Can a thoracic spine manipulation assist a patient with a diagnosis of adhesive capsulitis?
Answer
There have been a number of studies that have looked at thoracic manipulation and shoulder pathology. Most of what I have seen has been regarding impingement rather than adhesive capsulitis. That being said, I think that given the posture of these patients and most patients that we see with shoulder pathology, thoracic spine mobilization and/or manipulation, as long as the patient does not have any contraindications to the techniques, is very appropriate. Again, is it imparting change on the capsule itself? No. Is it changing them from one stage to another? No, but we know that there are concomitant changes with thoracic mobility with these shoulder patients. We know that there are changes in their posture. I think that it is an area that can be very helpful especially in the earlier stages, because we know that there is a pain mediation response with manipulation and we cannot be very aggressive with our direct shoulder glenohumeral techniques. My decisions on manipulation versus mobilization are determined by the overall health of the patient as well as osteoporosis and fracture risk, etc. However, with the vast majority of my shoulder patients, I am looking and doing something at the thoracic spine, and these patients are no different. I have not seen a lot of literature as far as looking at short-term or long-term effects specific to this group.
David Nolan, PT, DPT, MS, OCS, SCS, CSCS
Dr. Nolan is an Associate Clinical Professor at Northeastern University in the Department of Physical Therapy, Movement and Rehabilitation Sciences as well as a Graduate Lecturer in the College of Professional Studies in the transitional Doctor of Physical Therapy Program at Northeastern University. He is also a Lecturer at Harvard Medical School in the Physical Medicine and Rehabilitation. David is also a Clinical Specialist at the Mass General Sports Physical Therapy Service and the Director of the MGH / Northeastern University Sports Physical Therapy Residency Program.
David is a board certified Orthopedic Clinical Specialist and Sports Clinical Specialist through the American Board of Physical Therapy Specialties and a Certified Strength and Conditioning Specialist through the National Strength and Conditioning Association. In 2019, Dr. Nolan was the recipient of the Lynn Wallace Clinical Educator Award from the American Academy of Sports Physical Therapy. He is a past recipient of the “Excellence in Clinical Teaching” award from the New England Consortium of Academic Coordinators of Clinical Education as well as the award for Outstanding Achievement in Clinical Practice by the Massachusetts Chapter of the APTA. In 2022, Dr. Nolan received the Richard Kessler Memorial Award from the APTA of Massachusetts. Dr. Nolan was also honored with the APTA Academy of Physical Therapy Education's Distinguished Mentor in Residency/Fellowship Education Award in the same year.
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