Article Title: Cervical/Thoracic Spine Mobilization/ Manipulation for Shoulder Conditions Studies Reviewed: 1. McClatchie L et al. Mobilizations of the asymptomatic cervical spine can reduce signs of shoulder dysfunction in adults. Manual Therapy 2009; 14: 369-374. 2. Boyles RE et al. The short-term effects of thoracic spine thrust manipulation on patients with shoulder impingement syndrome. Manual Therapy 2009; 14: 375-380. BACKGROUND INFORMATION: Readers should be familiar with shoulder impingement syndrome (SIS), a generic term for a common ailment involving painful impingement of the rotator cuff beneath the acromion. This condition (of variable origin) is responsible for a large percentage of shoulder complaints. Whatever the cause, shoulder pain (including SIS) is prevalent, affecting up to 35 per cent of the adult population. It can be recurrent, and is often disabling. Numerous potential pain generators exist in this region, but unfortunately an exact diagnosis is often elusive as many common orthopedic tests are of limited value. A relationship between cervical and thoracic spine joint dysfunction and shoulder pain has long been suggested, and makes sense based on the segmental innervation of shoulder structures as well as the functional anatomy of the region. Anecdotally, chiropractors have reported reduction of shoulder symptoms after treatment aimed at the cervical and/or thoracic spine regions, despite a lack of published literature to support this approach. Although the two studies discussed here are small and thus must be considered preliminary, taken together they provide some promising evidence that manipulation and mobilization represent viable treatment options for shoulder complaints. Larger studies that address the inherent limitations of these study designs are needed to further develop this body of knowledge, but the potential benefi t of these treatment strategies has certainly been established and we should be aware of this literature. STUDY DESCRIPTIONS AND RESULTS: Study #1, McClatchie et al.: This randomized, blinded, placebo-controlled cross-over trial assessed the immediate effects of C5-7 lateral glide mobilizations on shoulder pain intensity and abduction painful arc in 21 subjects with shoulder pain (average age ~49) who were asymptomatic in the cervical spine. Study #2, Boyles et al.: This study, featuring a larger, younger study group (n=56, average age 32), was an exploratory, one group pre-test/post-test study investigating the short-term effects of thoracic thrust manipulation on shoulder impingement subjects. CONCLUSIONS AND PRACTICAL APPLICATION: Despite their limitations and small size, the two studies summarizedin this review paint a promising picture for the role of manipulation/mobilization in the management of shoulder conditions. Improvements were noted in pain levels, range of motion, and orthopedic test pain levels. Stay tuned for further research on this topic… For the full review, with complete descriptions for each study, please visit www.canadian chiropractor.ca.