Background: Shoulder pain affects up to 67% of the population at some point in their lifetime with subacromial pain syndrome (SAPS) representing a common etiology. Despite a plethora of studies there remains conflicting evidence for appropriate management of SAPS.Purpose: To compare outcomes, for individuals diagnosed with SAPS, performing a 6-week protocol of eccentric training of the shoulder external rotators (ETER) compared to a general exercise (GE) protocol. Study Design: Randomized controlled trialMethods: Forty-eight individuals (mean age 46.8 years +/-17.29) with chronic shoulder pain, and a clinical diagnosis of SAPS were randomized into either an experimental group performing ETER or a control group performing a GE program. The intervention lasted for six weeks, and outcomes were measured after three weeks, six weeks, and again at six months post intervention.

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.

Objectives: Sleep impairments are a strong predictor of pain, making sleep a potential interest when treating patients with spine pain. Typical beliefs about the importance of sleep in patients seeking care for spinal pain are unknown. The purpose of this study was to describe the beliefs and attitudes about sleep in patients seeking care for spinal pain and to examine the relationships between dysfunctional beliefs and attitudes about sleep (DBAS), disordered sleep, and pain interference. Materials and Methods: This cross-sectional study included patients presenting to physical therapy with spine pain. Participants completed questionnaires including demographics, medical history, pain interference (pain, enjoyment, and general activity), DBAS-16, and sleep-related impairment (Patient-Reported Outcome Measurement Information System). Correlations were calculated between DBAS-16 scores and measures of sleep quality/quantity, and a generalized linear model was used to investigate the predictive ability of DBAS-16 scores on pain interference. Results: The mean DBAS-16 score was 4.22 (SD=2.03), with 52.5% of participants having DBAS. There was a strong relationship between DBAS-16 and Patient-Reported Outcome Measurement Information System (r s=0.7; P<0.001). For every point higher score on the DBAS-16, pain interference scores increased by approximately half a point (B=0.46; 95% CI 0.33, 0.59, 1.80; P <0.001) Discussion: These results highlight a strong relationship between beliefs and attitudes about sleep and measures of sleep quality/quantity and a linear association with pain interference scores. These findings provide a rationale for targeting beliefs and attitudes about sleep when managing pain-related symptoms in patients seeking care for spine pain.

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