The purpose of this unblinded, controlled pilot study was to compare the effectiveness of Spinal Manipulative Therapy and a shoulder rehabilitation program, focussing on improving muscular and postural imbalances, verses Spinal Manipulative Therapy alone in the treatment of sub-acute and chronic shoulder impingement syndrome found in swimmers. In executing the comparison, it was anticipated that both treatment protocols would be effective, but the combined therapy of Spinal Manipulative Therapy and rehabilitation would be the most effective in treating sub-acute and chronic shoulder impingement syndrome in swimmers. This treatment protocol focused on correcting the biomechanical dysfunction in the cervical spine and thoracic spine coupled with a rehabilitation program to stretch anterior musculature, strengthen posterior musculature and strengthen the shoulder in external rotation. These muscular and postural imbalances are a contributing factor in perpetuating the pathomechanics causing sub-acute and chronic shoulder impingement syndrome found in swimmers. Shoulder impingement syndrome of this kind in swimmers is known as Swimmer’s shoulder. Thirty swimmers between the ages of 18 and 60 with subacute and chronic shoulder pain were recruited by advertising in the local newspapers. Two groups of fifteen patients were created. Patients were randomly assigned to one of the groups as they enrolled for participation. Group A underwent Spinal Manipulative Therapy of the thoracic and cervical spines in conjunction with shoulder strengthening and postural corrective exercises. Group B underwent Spinal Manipulative Therapy of the thoracic and cervical spines. Each patient was treated nine times in three weeks. A Saunders Digital Inclinometer was used to record objective glenohumeral ranges of motion and a painful arc was determined as positive between 45 and 120 degrees. The Supraspinatus Test was performed which was recorded as positive or negative. Subjective findings were measured with the use of the Visual Analogue Pain Scale and a questionnaire modified from Athletic Shoulder Outcome Rating Scale and American Shoulder and Elbow Surgeons’ Shoulder Evaluation Form. Data was collected prior to the first, fourth, seventh and ninth visit. III The results indicated that both groups were effective in treating Swimmer’s shoulder. Group A showed the most positive results in terms of objective and subjective clinical findings. In conclusion, Group A (Spinal Manipulative Therapy and Rehabilitation) was the most effective treatment protocol for the management of sub-acute and chronic shoulder impingement syndrome in swimmers. This treatment protocol had a greater benefit with regard to improvement of shoulder abduction range of motion, painful arc, Supraspinatus Test and Visual Analogue Pain Scale than Group B (Spinal Manipulative Therapy only). / Dr. B. Losco Dr. C. Lyons

Repetitive movements of the arm in or above the horizontal plane, can initiate the development of impingement syndrome of the shoulder (Wolin and Tarbet, 1997:56, 59). Impingement syndrome of the shoulder is a common problem, yet the diagnosis and management of it is still not completely understood. The purpose of this pilot study was to determine the most effective treatment protocol in the management of impingement syndrome of the shoulder due to supraspinatus tendonitis. This randomised study consisted of three groups of ten patients, between the ages of eighteen and forty-five. All potential candidates for the trial were examined and admitted once all the exclusion and inclusion criteria had been met. Once joint restrictions were found in the cervical and/ or thoracic spine and the acromioclavicular joint, diversified chiropractic manipulative therapy was administered to all the patients. Group A received cervical and/ or thoracic spine manipulations, Group B received acromioclavicular joint manipulations, and Group C received a combination of spinal manipulations (cervical and/ or thoracic) and acromioclavicular joint manipulations. Patients were treated over a two-week treatment period. Measurements were recorded on the first, third and sixth treatments. The objective data consisted of pain free shoulder abduction range of motion, the presence of a painful arc of the shoulder, a positive supraspinatus test and/or Neers and/or Hawkins impingement test. The subjective data included the numerical pain rating scale 101 questionnaire. The statistical analysis that was conducted included the One Way ANOVA (analysis of variance) as well as the Student-Newman-Keuls Method to compare intra-group and inter-group data. Statistically significant changes were seen in all three groups. However, group A (cervical and/ or thoracic spinal manipulations) and group B (acromioclavicular joint manipulations) showed to be the most effective in treating impingement syndrome of the shoulder. This does however require further research, and a larger sample size. / Dr. M. Moodley Dr. G. Sher