Which Manual Therapies Are the Best for Upper Body Pain?

An estimated 70% of adults experience pain in the neck, shoulders, and arms at some in point in life.  After back pain, musculoskeletal conditions in the upper quadrant region are the second most common cause of work-related illness.

Although research shows that manual chiropractic therapies can be beneficial for many of these conditions, understanding which patients will respond best to specific treatments is more difficult to discern. A recent literature review from the Journal of Manual and Manipulative Therapy sought to elucidate the best manual interventions for various upper quadrant pain conditions.

In the past, physicians and other health practitioners alike fixated on determining the exact source of a patient's pain. That traditional tissue-based model has produced only limited results for managing upper quadrant pain, argued lead researcher Ana Isabel de-la-Llave-Rincón and colleagues.  Although musculoskeletal pain often originates in the spine, it's not always possible to locate the exact anatomical source of nonspecific musculoskeletal conditions.  As a result, recent research is fueling a paradigm shift away from the traditional biomedical model of pain towards a more inclusive, bio-psycho-social model. This model considers psychological and social factors of pain in addition the biological factors. Using this holistic model of pain, de-la-Llave-Rincón et al conducted an extensive literature review of manual therapies to establish recommendations for a "treatment-based classification approach" for managing upper quadrant pain conditions.

A central focus of this approach lies in identifying whether a patient is experiencing increased pain sensitivity as a result of their musculoskeletal condition. This hypersensitivity is often a sign of sensitization of the nervous system, a process in which increased excited-ability of the neurons makes you more sensitive to sensory inputs and stimuli. There is evidence of both peripheral and central sensitization in patients with upper quadrant conditions. Peripheral sensitization refers to pain hypersensitivity at the site of an injury. On the other hand, central sensitization can result in pain sensitivity far from the original source of pain. While peripheral sensitization is common in the early stages of conditions like carpal tunnel syndrome and tennis elbow, central sensitization may be a sign of chronic symptoms. Studies show that central sensitization can prolong symptoms in patients with whiplash-associated disorders.

De-la-Llave-Rincón et al suggested that patients with peripheral sensitization should be treated with localized treatments and functional exercises. For instance, a patient with shoulder pain characterized by peripheral input could benefit from shoulder joint mobilization, trigger point therapy, and upper limb exercises. However, patients with more chronic conditions and signs of central sensitization may need a multimodal approach that addresses physical and cognitive symptoms of pain. They suggested that practitioners use manual therapies aimed at desensitizing the central nervous system, like chiropractic adjustments, dry needling, and mobilization of active trigger points, all of which have been shown to improve symptoms of sensitization.

Their findings suggest that managing sensitization could be a crucial component of treating chronic musculoskeletal conditions. Although treatment approaches will vary, these recommendations can help to refine best practices for naturally treating upper quadrant pain conditions.

Research suggests that chiropractic treatments can provide effective relief for many patients with whiplash-associated disorders, carpal tunnel syndrome, and other types of neck, arm, and shoulder pain.



de-la-Llave-Rincón AI, Puentedura EJ, Fernández-de-las-Peñas C. Clinical presentation and manual therapy for upper quadrant musculoskeletal conditions. Journal of Manual and Manipulative Therapies 2011l 19(4):201-11.