Summaries for Patients |

Manipulative Therapy for Patients with Shoulder Pain FREE

[+] Article, Author, and Disclosure Information

The summary below is from the full report titled “Manipulative Therapy in Addition to Usual Medical Care for Patients with Shoulder Dysfunction and Pain. A Randomized, Controlled Trial.” It is in the 21 September 2004 issue of Annals of Internal Medicine (volume 141, pages 432-439). The authors are G.J.D. Bergman, J.C. Winters, K.H. Groenier, J.J.M. Pool, B. Meyboom-de Jong, K. Postema, and G.J.M.G. van der Heijden.

Ann Intern Med. 2004;141(6):I-27. doi:10.7326/0003-4819-141-6-200409210-00003
Text Size: A A A

What is the problem and what is known about it so far?

Shoulder pain is a common reason for seeking medical care. The best treatment for shoulder pain is unclear unless the pain is due to a bone fracture or other specific injury that requires surgical therapy. Care for shoulder pain often includes medications to treat pain and inflammation, physical therapy to improve range of motion and strength, and therapies such as massage or heat to relieve symptoms. Manipulative therapy is an alternative therapy that some believe can be helpful in shoulder pain that is accompanied by neck symptoms. During manipulative therapy, a specially trained therapist or chiropractor applies movements to the spine with the aim of realigning or mobilizing specific segments. Manipulative therapy is different from physical therapy. Physical therapy involves range-of-motion and strengthening exercises that do not aim to realign or mobilize the spine.

Why did the researchers do this particular study?

To see whether the addition of manipulative therapy to usual care improves outcomes for patients with shoulder pain.

Who was studied?

150 Dutch patients 18 years of age or older who presented to their primary care physicians with shoulder pain, defined as pain that occurs at rest or during movement of the upper arm in the area between the neck and the elbow and that is accompanied by neck symptoms. Patients who had signs of compression of the nerves in the neck or whose shoulder pain was due to severe trauma, fracture, rupture, dislocation, specific joint disease such as rheumatoid arthritis, or disease of the chest or abdomen were not eligible for the study.

How was the study done?

The researchers assigned patients to receive usual care from their primary care physicians (usual care could include physical therapy) or usual care plus manipulative therapy. Manipulative therapy included up to 6 sessions over 12 weeks. One of 8 specially trained therapists provided the manipulative therapy. The researchers compared patients' reports of recovery, severity of pain, shoulder disability, and general health at 6, 12, 26, and 52 weeks after assignment to a treatment group.

What did the researchers find?

At 6 weeks, there were no differences between the study groups. At 12 weeks, 43% of the patients who received manipulative therapy plus usual care reported recovery compared with only 21% in the usual care group. At 52 weeks, 52% of the patients who received manipulative therapy plus usual care reported recovery compared with 35% of the usual care group.

What were the limitations of the study?

The patients knew which treatment they were receiving, and this knowledge alone may have influenced their reports of improvement. It is also uncertain whether different therapists would achieve similar results.

What are the implications of the study?

In patients with shoulder pain accompanied by neck symptoms, manipulative therapy added to usual care may increase patient-reported recovery from shoulder pain.





Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Submit a Comment/Letter
Submit a Comment/Letter

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.


Want to Subscribe?

Learn more about subscription options

Related Articles
Related Point of Care
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.