Is thoracic spine posture associated with shoulder pain, range of motion and function? A systematic review
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This is a review of ten scientific studies of the relationship between shoulder pain and thoracic spine posture, specifically kyphosis, the slouched or “hunchback” upper back curvature widely assumed to be a cause of pain. Six of the studies were judged to have a moderate to high risk of bias. Collectively these studies produced “moderate” evidence of no relationship: that is, there’s “no significant difference in thoracic kyphosis between groups with and without shoulder pain.” One study (with a high risk of bias) contradicted the others, identifying more kyphosis in people with shoulder pain. There is strong evidence that shoulder movement is greater if you’re straighter.
original abstract
INTRODUCTION: Excessive thoracic kyphosis is considered a predisposing factor for shoulder pain, though there is uncertainty about the nature of the relationship between shoulder pain and thoracic spine posture. The aim of this systematic review was to investigate the relationship between thoracic kyphosis and shoulder pain, shoulder range of motion (ROM) and function.
METHODS: Two reviewers independently searched eight electronic databases and identified relevant studies by applying eligibility criteria. Sources of bias were assessed independently by two reviewers using a previously validated tool (Ijaz et al., 2013). Data were synthesised using a level of evidence approach (van Tulder et al., 2003).
RESULTS: Ten studies were included. Four studies were rated as low risk of bias, three at moderate risk of bias and three at high risk of bias. There is a moderate level of evidence of no significant difference in thoracic kyphosis between groups with and without shoulder pain. One study at high risk of bias demonstrated significantly greater thoracic kyphosis in people with shoulder pain (p < 0.05). There is a strong level of evidence that maximum shoulder ROM is greater in erect postures compared to slouched postures (p < 0.001), in people with and without shoulder pain.
CONCLUSIONS: Thoracic kyphosis may not be an important contributor to the development of shoulder pain. While there is evidence that reducing thoracic kyphosis facilitates greater shoulder ROM, this is based on single-session studies whose long-term clinical relevance is unclear. Higher quality research is warranted to fully explore the role of thoracic posture in shoulder pain.
related content
- “The association between cervical spine curvature and neck pain,” an article in European Spine Journal, 2007.
One article on PainScience.com cites Barrett 2016 as a source:
- PS Does Posture Correction Matter? — Posture correction strategies and exercises … and some reasons not to care or bother
