How Cervical and Thoracic (Neck and Upper Back) Manipulations play a role in Shoulder Dysfunction:

July 23, 2017

There are 2 main types of injuries that occur in the body. The first is caused by an acute injury typically from an accident, fall, or during a sporting event. The second happens slowly over time and is categorized as “micro trauma”. Acute injuries are often hard to prevent due to their unpredictability in nature and the influence of external components that are beyond a person’s control; however, injuries such as “rotator cuff tendonitis and impingement syndrome” are often preventable as they are due to faulty arthrokinematics (joint mechanics) of the shoulder stemming from either poor form during exercises/sport or a postural imbalance predisposing a person to these injuries.


Most tendonitis occurs in the supraspinatus and the biceps tendon when a person’s scapula (shoulder blade) is tipped forward. This is due to the position of the acromion (a hook like structure on the top of the scapula) slowly fraying away at the rope like tendons with every overhead movement when the scapula is tipped forward. While most physical therapy is aimed at avoiding offensive overhead lifting and opening up the internal rotators of the shoulder (the subscapularis, latissimus dorsi, and the pectoralis major/minor) in combination with postural exercises that help with scapular retraining, it is also essential that a person’s thoracic (upper back) and cervical (neck) spine are cleared of any restrictions or rotations. If a person’s thoracic spine is not able to properly extend, their ribs are unable to glide forward allowing the scapula to tip back. If a Physical Therapist or Personal Trainer were to cue a person to “keep their shoulders back” while their thoracic spine is unable to extend, the person would end up over exerting their periscapular  (shoulder blade) muscles, including their rhomboids and trapezius, causing more symptoms such as a tight upper back and shoulders. This could end up making the problem worse and could exacerbate symptoms. Also, the malalignment of cervical vertebrae can cause many nerves of the brachial plexus (a network of nerves in the neck supplying signals to the arms) to misfire, potentially causing a disruption in normal glenohumeroscapulo (shoulder) rhythm that may lead to scapular dysfunctions such as a “winging scapula”. The scapula are the foundation of the shoulder and when they are not moving appropriately, the shoulder complex becomes “unstable” creating an increased risk of “impingement syndrome” which may result in tendonitis (partial tears) and, if untreated, tendonosis or a full thickness tear requiring surgery.


The bottom line: If you are noticing early onset shoulder pain, it is imperative to have your cervical and thoracic spine cleared of restrictions and rotations as well as learn the correct stretches and postural exercises as soon as possible in order to avoid unnecessary long-term complications. Call today to set up an appointment for a world class spinal realignment and corrective exercise treatment to begin your road to recovery!

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1708 Peachtree St. NW #109

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Dr. Benjamin Karpus, DPT.....404.597.7308

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