title: Cervical & thoracic manipulations: Acute effects upon pain pressure threshold and self-reported pain in experimentally induced shoulder pain.
abstract: BACKGROUND
  Emerging evidence suggests that cervical and thoracic joint manipulations may be advocated in treating patients with shoulder pain.
  
  
  OBJECTIVE
  To determine the acute effects of cervical, cervicothoracic, and thoracic joint manipulations on outcomes of self-reported pain and pain pressure threshold in experimentally induced shoulder pain.
  
  
  METHODS
  Repeated measures.
  
  
  METHODS
  Twenty (20) healthy volunteers were tested on two sessions. Session 1 consisted on baseline assessment of pain pressure threshold testing over the infraspinatus bilaterally and self-reported shoulder pain using the shoulder pain and disability index (SPADI) pain scale. An isokinetic exercise protocol was used to induce delayed onset muscle soreness. In session 2 (24-48 h later), all variables were reassessed before and immediately after a combination of cervical, cervicothoracic and thoracic manipulations.
  
  
  RESULTS
  SPADI pain scale scores were significantly different between time points (p < 0.001): the exercise protocol significantly increased reported pain [mean increase 14.1, p < 0.001] while the manipulation significantly decreased reported pain (mean decrease 5.60, p < 0.001)) although pain remained higher than baseline levels. Pain pressure threshold differences were also found between time points (p = 0.001): manipulation significantly increased pain threshold bilaterally (p < 0.001) similar to baseline levels.
  
  
  CONCLUSIONS
  Cervical, cervicothoracic, and thoracic joint manipulations acutely increased pain pressure threshold and decreased self-reported shoulder pain in participants with experimentally induced shoulder pain. Physiotherapists may consider the combination of such techniques to achieve short-term hypoalgesic effects and facilitate the application of more active interventions.
authors.affiliation: Department of Physical Therapy, East Tennessee State University, Johnson City, TN, USA. Electronic address: wassinger@etsu.edu.
authors.forename: Craig A
authors.initials: CA
authors.lastname: Wassinger
authors.affiliation: Department of Physical Therapy, East Tennessee State University, Johnson City, TN, USA.
authors.forename: Dustin
authors.initials: D
authors.lastname: Rich
authors.affiliation: Department of Physical Therapy, East Tennessee State University, Johnson City, TN, USA.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Cameron
authors.affiliation: Department of Physical Therapy, East Tennessee State University, Johnson City, TN, USA.
authors.forename: Shelley
authors.initials: S
authors.lastname: Clark
authors.affiliation: Department of Physical Therapy, East Tennessee State University, Johnson City, TN, USA.
authors.forename: Scott
authors.initials: S
authors.lastname: Davenport
authors.affiliation: Department of Physical Therapy, East Tennessee State University, Johnson City, TN, USA.
authors.forename: Maranda
authors.initials: M
authors.lastname: Lingelbach
authors.affiliation: Department of Physical Therapy, East Tennessee State University, Johnson City, TN, USA.
authors.forename: Albert
authors.initials: A
authors.lastname: Smith
authors.affiliation: School of Physiotherapy, University of Otago, Dunedin, New Zealand.
authors.forename: G David
authors.initials: GD
authors.lastname: Baxter
authors.affiliation: Department of Physical Therapy, East Tennessee State University, Johnson City, TN, USA.
authors.forename: Joshua
authors.initials: J
authors.lastname: Davidson
mesh_terms: D005260:Female; D064368:Healthy Volunteers; D006801:Humans; D008297:Male; D020393:Manipulation, Spinal / Q000379:methods*; D019547:Neck Pain / Q000628:therapy*; D010147:Pain Measurement; D017288:Pain Threshold / Q000502:physiology; D016059:Range of Motion, Articular / Q000502:physiology*; D057566:Self Report; D020069:Shoulder Pain / Q000628:therapy*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Cervical and thoracic manipulation; Experimental shoulder pain; Manual therapy