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Abstract
Background: It is commonplace for clinicians to utilize treatment of the thoracic spine as an adjunct to traditional interventions focused solely upon the shoulder. Research is beginning to substantiate this clinical practice. While still in its infancy, a clinical link between the thoracic spine and shoulder pain, function, strength, and motion potentially exists. This relationship between seeming unrelated areas of the body has been termed 'Regional Interdependence'. While evidence for regional interdependence between the thoracic spine and shoulder is being established, very little is known about the physiological mechanism behind such a link.
Objectives: The purpose of this paper is to explore the evidence that currently exists for a relationship between thoracic spine manipulation, shoulder pain, and shoulder function. Existing and proposed physiological mechanisms underlying manipulation are discussed and placed in the context of regional interdependence.
Major findings: Several models will be introduced to explain the physiological effects of thoracic manipulation on shoulder function including a novel allostatic response model. In addition, the clinical implications of regional interdependence will be discussed.
Conclusion: Research is demonstrating that a relationship exists between thoracic spine manipulation, shoulder pain, and shoulder function. While the physiology underlying such a relationship is still unclear, homeostasis and the body's allostatic response may provide an explanation for the regionally interdependent relationship.
We would like to thank Deborah Lowe and Sarah Woodin for their invaluable support and assistance with the content and editing of this article.
