Evidence for increased neuromuscular drive following spinal manipulation in individuals with subacromial pain syndrome

Review written by Robin Kerr info

Key Points

  1. Thoracic spine manipulation increased shoulder muscle activity, particularly the serratus anterior, in subjects with shoulder pain.
All key points available for members only


Anecdotally clinicians report alteration in shoulder muscle activity in shoulder pain patients and find that thoracic spine manipulation (TSM) can reduce pain and improve function in these patients.

This biomechanical study explored the effects of TSM on shoulder muscle activity and the relationships between muscle activity changes and clinical outcomes. The concept of altered neuromuscular drive post TSM resulting in improved muscle activity and subsequent shoulder improvement was explored (see Figure 1).


Anecdotally, clinicians often report alteration in shoulder muscle activity in shoulder pain patients.
This study identified a widespread immediate increase in shoulder muscle activity following the thoracic spine manipulation intervention.


Subjects with only subacromial pain syndrome were selected (n=28). Three high-velocity thrust (HVT) manipulations were administered to the C/T junction (sitting traction + P-A thrust), mid thoracic (Prone “Screw” HVT) and lower thoracic spine (Prone “Screw” HVT). A video of

to unlock full access to this review and 989 more