The relationship between spine and shoulder motion has not been well evaluated. The purpose of this study was to clarify the relationships among thoracic kyphosis and lumbar lordosis, spinal range of motion (ROM), spinal alignment and shoulder ROM.
Evaluation of spinal alignment was prospectively conducted in 317 subjects (114 males and 203 females, the average age: 67 years) who attended a public health checkup. Shoulder ROM with an angle meter and shoulder pain were evaluated. Thoracic kyphosis angle, lumbar lordosis angle, thoracic ROM, lumbar ROM and spinal inclination angle were measured using SpinalMouse®. The relationships of these factors with grip strength, back muscle strength, physical ability, osteoporosis and body mass index were examined and multivariate logistic regression analysis was performed to identify the risk factors for limited shoulder ROM.
Limited shoulder flexion was found in 35 patients (11 %) and limited abduction in 50 patients (16 %). In multivariate logistic regression analyses adjusted for age, shoulder pain and other parameters, increased thoracic kyphosis angle and increased spinal inclination angle were risk factors for limited shoulder flexion (p < 0.05). Increased thoracic kyphosis angle and weak back muscle strength were also determined as risk factors for limited shoulder abduction (p < 0.05).
This study provides the first evidence that increased thoracic kyphosis, increased spinal inclination and weak back muscle strength are the risk factors for limited shoulder ROM. These results suggest that maintenance of spinal alignment and back muscle strength may be important for better shoulder ROM.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
Greenfield B, Catlin PA, Coats PW, Green E, McDonald JJ, North C (1995) Posture in patients with shoulder overuse injuries and healthy individuals. J Orthop Sports Phys Ther 21:287–295
Nicholson GG (1989) Rehabilitation of common shoulder injuries. Clin Sports Med 8:633–655
Culham E, Peat M (1993) Functional anatomy of the shoulder complex. J Orthop Sports Phys Ther 18:342–350
Bang MD, Deyle GD (2000) Comparison of supervised exercise with and without manual physical therapy for patients with shoulder impingement syndrome. J Orthop Sports Phys Ther 30:126–137
Bergman GJ, Winters JC, Groenier KH, Pool JJ, Meyboom-de Jong B, Postema K, van der Heijden GJ (2004) Manipulative therapy in addition to usual medical care for patients with shoulder dysfunction and pain: a randomized, controlled trial. Ann Intern Med 141:432–439 (pii:141/6/432)
Boyles RE, Ritland BM, Miracle BM, Barclay DM, Faul MS, Moore JH, Koppenhaver SL, Wainner RS (2009) The short-term effects of thoracic spine thrust manipulation on patients with shoulder impingement syndrome. Man Ther 14:375–380. doi:10.1016/j.math.2008.05.005
Strunce JB, Walker MJ, Boyles RE, Young BA (2009) The immediate effects of thoracic spine and rib manipulation on subjects with primary complaints of shoulder pain. J Man Manip Ther 17:230–236
Winters JC, Sobel JS, Groenier KH, Arendzen HJ, Meyboom-de Jong B (1997) Comparison of physiotherapy, manipulation, and corticosteroid injection for treating shoulder complaints in general practice: randomised, single blind study. BMJ 314:1320–1325
Orimo H, Hayashi Y, Fukunaga M, Sone T, Fujiwara S, Shiraki M, Kushida K, Miyamoto S, Soen S, Nishimura J, Oh-Hashi Y, Hosoi T, Gorai I, Tanaka H, Igai T, Kishimoto H (2001) Diagnostic criteria for primary osteoporosis: year 2000 revision. J Bone Miner Metab 19:331–337
Post RB, Leferink VJ (2004) Spinal mobility: sagittal range of motion measured with the SpinalMouse, a new non-invasive device. Arch Orthop Trauma Surg 124:187–192. doi:10.1007/s00402-004-0641-1
Imagama S, Matsuyama Y, Hasegawa Y, Sakai Y, Ito Z, Ishiguro N, Hamajima N (2010) Back muscle strength and spinal mobility are predictors of quality of life in middle-aged and elderly males. Eur Spine J. doi:10.1007/s00586-010-1606-4
Graichen H, Stammberger T, Bonel H, Wiedemann E, Englmeier KH, Reiser M, Eckstein F (2001) Three-dimensional analysis of shoulder girdle and supraspinatus motion patterns in patients with impingement syndrome. J Orthop Res 19:1192–1198. doi:10.1016/S0736-0266(01)00035-3
McClure PW, Michener LA, Karduna AR (2006) Shoulder function and 3-dimensional scapular kinematics in people with and without shoulder impingement syndrome. Phys Ther 86:1075–1090
McClure PW, Michener LA, Sennett BJ, Karduna AR (2001) Direct 3-dimensional measurement of scapular kinematics during dynamic movements in vivo. J Shoulder Elb Surg 10:269–277. doi:10.1067/mse.2001.112954
Bullock MP, Foster NE, Wright CC (2005) Shoulder impingement: the effect of sitting posture on shoulder pain and range of motion. Man Ther 10:28–37. doi:10.1016/j.math.2004.07.002
Lewis JS, Wright C, Green A (2005) Subacromial impingement syndrome: the effect of changing posture on shoulder range of movement. J Orthop Sports Phys Ther 35:72–87
Kebaetse M, McClure P, Pratt NA (1999) Thoracic position effect on shoulder range of motion, strength, and three-dimensional scapular kinematics. Arch Phys Med Rehabil 80:945–950 (pii:S0003-9993(99)90088-6)
Schenkman M, Rugo de Cartaya V (1987) Kinesiology of the shoulder complex. J Orthop Sports Phys Ther 8:438–450
Wang CH, McClure P, Pratt NE, Nobilini R (1999) Stretching and strengthening exercises: their effect on three-dimensional scapular kinematics. Arch Phys Med Rehabil 80:923–929 (pii:S0003-9993(99)90084-9)
Imagama S, Hasegawa Y, Matsuyama Y, Sakai Y, Ito Z, Hamajima N, Ishiguro N (2011) Influence of sagittal balance and physical ability associated with exercise on quality of life in middle-aged and elderly people. Arch Osteoporos 6:13–20. doi:10.1007/s11657-011-0052-1
We are grateful to the staff of the Comprehensive Health Care Program held in Yakumo, Hokkaido and to Ms. Kae Shikii and Ms. Saho Horiuchi of Nagoya University for their assistance with data collection. This study was supported by the Japanese Ministry of Health, Labor, and Welfare Grants-in Aid for Scientific Research (B)(2)(20390397).
Conflict of interest
The authors report no conflict of interest except for this national grant. No other funds were received in support of this work.
About this article
Cite this article
Imagama, S., Hasegawa, Y., Wakao, N. et al. Impact of spinal alignment and back muscle strength on shoulder range of motion in middle-aged and elderly people in a prospective cohort study. Eur Spine J 23, 1414–1419 (2014). https://doi.org/10.1007/s00586-014-3251-9
- Shoulder range of motion
- Thoracic kyphosis
- Spinal inclination
- Back muscle strength
- Spine-shoulder syndrome