The Somatic Connection  |   March 2006
Manipulation of the Shoulder Girdle Accelerates Recovery of Patients With Shoulder Symptoms
Article Information
The Somatic Connection   |   March 2006
Manipulation of the Shoulder Girdle Accelerates Recovery of Patients With Shoulder Symptoms
The Journal of the American Osteopathic Association, March 2006, Vol. 106, 119. doi:
The Journal of the American Osteopathic Association, March 2006, Vol. 106, 119. doi:
Dysfunction of the cervicothoracic spine and the adjacent ribs (ie, the shoulder girdle) is considered to be a predictor of the occurrence and poor outcome of shoulder symptoms. Shoulder disorders can be treated with various manual techniques, but there is a lack of scientific evidence to support the efficacy of such manipulation. 
A randomized, controlled trial was conducted at family medicine practices in Groningen, The Netherlands. Patients with shoulder symptoms and dysfunction of the shoulder girdle (N=150) were randomized into two study groups: those who received only traditional medical care (n=71) and those who received traditional medical care in addition to as many as six sessions of manual treatment (in a 12-week period) from physical therapists (n=79). 
The manual treatment provided to patients consisted of various techniques described by Cyriax, Greenman, and Lewit: manipulations (low-amplitude, high-velocity thrust) and mobilizations (high-amplitude, low-velocity thrust). 
After treatment for 6 weeks, no significant difference was observed between study groups. Following completion of treatment at 12 weeks, significantly more patients in the manipulation group (34 [43%]) than in the control group (15 [21%]) reported full recovery. 
At the 52-week follow-up, the two study groups continued to differ significantly in perceived recovery. During intervention and follow-up, consistent differences remained between the groups in severity of the main complaint, shoulder pain, disability, and general health. 
The results of the Groningen trial demonstrate that manipulation of the shoulder girdle is efficacious when combined with traditional medical care. Specifically, the trial found that these interventions improved overall joint function and decreased restrictions in movement at both single and multiple segmental levels in the cervical spine, upper thoracic spine, and adjacent ribs.  
 “The Somatic Connection” highlights and summarizes important contributions to the growing body of literature on the musculoskeletal system's role in health and disease. This new section of JAOA—The Journal of the American Osteopathic Association strives to chronicle the significant increase in published research on manipulative methods in the United States and the renewed interest in manual medicine internationally, especially in Europe.
 Designed to inform osteopathic physicians about significant musculoskeletal research being published in journals other than the JAOA, “The Somatic Connection” gives special attention to research articles directly related to the tenets and principles of osteopathic medicine.
 With the launch of this new section, the JAOA is focusing on studies that test the efficacy of manipulative methods in a variety of clinical situations. As the section develops, “The Somatic Connection” will include research that explores other aspects of the musculoskeletal system, including the mechanism of chronic pain and interventions other than spinal manipulation.
 To identify research articles to feature, the editors of “The Somatic Connection” search multiple electronic databases and assess articles for their scientific validity. As the editors may easily miss important citations in the literature, readers are encouraged to submit scientific reports for consideration to the following editors of “The Somatic Connection”: JAOA Associate Editor Felix J. Rogers, DO, at or Michael A. Seffinger, DO, at
 Bergman GJD et al. Ann Intern Med. 2004;141:432–439.