Spinal manipulation combined with exercise therapy could be more effective than exercise therapy alone for shoulder pain and disability: A systematic review and meta-analysis

Objective

To investigate whether exercise therapy associated with spinal manipulation is more effective than exercise therapy alone in patients with shoulder pain.

Data sources

Studies were identified by searching MEDLINE/PubMed, Embase, CENTRAL, PEDro, and clinical trial registers. Included studies were written in English without date restrictions.

Study selection

We selected controlled trial studies investigating thoracic, cervical, and cervicothoracic spinal manipulations and therapeutic exercises for patients with shoulder pain symptoms and dysfunction outcomes.

Data extraction

The study included six clinical trials with 431 participants. Low and very low-quality evidence suggests that the association of interventions can be effective for pain intensity in the first 2 weeks (mean difference [MD], −0.99; [confidence interval] CI, −1.61–0.38) and from the 4th to the 6th week (MD, −0.61; CI, −1.01 to 0.20), respectively. Furthermore, very low-quality evidence suggests that this association was effective in improving shoulder pain disability for up to 6 weeks (up to 2 weeks, standardized mean differences [SMD], −0.65; CI, −1.25 to −0.06; 4th through the 6th week SMD, −0.48; CI -0.71 to −0.26).

Data synthesis

Comparison of spinal manipulation plus exercises with only exercises for pain intensity and shoulder pain disability showed that: after two and four to six weeks after treatment, there was a significant mean difference between groups for pain intensity pain and disability. At 6 months, there was no difference between the groups neither for pain intensity nor for disability.

Conclusion

The association of spinal manipulation with strengthening and stretching exercises can be more effective than isolated exercises for shoulder pain intensity up to 2 weeks and disability within 6 months.

Implications for practice

Physical therapists may associate spinal manipulation with exercises for shoulder pain, which may improve pain intensity and disability, especially in the initial treatment phase.