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Impact of Spinal Alignment and Back Strength on Shoulder Range of Motion (ROM) in Middle-aged and Elderly Patients

Date Posted:27/06/2015
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Publication: European Spinal Journal 2014

Authors: Imagama,s.; Hasegama, Y.; Wakao, N.; et al


Age related changes in curvature of the thoracic spine (the spine in the mid back where the ribs attach) and shoulder are thought to have an impact on a person's activites of daily living (ADL). This can have an impact on the nursing and medical needs of a person. Several studies have shown that manipulation of the spine and ribs can improve the symptoms of shoulder pain and 'shoulder impingement syndrome', even if no rehabilitation is applied.

The Purpose of the Study

The study aims to clarify the influence of the spine on shoulder ROM by evaluating spinal alignment, spinal ROM and shoulder ROM.

The Study

The study was done prospectively and the following are the characteristics of the sample:

  • 114 males and 203 females (317 total participants)
  • age between 50 and 90 years
  • average back muscle strength of 66.9 kg
  • average grip strength of 28.3 kg
  • BMI of 10.6 kg/m2
  • osteoporosis was evident in 29.7% of all participants
  • the following characteristics were exclusion criteria: people with a history of spinal or shoulder surgery; people with neurological symptoms originating from the neck

The following measurements were taken:

1. shoulder measurements:

  • shoulder pain was present in 9.1% of participants
  • average shoulder flexion was 177.0o
  • average shoulder abduction was 175.3o
  • the limited shoulder flexion group was 35 participants (11%)
  • the limited shoulder abduction group was 50 participants (15.8%)

2. spinal measurements:

  • average thoracic kyphosis was 43.1o
  • average lumbar (low back) lordosis was 19.8o
  • average thoracic ROM was 16.9o
  • average lumbar lordosis was 44.2o

Strengths and Weaknesses of the Study

Strengths Weaknesses
The study provides the first evidence that there is a link between spinal dysfunction and shoulder ROM. This can be used for further research. The findings may not be generalisable to all populations and no participants had severe shoulder pain and dysfunction.
  The relationship between the surrounding shoulder muscles and shoulder pain and dysfunction was not evaluated. This requires further study.


It was noted that in the following age ranges: 50-59; 60-69, 70-79, 80-90, there was gradual decrease in shoulder and spinal ROM and lumbar lordosis; and an increase in thoracic kyphosis.

The following outcomes were also evident:

  • there was a negative correlation between increased age and, thoracic kyphosis and decreased shoulder ROM
  • there was a positive correlation between increased back strength and, lumbar lordosis and, lumbar ROM  and increased shoulder ROM
  • an increased thoracic kyphosis is related to a significant risk in limitation of both shoulder flexion and abduction.


It is not yet clear if spinal issues lead to shoulder ROM changes or vice versa, but, an important relationship between thoracic kyphosis and the shoulder joint in middle-aged and elderly patients was identified in this study.

Several reports have already suggested that thoracic manipulation can improve the shoulder pain and ROM in patients with limited shoulder ROM.

This study also showed that lumbar strength can also be a factor in shoulder problems and it is thought that a daily exercise regime targeting the spine in middle-aged and elderly patients improves their quality of life.

Overall, the study shows that patients can benefit from a combination of appropriate manipulation therapy and exercise regime to maintain overall spinal function.

Glossary of Terms

BMI (Body Mass Index): this is a measurement used by adults to see if they are a healthy weight for their height. For most adults a health BMI is 18.4 to 249 kg/m2

kyphosis: this is the rounding of the thoracic spine (mid back, where the ribs attached)

lordosis: this is the rounding of the lumbar spine (lower back), and is is usually rounding in to the body, in the opposite direction to the thoracic kyphosis

osteoporosis: a condition affecting the bones causing them to weaken, be more fragile and more likely to fracture (break)

positive correlation: a relationship where large values of one variable are associated with large values of another

prospective (study):  to determine the outcomes at a future date

negative correlation: a relationship where large values of one variable are associated with small values of another

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