The shoulder has been reported to be the fifth most common cause of chronic pain.1 Subacromial pain syndrome (SAPS) is one of the most common causes of shoulder pain, with multiple etiologies and known to be a combination of rotator-cuff pathologies, such as tendonitis bursitis tendinopathies, and tears.2
Previously, there has been little knowledge of the natural history and treatment of SAPS, with the focus on treating inflammation through steroid injections and NSAIDs, although the presence of said inflammation has not been confirmed.3 All non-surgical interventions, including injections, medication, manual therapy, exercise, electrotherapy, and cognitive therapy as first-line management, remain unclear as to dose, type and load.4
The prognosis of SAPS is poor, with 40-50 percent of patients reporting pain 6-12 months after an initial consultation.5 With historical treatments remaining unclear, a thoracic spine low-amplitude, high-velocity thrust (manipulation or chiropractic spinal adjustment) immediately increases neuromuscular drive, and improves pain and function.6 When evaluating pain inhibition and increased function, this high-velocity low-amplitude thrust (HVLAT) mechanism shows a level of consistency in a physiological mechanism rendering positive outcomes.
An HVLAT involves gapping the zygapophyseal joints, reducing the impaction and opening the joint, encouraging the misplaced meniscoid (spacer) to return to its normal anatomical position in the joint cavity. With the meniscoid displaced, the articular cartilage buckles, forming a space-occupying lesion under the capsule, causing a meniscoid entrapment.
Many type 3 and type 4 nerve fibers (nociceptors) have been observed in the joint capsule and render central sensitization involving muscles spasms and resultant malfunction.7
It has also been reported that an HVLAT causes hypoalgesia and increased mechanical function in disparate regions through central sensitization.8-9 These mechanisms are intact in symptomatic and asymptomatic patients, and offer therapeutic answers to those in pain and those seeking increased function or strength.
The evidence of a thoracic spinal HVLAT leading to an immediate increase in muscle activity linked to short-term changes in reported shoulder pain is consistent with previous findings. So is the connection between an HVLAT and central sensitization as the neurological connection to cause and effect.6-7,10
References
When sports chiropractors first appeared at the Olympic Games in the 1980s, it was alongside individual athletes who had experienced the benefits of chiropractic care in their training and recovery processes at home. Fast forward to Paris 2024, where chiropractic care was available in the polyclinic for all athletes, and the attitude has now evolved to recognize that “every athlete deserves access to sports chiropractic."
It is estimated that 61% of patients with CTS avoid taking surgical options due to postoperative complications and costly surgical procedures. Chiropractic care offers a comprehensive and effective treatment for carpal tunnel syndrome, addressing the condition from multiple angles. Recent studies also have unveiled a game-changing adjunct to chiropractic treatments for CTS: nerve flossing.
Some doctors thrive in a personality-based clinic and have a loyal following no matter what services or equipment they offer, but for most chiropractic offices who are trying to grow and expand, new equipment purchases help us stay relevant and continue to service our client base in the best, most up-to-date manner possible. So, regarding equipment purchasing: should you lease, get a bank loan, or pay cash?
