The KEY to Thrust Manipulation = Mobility Exercises

As physical therapists we are aware of the benefit that can be achieved with thoracic thrust manipulation for spine pain.  

A developing body of literature also supports the effectiveness of this intervention for patients with shoulder pain.(1)  Improved shoulder range of motion, function and reduced symptoms, immediately following manipulation, has been demonstrated in several studies.(1)  The mechanisms to explain this benefit are likely neurophysiological with further consideration for non-specific effects and patient expectations.(2,3)

One can leverage this immediate reduction in pain with adjunct exercise.  Adjunct interventions could consist of active mobility, passive stretching and motor control exercises.  Active mobility exercises are an excellent bridge between thoracic manipulation and motor control/strength training.

This side-lying thoracic rotation mobility exercise is a great technique to utilize immediately post manipulation.

The patient assumes the sidelying position with the arms at 90 degrees of shoulder flexion.  Thoracic rotation is initiated by rotating the arms apart while hip and knee flexion is maintained to create tension through the lumbar spine.  The clinician can provide overpressure to the shoulder and opposite hip in order to achieve a greater amount of rotation.

Progression can occur by integrating more advanced techniques in the quadruped position or with a fixed lower extremity such as the following mobility exercise.


  1. Sueki D, Chaconas E. The effect of thoracic manipulation on shoulder pain: a regional interdependence model.  Phys Ther Rev. 2011;16(5).399-408.
  2. Bialosky JE, Bishop MD, Price DD, Robinson ME, George SZ. The mechanisms of manual therapy in the treatment of musculoskeletal pain: a comprehensive model.  Man Ther. 2009 Oct;14(5):531-8.
  3. Bialosky JE, Bishop MD, George SZ, Robinson ME.  Placebo response to manual therapy: something out of nothing? J Man Manip Ther. 2011 Feb;19(1):11-9.