Is thoracic spine posture associated with shoulder pain, range of motion and function? A systematic review

PainSci » bibliography » Barrett et al 2016
updated May 15, 2023

Tags: etiology, posture, shoulder, pro, biomechanics, head/neck

Two articles on PainSci cite Barrett 2016: 1. Does Posture Matter? 2. Complete Guide to Frozen Shoulder

PainSci commentary on Barrett 2016: ?This page is one of thousands in the PainScience.com bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided wherever possible.

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 source of pain. Six of the studies were deemed to have a medium to high risk of bias. Collectively they show “moderate” evidence of no relationship: that is, there’s “no significant difference in thoracic kyphosis between groups with and without shoulder pain.” One study contradicted the others, identifying more kyphosis in people with shoulder pain — but it was the study with the highest risk of a bias. So this review confirms that there is some evidence-of-absence for kyphosis as a cause of shoulder pain, and almost nothing pointing the other way.

But there is some strong evidence in these studies that shoulder movement is greater if you’re straighter: less kyphosis, more shoulder action.

~ Paul Ingraham

original abstract †Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

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.

original abstract †Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

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