The purpose of this study was to examine the effect of manipulative therapy on the
shoulder girdle, in addition to usual care provided by the general practitioner, on
the outcomes of physical examination tests for the treatment of shoulder complaints.
This was a randomized controlled trial in a primary care setting in the Netherlands.
A total of 150 participants were recruited from December 2000 until December 2002.
All patients received usual care by the general practitioner. Usual care included
one or more of the following depending on the needs of the patient: information/advice,
oral analgesics or nonsteroidal antiinflammatory drugs, corticosteroid injections,
exercises, and massage. In addition to usual care, the intervention group received
manipulative therapy, up to 6 treatment sessions in a 12-week period. Twenty-four
physical examination tests were done at baseline and after 6, 12, and 26 weeks. Factor
analysis was done to reduce the number of outcome measures.
The factor analysis resulted in 4 factors: “shoulder pain,” “neck pain,” “shoulder
mobility,” and “neck mobility.” At 6 weeks, no significant differences between groups
were found. At 12 weeks, the mean changes of all 4 factors favored the intervention
group; the factors “shoulder pain” and “neck pain” reached statistical significance
(95% confidence interval [CI], 0.1-2.1). At 26 weeks, differences in the factors “shoulder
pain” (95% CI, 0.0-2.6), “shoulder mobility” (95% CI, 0.2-1.7), and “mobility neck”
(95% CI, 0.2-1.3) statistically favored the intervention group.
In this pragmatic study, manipulative therapy, in addition to usual care by the general
practitioner, diminished severity of shoulder pain and neck pain and improved shoulder
and neck mobility.