Purpose: Identify individuals with shoulder pain who are likely to experience immediate improvement in pain and disability following cervical and thoracic spine manipulation.

Stage of CPR Development: Invalidated (Mintken et al., 2017)


1. Pain-free shoulder flexion < 127°
2. Shoulder internal rotation < 53° at 90° of abduction
3. Negative Neer test
4. Not taking medications for their shoulder pain
5. Symptoms less than 90 days

Derivation Study (Mintken et al., 2010):

Variables Sensitivity Specificity +LR Prob of Success
2 0.90 0.61 2.30 78%
3 0.51 0.90 5.30 89%
4 0.27 1.00 100%

Validation Study (Mintken et al., 2017):

Analysis p-value
Linear Mixed-Model with Repeated Measures 0.094
Positive on Rule MT+Ex v. Ex Only (SPADI) 0.69
3-way Interaction (SPADI) 0.27
3-way Interaction (Pain Score) 0.70
Repeated Measures Analyses (SPADI) 0.62
Repeated Measures Analyses (Pain Score) 0.87

Continued Learning…

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Continued Reading…


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  1. Shoulder pain is becoming a concern these days. A person who is experiencing always wishes to get rid of the pain and we thankfully have great remedies for the same. Thank you for sharing the post.


  2. With the rapid competition in any field, there are hardly few people who are lucky enough not to have back pain and shoulder pain. Helpful information. Thanks for the post.


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