Posted by Stephen Messineo on Wed, Nov 05, 2008 @ 12:49 PM
One of the treatment strategies we often incorporate here at All-Access Physical Therapy to treat shoulder injuries pre and post surgery is joint mobilization. Use of joint mobilization techniques in treatment depend on ROM limitations combined shoulder capsule restriction that a patient may present with at initial evaluation. Two of the most common diagnoses for which we incorporate joint mobilization into our treatment plans are adhesive capsulitis and shoulder impingement syndrome. Two common joint mobilization techniques we utilize are posterior glides or mobilizations that decrease posterior capsule restriction, and mobilization with movement. We recently investigated the research behind use of joint mobilization for treatment of these conditions.
A study by Johnson et. al. compared the effect of anterior joint mobilization glides versus posterior glides to increase shoulder external rotation in patients with adhesive capsulitis. Their results showed the 10 patients in both groups had a significant reduction in pain, but the posterior glide group showed a mean increase of 31 degrees of external rotation versus a 3 degree increase for the anterior glide group over the course of 6 therapy sessions. (1)
Another study by Yang et. al. compared use of mid-range mobilization, end-range mobilization, and mobilization with movement when treating adhesive capsulitis. They concluded that end-range mobilizations and mobilization with movement techniques provided better functional scores and shoulder kinematics in patients versus using mid-range mobilization techniques. They also reported mobilization with movement significantly improved scapulohumeral rhythm after 3 weeks.(2)
Finally, two different studies conducted by Bang et. al.(3) and Senbursa et. al. (4) compared use of manual therapy and exercise versus exercise alone when treating shoulder impingement syndrome. Results from both studies showed patients receiving manual therapy treatment along with exercise showed greater improvements in function, ROM, and strength along with decreased pain, as compared to the patients receiving exercise treatment alone.
Presenting this research is not to say we are absolutely correct in our approach to using the joint mobilization techniques we use to treat the shoulder, but rather to show that we are utilizing effective evidence based techniques when treating the patients here. As research is ongoing in all health care fields, we may find that we may need to change our approach at some point. In the end for us, it is how patients respond to our treatment that matters most.
References:
- 1. Johnson AJ, Godges JJ, Zimmerman GJ, Ounanian LL. The effect of anterior versus posterior glide joint mobilization on external rotation range of motion in patients with shoulder adhesive capsulitis. Department of Physical Rehabilitation, Beaver Medical Group, Redlands, CA, USA. ajohnson@epiclp.com. J Orthop Sports Phys Ther. 2007 Mar;37(3):88-99.
- 2. Yang JL, Chang CW, Chen SY, Wang SF, Lin JJ. Mobilization techniques in subjects with frozen shoulder syndrome: randomized multiple-treatment trial. Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan. Phys Ther. 2007 Oct;87(10):1307-15. Epub 2007 Aug 7.
- 3. Bang MD, Deyle GD. Comparison of supervised exercise with and without manual physical therapy for patients with shoulder impingement syndrome. Department of Medicine, Kaiser Permanente Medical Center, Vallejo, Calif. 94590, USA. Mbang96@aol.com. J Orthop Sports Phys Ther. 2000 Mar;30(3):126-37.
- 4. Senbursa G, Baltaci G, Atay A. Comparison of conservative treatment with and without manual physical therapy for patients with shoulder impingement syndrome: a prospective, randomized clinical trial. School of Physiotherapy and Rehabilitation, Hacettepe University, 06100 Ankara,Turkey. Knee Surg Sports Traumatol Arthrosc. 2007 Jul;15(7):915-21. Epub 2007 Feb 28.