Has your shoulder pain not resolved? Your thoracic spine may be involved…

Written By Greg Usherwood


Shoulder pain is a common condition which effects many people from all walks of life. Shoulder injuries can be both acute or chronic and recovery time can vary from a few short days to a frustrating long-term condition

The complex anatomy of the shoulder joint allows for a large amount of movement of the upper limb. Which is helpful for functional tasks such as putting on your clothes and scratching your back. But this comes at the expense of decreased stability of the joint. The shoulder has to rely on the strength and coordination of multiple muscles and ligaments to provide this additional stability that the joint structured does not provide. There are multiple muscles involved and some attach locally to the shoulder and some are more widespread attaching to the spine and the ribs.

As the thoracic (mid) spine is closely related to the shoulder via muscle and neural connections it is involved in its function and movement. When the arm is elevated the upper thoracic spine side flexes and rotates to the same side in a coordinated movement with the shoulder (Theodoridis & Ruston, 2002).

If this movement of the thoracic spine does not occur it can change the biomechanics of the shoulder and cause or contribute to shoulder pain.

Therefore, when someone is experiencing shoulder pain it is important to get a physiotherapist to perform a through assessment of the thoracic spine to see if it is contributing.

If it is determined that a restriction in the thoracic spine is contributing to the shoulder pain a manipulative physiotherapist can perform an appropriate manual therapy technique to restore its movement. This in turn will often result in an improvement in shoulder pain. This has been shown in multiple research articles which have investigated the use of spinal manipulation to improve shoulder pain and function (Muth, Barbe, Lauer, & McClure, 2012), (Strunce, Walker, Boyles, & Young, 2009), (Sueki & Chaconas, 2011).

At Elizabeth Street Physiotherapy we have experienced Manipulative Physiotherapists who can thoroughly assess spinal movement and its contribution to surrounding structures. They can then apply manual therapy techniques such as spinal manipulation and mobilization to help resolve the condition. If you want to find out more please contact us for an appointment.



  1. Muth, S., Barbe, MF., Lauer, R., & McClure, P. (2012). The effects of thoracic spine manipulation in subjects with signs of rotator cuff tendinopathy. JOSPT, 42(12), 1005-1016.
  2. Strunce, JB., Walker, MJ., Boyles, RE., & Young, BA. (2009 ). The immediate effects of thoracic spine and rib manipulation on subjects with primary complaints of shoulder pain. The Journal of Manual and Manipulative Therapy, 17(4), 230-236.
  3. Sueki, DG., & Chaconas, EJ. (2011). The effect of thoracic manipulation on shoulder pain: a regional interdependence model. Physical Therapy Reviews, 16(5), 399-408.
  4. Theodoridis, D., & Ruston, S. (2002). The effects of shoulder movement on thoracic spine 3Dmotion. Clin Biomech, 17(5), 418-421.