Effectiveness of Thoracic Spine Manual Therapy for Subacromial Impingement Syndrome

Date Posted:

April 2026

Study Title:

Effectiveness of Thoracic Spine Manual Therapy in Treating Subacromial Impingement Syndrome: A Systematic Review and Meta-analysis

Authors:

Yu S, Chen S, Yang Z et al.

 

Shoulder pain is very common, and subacromial impingement syndrome (SIS) is one of the more common causes that clinicians encounter in practice. Characterized by repetitive compression or impingement of structures like the supraspinatus tendon, subacromial bursa and long head of biceps, it can limit reaching, lifting, sleeping, and general overhead activity. SIS often becomes a frustrating problem for patients because symptoms can severely limit daily activities, occupational tasks and recreation or fitness endeavors.

Thoracic spine manual therapy has been suggested as a potentially useful intervention for SIS, emerging from the theory that the shoulder does not work in isolation (this encapsulates the concept of ‘regional interdependence’, wherein the function in one joint or body region can impact function in another joint or region). Thoracic mobility, posture, scapular mechanics, and regional movement patterns can all influence shoulder symptoms and loading. In theory, this provides chiropractors with many reasonable structures and functions to assess and potentially address with manual therapy, exercise or other interventions. One of these areas is the thoracic spine.

The evidence regarding thoracic treatment for SIS has been mixed over the years. Some studies suggest thoracic manipulation or mobilization can help, at least in the short term, while others have shown smaller or less convincing effects. Previous reviews also tended to mix different shoulder diagnoses, which makes it harder to know whether the findings really apply to SIS specifically.

The current review attempts to improve on this by narrowing the investigation to SIS and looking specifically at whether thoracic manual therapy changes pain, disability, and shoulder range of motion in patients with this condition.