 https://doi.org/10.1186/1129-2377-15-67

[vi] Bryans R1, Descarreaux M, Duranleau M, Marcoux H, Potter B, Ruegg R, Shaw L, Watkin R, White E.Evidence-based guidelines for the chiropractic treatment of adults with shoulder pain-sprain/strain. J Manipulative Physiol Ther. 2011 Jun;34(5):274-89. doi: 10.1016/j.jmpt.2011.04.008.

[vii] Garcia JD1, Arnold S1, Tetley K1, Voight K1, Frank RA1. Front Neurol.Mobilization and Manipulation of the Cervical Spine in Patients with Cervicogenic Shoulder pain-sprain/strain: Any Scientific Evidence? 2016 Mar 21;7:40. doi: 10.3389/fneur.2016.00040. eCollection 2016.

[viii] Lozano López C, Mesa Jiménez J, de la Hoz Aizpurúa JL, Pareja Grande J, Fernández de Las Peñas C. Neurologia. Efficacy of manual therapy in the treatment of tension-type shoulder pain-sprain/strain. A systematic review from 2000-2013. 2014 May 21. pii: S0213-4853(14)00011-5.

[ix] Castien RF1, van der Windt DA, Grooten A, Dekker J. Cephalalgia. Effectiveness of manual therapy for chronic tension-type shoulder pain-sprain/strain: a pragmatic, randomised, clinical trial. 2011 Jan;31(2):133-43. doi: 10.1177/0333102410377362. Epub 2010 Jul 20.

SELF CARE: 0/5

While some people may try to do self- manipulation, we don’t recommend it. As a practical matter, one cannot manipulate or mobilize themselves. Obviously, home-based exercise is important to restore mobility, but that is vastly different than a doctor or therapist manipulating or mobilizing the joint while you passively lay there being treated.

COST: 5/5

Manipulation, most commonly provided by Doctors of Chiropractic, is covered by most insurance plans. National guidelines recommend trial of care, that is, 6-12 visits with a reevaluation after the trial to ensure treatment is helping. If there is no improvement after 12 visits, it’s time to move on! [i]

Sources:

[i] Haldeman S, Carey P, Townsend M, Papadopoulos C. Arterial dissections following cervical manipulation: the chiropractic experience. CMAJ: Canadian Medical Association Journal. 2001;165(7):905-906.

USEFULNESS: 3/5

Extremity manipulation/mobilization is widely used, safe and a relatively inexpensive treatment for shoulder sprain/strain. To date there is minimal research related to the use of shoulder manipulation for the treatment of shoulder sprain/strain. If you are going to consider manipulation be sure to consult providers both educated and licensed to provide the service. Doctors of Chiropractic receive more education and training regarding “manipulation” (mild movements which may or may not produce and audible noise or “cracking sound”), but both Doctors of Chiropractic and physical therapists are trained in the art of “mobilization” (gentle movements designed to restore range of motion). As with any treatment, improvement in pain and function (i.e., the joint is moving better) is expected to some degree within a trial period of up to six visits over a two-week period. [i], [ii], [iii]

Sources:

[i] Bergman GJ, Winters JC, Groenier KH, Pool JJ, Meyboom-de Jong B, Postema K, van der Heijden GJ. Manipulative therapy in addition to usual medical care for patients with shoulder dysfunction and pain: a randomized, controlled trial. Ann Intern Med. 2004 Sep 21;141(6):432-9.

[ii] Michener LA, Walsworth MK, Burnet EN. Effectiveness of rehabilitation for patients with subacromial impingement syndrome: a systematic review. J Hand Ther. 2004 Apr-Jun;17(2):152-64.

[iii] Verhagen AP, Karels C, Bierma-Zeinstra SM, Burdorf L, Feleus A, Dahaghin S, de Vet HC, Koes BW. Ergonomic and physiotherapeutic interventions for treating work-related complaints of the arm, neck or shoulder in adults. Cochrane Database Syst Rev. 2006 Jul 19;(3):CD003471.