Download Mobilization Notes: A Rehabilitation Specialist's Pocket by Christopher H. Wise PT DPT OCS FAAOMPT MTC ATC, Dawn PDF

By Christopher H. Wise PT DPT OCS FAAOMPT MTC ATC, Dawn Gulick PT PhD ATC CSCS

This useful, complete colour, pocket advisor offers the rehabilitation expert with cutting edge intervention concepts which are designed to deal with impairments in joint mobility. prepared by means of anatomic area, it offers an summary of useful anatomy and joint kinematics for the backbone and extremities. for every mobilization process, an in depth description of sufferer and clinician place in addition to photos that come with strength vector arrows and issues of stabilization is supplied. Write-on/wipe-off pages enable the reader to take notes simply.

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Abd = elastic Hard Add (retraction) = 4–5 cm abd capsular = Scaption = Upward rotation = 60° frozen elastic Downward rotation = 20° shoulder IR/ER = Sternoclavicular Elevation = 45° elastic/firm Capsular = ER Depression = 5° > abd Horizontal > IR Protraction = 15°–20° add = soft tissue Retraction = 15°–20° Ext = firm Upward rotation = 25°–55° Horizontal Downward rotation = <10° abd = firm/ Acromioclavicular Total IR/ER = 30° elastic Total A/P tilting = 30°–40° Upward rotation = 30° Downward rotation = 17° SHOULDER Glenohumeral Elevation (flex, abd) = 180° Ext = 60° Total IR/ER = 180° Scapulohumeral rhythm 2:1 = 120°:60° 34 2:58 PM Scapulothoracic 7/1/09 2096_Tab01_033-048 Normal ROM Accessory (Arthrokinematic) Motions of the Shoulder Arthrokinematics Convex surface: Thorax Concave surface: Scapula To facilitate elevation: Scapula glides superior on thorax To facilitate protraction: Scapula glides lateral around thorax To facilitate upward rotation: Inferior angle of scapula glides superior & lateral around thorax Convex surface: Clavicular head Concave surface: Disc & manubrium To facilitate elevation: Lateral clavicle rolls upward & medial clavicle glides inferior on disc & manubrium Concave surface: Clavicle & disc Convex surface: Manubrium Convex surface: Clavicle Concave surface: Acromion To facilitate depression: Scapula glides inferior on thorax To facilitate retraction: Scapula glides medial around thorax To facilitate downward rotation: Inferior angle of scapula glides inferior & medial around thorax To facilitate depression: Lateral clavicle rolls downward & medial clavicle glides superior on disc & manubrium To facilitate retraction: To facilitate protraction: Medial clavicle & disc roll & Medial clavicle & disc roll & glide posterior on manubrium glide anterior on manubrium To facilitate upward rotation: Scapula (acromion) glides superior & lateral on clavicle To facilitate downward rotation: Scapula (acromion) glides inferior & medial on clavicle Continued SHOULDER 35 Sternoclavicular Joint Acromioclavicular Joint 2096_Tab01_033-048 7/1/09 2:58 PM Scapulothoracic Joint Page 35 Arthrology Concave surface: Glenoid Fossa Convex surface: Humeral head 2:58 PM Page 36 Glenohumeral Joint Arthrology To facilitate flex: Humeral head rolls superior & glides inferior, anterior To facilitate IR: Humeral head rolls posterior & glides anterior To facilitate abd: Humeral head rolls superior & glides inferior, posterior To facilitate ER: Humeral head rolls anterior & glides posterior Scapulothoracic Mobilization Techniques Indications: SHOULDER ■ ■ ■ ■ ■ ■ ■ ■ Any condition in which mobility of scapula relative to thoracic wall is reduced &/or painful Lateral glide for protraction, elevation, horizontal abd Medial glide for retraction, horizontal add Upward rotation glide for elevation Downward rotation glide for return to neutral Superior glide for elevation Inferior glide for depression An alternate technique may involve compression Patient: ■ Sidelying with arm at side & scapula in neutral or may pre-position with arm at point of restriction 36 Scapulothoracic (S/T) Distraction & Glides 7/1/09 2096_Tab01_033-048 Arthrokinematics Clinician: Page 37 ■ Face pt ■ Caudal hand beneath pt’s arm capturing inferior angle of scapula in web space of hand ■ Cephalad hand capturing superior angle of scapula in web space of hand ■ Pt shoulder in contact with clinician’s chest/abdomen to assist with mobilization 37 ■ Maintain all contacts ■ Distraction produced through hand contacts at anterior aspect of scapula to lift scapula away from thoracic wall ■ Move hands in unison to mobilize scapula in lateral/medial, up/downward rotation, or superior/inferior directions Accessory With Physiologic Motion Technique: ■ ■ ■ ■ Pt sitting Clinician standing on ipsilateral or contralateral side Pt actively moves into direction of greatest restriction During active mov’t, clinician mobilizes scapula on thorax in direction of restriction t/o entire ROM ■ ST compression with contacts at midclavicle & medial-inferior scapula may also be considered SHOULDER 2096_Tab01_033-048 7/1/09 2:58 PM Accessory Motion Technique: S/T Medial & Lateral Glide x x SHOULDER 2096_Tab01_033-048 7/1/09 S/T Superior/Inferior Glides S/T Compression With Physiologic Motion 38 2:58 PM Page 38 x S/T Upward & Downward Rotation Sternoclavicular Mobilization Techniques Page 39 Sternoclavicular (S/C) Glides Indications: 39 Patient: ■ Supine with arm in neutral & supported by pillows with hand placed over abdomen; may pre-position with arm in elevation to point of restriction during inferior glides or horizontal abd for posterior glides Clinician: ■ Stand to side of pt ■ Position forearms in direction of mobilization ■ Mobilizing contact: Thumb-over-thumb or hypothenar-eminence-over-thumb contact made as follows: ■ Posterior glide: Contact is on anterior surface of proximal clavicle ■ Inferior glide: Contact is on superior surface of proximal clavicle ■ Superior glide: Contact is on inferior surface of proximal clavicle SHOULDER 2096_Tab01_033-048 7/1/09 2:58 PM ■ Any condition in which mobility of clavicle or scapula relative to thoracic wall is reduced &/or painful ■ Posterior glide for horizontal abd ■ Inferior glide for elevation ■ Superior glide for return to neutral ■ An alternate technique may involve compression Accessory Motion Technique: Page 40 ■ With thumb in direct contact with clavicular head, mobilizing thumb or hypothenar eminence elicits force in posterior, inferior, or superior directions Accessory With Physiologic Motion Technique: SHOULDER 7/1/09 2096_Tab01_033-048 Pt sitting & clinician standing on contralateral side Pt actively moves into the direction of greatest restriction During active mov’t, clinician mobilizes SC joint in direction of restriction t/o entire ROM Alternate technique involves compression with contacts over clavicle & scapula t/o entire ROM 40 2:58 PM ■ ■ ■ ■ S/C Inferior Glide S/C Superior Glide S/C Inferior Glide With Physiologic Motion SHOULDER 2096_Tab01_033-048 41 7/1/09 2:58 PM Page 41 S/C Posterior Glide Glenohumeral Mobilization Techniques Page 42 Glenohumeral (G/H) Distraction Indications: ■ To improve motion in all directions 2:58 PM Patient: ■ Supine with arm in neutral or may pre-position with arm at point of restriction Sitting or standing on ipsilateral side facing cephalad Stabilizing contact: Grasps lateral aspect of distal humerus Mobilizing contact: Drape hand with a towel & place in pt’s axilla Mobilization strap may be applied to proximal humerus & around clinician’s gluteals Accessory Motion Technique: ■ Laterally-directed force applied through mobilizing hand or strap as stabilizing contact provides counterforce at distal humerus, thus producing a short-arm lever Accessory With Physiologic Motion Technique: SHOULDER 2096_Tab01_033-048 7/1/09 ■ ■ ■ ■ ■ ■ ■ ■ Pt supine & clinician standing on ipsilateral side Pt actively moves into direction of greatest restriction During active movment, clinician applies distraction force through mobilizing hand t/o entire ROM Clinician must be prepared to follow the extremity through its excursion of motion 42 Clinician: Page 43 G/H Distraction x G/H Inferior Glide Indications: ■ To improve elevation of G/H joint ■ Combined ext, add, IR position indicated when there are restrictions &/or pain with this combined mov’t pattern Patient: ■ Supine or sitting with arm in neutral or may pre-position with arm at point of restriction Clinician: ■ Sitting or standing on ipsilateral side facing cephalad ■ Stabilizing contact: Drape hand with a towel & place in pt’s axilla ■ Mobilizing contact: Grasps distal humerus with pt’s forearm held between clinician’s arm & body SHOULDER 43 2:58 PM 7/1/09 2096_Tab01_033-048 G/H Distraction With Physiologic Motion Accessory Motion Technique: Page 44 ■ While maintaining all contacts, clinician rotates trunk away from pt, producing inferior glide against pressure from stabilizing contact in pt’s axilla ■ When mobilizing out of neutral, an inferiorly directed force is applied over lateral aspect of proximal humerus while stabilization is provided at elbow with pt in supine or sitting ■ Alternate technique: Clinician can stand alongside pt’s head, with mobilizing hand on superior aspect of humerus to impart an inferior glide G/H Inferior Glide With Physiologic Motion x G/H Inferior Glide x x SHOULDER 2096_Tab01_033-048 7/1/09 ■ Pt sitting or standing with shoulder in ext, add, IR elbow flexed & forearm held by uninvolved hand ■ Clinician on ipsilateral side with mobilizing hand contact or mobilization strap at pt’s forearm just distal to flexed elbow t/o entire ROM ■ Stabilizing hand contact within pt’s axilla ■ Inferior glide performed while pt moves with assistance of clinician & uninvolved hand into greater degrees of motion 44 2:58 PM Accessory With Physiologic Motion Technique: G/H Posterior Glide Page 45 Indication: ■ To improve ER & abd Patient: 45 Clinician: ■ Technique 1: Standing on ipsilateral side facing cephalad ■ Stabilizing contact: Holds arm in neutral or placed under scapula in lieu of wedge ■ Mobilizing contact: Palm contacts humeral head ■ Technique 2: Standing on ipsilateral side facing caudally ■ Stabilizing contact: Pt’s arm brought into elevation to point of restriction & held between clinician’s arm & body ■ Mobilizing contact: Both hands wrapped around proximal humerus with thumbs contacting the anterior humerus within the axilla Accessory Motion Technique: ■ Technique 1: With contacts in place, a posterolateral glide is performed ■ Technique 2: With contacts in place, a posterior glide (followed by anterior glide) may be applied at the end range of available motion in single or combined planes of elevation SHOULDER 2096_Tab01_033-048 7/1/09 2:58 PM ■ Supine with wedge to stabilize scapula posteriorly & bolster supporting elbow in flexed position, hand on abdomen; may pre-position with arm at point of restriction Accessory With Physiologic Motion Technique: 2:58 PM G/H Posterior Glide Technique #1 x 7/1/09 x SHOULDER 2096_Tab01_033-048 G/H Posterior Glide With Physiologic Motion 46 Page 46 ■ Pt sitting or standing ■ Clinician standing on contralateral side with mobilizing hand, or mobilization strap, over anterior humeral head & stabilizing contact over scapula ■ Pt actively moves into elevation in the direction of greatest restriction ■ During active mov’t, clinician applies a posterolaterally directed force over humerus while stabilizing scapula t/o entire ROM G/H Anterior Glide Page 47 Indications: ■ To improve IR, flex, & ext Patient: 47 Clinician: ■ Technique 1: Standing on ipsilateral side facing cephalad ■ Stabilizing contact: Holds arm in neutral ■ Mobilizing contact: Hypothenar eminence of mobilizing hand contacts posterior aspect of humeral head ■ Technique 2: Standing on ipsilateral side ■ Stabilizing contact: Contacts anterior aspect of distal clavicle & scapula just proximal to glenoid fossa.

The higher the score, the greater the disability. Vernon & Minor, 1991 2096_Intro_001-032 7/1/09 2:57 PM Page 26 The 4-Tier Premobilization Screening Process for the Spine Tier 1: Historical Interview ■ Review contraindications ■ Rheumatoid arthritis, Down’s syndrome, Ehrlers-Danlos syndrome, Marfan’s syndrome, lupus erythematosus, ankylosing spondylitis, diffuse idiopathic skeletal hyperostosis (DISH), spondyloarthropathy, cancer (patient >50 yr, failure to respond, unexplained weight loss, previous history), bone density concerns (osteoporosis, steroid use, chronic renal failure, postmenopausal females) ■ Pregnancy or immediately postpartum, oral contraceptives, anticoagulant therapy ■ Recent trauma, radiculopathy (distal to knee), cauda equina syndrome (+ B/B signs) ■ Intolerance for static postures ■ Acute pain with movement, improved with external support ■ Extension brings on vertigo, nausea, diplopia, tinnitus, dysarthria, & nystagmus Tier 2: Medical Testing & Diagnostic Imaging ■ Lab values suggesting systemic disease (see Tier 1) ■ Plain film radiography including: ■ Open-mouth view: Visualize odontoid & C1–C2 ■ Lateral views & lateral stress views: Visualize parallel line relationship & atlantodental interface (>3 mm) ■ Oblique views: Visualize defect in pars interarticularis ■ MRI, CT scans, scintigraphy for identification of subtle pathology ■ Doppler ultrasound for detection of vertebrobasilar ischemia (VBI) 26 2096_Intro_001-032 7/1/09 2:57 PM Page 27 27 Tier 3: Clinical Screening Procedures for Segmental Stability ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ Sharp-Purser test Aspinall’s test Transverse ligament stress test Alar ligament stress test Prone lumbar segmental stability test Anterior lumbar segmental stability test Posterior lumbar segmental stability test Torsional lumbar segmental stability test Prone knee flex test Axial compression test Passive intervertebral mobility testing (>Grade 5) Mobilization prepositioning AROM assessment revealing poor movement quality Palpation revealing step when unsupported & band of hypertrophy Tier 4: Clinical Screening Procedures for Vertebrobasilar Ischemia (VBI) (Cervical Only) ■ Vertebral artery test ■ Neck torsion test (sitting trunk rotation with head stabilized) Clinical Screening Procedures Vertebral Artery Test ■ Patient: Supine without head support ■ Clinician: Sitting at head of table supporting occiput ■ Procedure: Neck sequentially brought into ext, SB, & ipsilateral rotation; held for 15 seconds while clinician monitors pt & engages pt in conversation; rest for 15 seconds, then test other side ■ Interpretation: Test (+) if following are present: dizziness, nausea, tinnitus, diplopia, slurred speech, slow response, nystagmus, altered pupil dilation ■ Statistics: Sensitivity = 0%; Specificity = 67%-90% 2096_Intro_001-032 7/1/09 2:57 PM Page 28 Sharp-Purser Test ■ Patient: Sitting with flex of the head on neck ■ Clinician: One hand on pt’s forehead & other thumb over spinous process of C2 to stabilize ■ Procedure: As pt flexes, clinician imparts force posteriorly through forehead contact ■ Interpretation: Test (+) if head slides posteriorly indicating a reduction of the subluxed atlas on axis or if end feel not firm Aspinall’s Test ■ ■ ■ ■ Patient: Supine Clinician: Stabilizes flexed occiput on atlas Procedure: An anteriorly directed force is applied to atlas Interpretation: Test (+) if end feel soft or pt reports symptoms including esophageal pressure & other neurologically related cord compression signs or symptoms Transverse Ligament Stress Test ■ Patient: Supine ■ Clinician: Supports the occiput with fingers over the atlas ■ Procedure: Occiput & atlas together are brought anteriorly without flex or ext & held for 15 seconds ■ Interpretation: Test (+) if end feel soft; muscle spasm, nausea, vertigo, paresthesia, nystagmus, esophageal pressure suggesting transverse ligament compromise Alar Ligament Stress Test ■ Patient: Supine ■ Clinician: Supports occiput with hands while index fingers palpate spinous process of axis ■ Procedure: Occiput passively moved slightly to each side ■ Interpretation: Test (+) if there is delay in mov’t of spinous process of axis suggesting alar ligament compromise 28 2096_Intro_001-032 7/1/09 2:57 PM Page 29 29 Prone Lumbar Segmental Stability Test ■ Patient: Prone with trunk on table & feet on floor ■ Clinician: Standing with hand contact on segment in question ■ Procedure: A gentle posterior-to-anterior force applied with pt’s feet resting & force then reapplied with the feet actively lifted off floor ■ Interpretation: Test (+) if soft end feel & symptoms noted in the resting position that reduce when the feet are unsupported Anterior Lumbar Segmental Stability Test ■ Patient: Side-lying with hips & knees flexed to 90° ■ Clinician: Standing with pt’s flexed knees fixed & hand at segment to be tested ■ Procedure: A gentle posterior force applied through femurs while the hand stabilizes ■ Interpretation: Test (+) if relative mov’t of superior vertebra felt to move anteriorly on inferior vertebra Posterior Lumbar Segmental Stability Test ■ Patient: Sitting with arms folded ■ Clinician: Standing with pt’s flexed elbows in contact with clinician’s chest & clinician’s hands resting on lumbar segment to be tested ■ Procedure: Pt pushes into clinician through the forearms as clinician stabilizes the segment with hands ■ Interpretation: Test (+) if relative mov’t of superior vertebra felt to move posteriorly on inferior vertebra Torsional Lumbar Segmental Stability Test ■ Patient: Prone ■ Clinician: Standing with contact on contralateral anterior ilium while other hand stabilizes above segment to be tested ■ Procedure: Clinician pulls ilium upward producing rotation of pelvis on stabilized lumbar segment 2096_Intro_001-032 7/1/09 2:57 PM Page 30 ■ Interpretation: Test (+) if symptoms reproduced & ↑segmental mobility noted Prone Knee Flexion Test ■ Patient: Prone ■ Clinician: Contact made at segment to be tested while other hand grasps pt’s leg ■ Procedure: Posterior-to-anterior pressure applied over spinal segment while knee passively flexed ■ Interpretation: Test (+) if symptoms reproduced & ↑segmental mobility noted ■ Statistics: Sensitivity = 84% Axial Compression Test ■ Patient: Standing ■ Clinician: Both hands placed on pt’s shoulders ■ Procedure: Downward axial compressive forces applied equally through both hand contacts ■ Interpretation: Test (+) if reproduction of symptoms along with ↑segmental mobility, soft end feel, & ↑paravertebral muscle activity noted ■ Statistics: Sensitivity = 30%–92%; Specificity = 74%–100% Lumbar Passive Intervertebral Mobility (PIVM) Test ■ Patient: Side-lying or prone ■ Clinician: Standing with one hand producing motion at lumbar spine & other palpating for segmental mobility ■ Procedure: Mov’t introduced through the LE as palpating finger identifies the degree of intervertebral mobility for: a.

Abd = elastic Hard Add (retraction) = 4–5 cm abd capsular = Scaption = Upward rotation = 60° frozen elastic Downward rotation = 20° shoulder IR/ER = Sternoclavicular Elevation = 45° elastic/firm Capsular = ER Depression = 5° > abd Horizontal > IR Protraction = 15°–20° add = soft tissue Retraction = 15°–20° Ext = firm Upward rotation = 25°–55° Horizontal Downward rotation = <10° abd = firm/ Acromioclavicular Total IR/ER = 30° elastic Total A/P tilting = 30°–40° Upward rotation = 30° Downward rotation = 17° SHOULDER Glenohumeral Elevation (flex, abd) = 180° Ext = 60° Total IR/ER = 180° Scapulohumeral rhythm 2:1 = 120°:60° 34 2:58 PM Scapulothoracic 7/1/09 2096_Tab01_033-048 Normal ROM Accessory (Arthrokinematic) Motions of the Shoulder Arthrokinematics Convex surface: Thorax Concave surface: Scapula To facilitate elevation: Scapula glides superior on thorax To facilitate protraction: Scapula glides lateral around thorax To facilitate upward rotation: Inferior angle of scapula glides superior & lateral around thorax Convex surface: Clavicular head Concave surface: Disc & manubrium To facilitate elevation: Lateral clavicle rolls upward & medial clavicle glides inferior on disc & manubrium Concave surface: Clavicle & disc Convex surface: Manubrium Convex surface: Clavicle Concave surface: Acromion To facilitate depression: Scapula glides inferior on thorax To facilitate retraction: Scapula glides medial around thorax To facilitate downward rotation: Inferior angle of scapula glides inferior & medial around thorax To facilitate depression: Lateral clavicle rolls downward & medial clavicle glides superior on disc & manubrium To facilitate retraction: To facilitate protraction: Medial clavicle & disc roll & Medial clavicle & disc roll & glide posterior on manubrium glide anterior on manubrium To facilitate upward rotation: Scapula (acromion) glides superior & lateral on clavicle To facilitate downward rotation: Scapula (acromion) glides inferior & medial on clavicle Continued SHOULDER 35 Sternoclavicular Joint Acromioclavicular Joint 2096_Tab01_033-048 7/1/09 2:58 PM Scapulothoracic Joint Page 35 Arthrology Concave surface: Glenoid Fossa Convex surface: Humeral head 2:58 PM Page 36 Glenohumeral Joint Arthrology To facilitate flex: Humeral head rolls superior & glides inferior, anterior To facilitate IR: Humeral head rolls posterior & glides anterior To facilitate abd: Humeral head rolls superior & glides inferior, posterior To facilitate ER: Humeral head rolls anterior & glides posterior Scapulothoracic Mobilization Techniques Indications: SHOULDER ■ ■ ■ ■ ■ ■ ■ ■ Any condition in which mobility of scapula relative to thoracic wall is reduced &/or painful Lateral glide for protraction, elevation, horizontal abd Medial glide for retraction, horizontal add Upward rotation glide for elevation Downward rotation glide for return to neutral Superior glide for elevation Inferior glide for depression An alternate technique may involve compression Patient: ■ Sidelying with arm at side & scapula in neutral or may pre-position with arm at point of restriction 36 Scapulothoracic (S/T) Distraction & Glides 7/1/09 2096_Tab01_033-048 Arthrokinematics Clinician: Page 37 ■ Face pt ■ Caudal hand beneath pt’s arm capturing inferior angle of scapula in web space of hand ■ Cephalad hand capturing superior angle of scapula in web space of hand ■ Pt shoulder in contact with clinician’s chest/abdomen to assist with mobilization 37 ■ Maintain all contacts ■ Distraction produced through hand contacts at anterior aspect of scapula to lift scapula away from thoracic wall ■ Move hands in unison to mobilize scapula in lateral/medial, up/downward rotation, or superior/inferior directions Accessory With Physiologic Motion Technique: ■ ■ ■ ■ Pt sitting Clinician standing on ipsilateral or contralateral side Pt actively moves into direction of greatest restriction During active mov’t, clinician mobilizes scapula on thorax in direction of restriction t/o entire ROM ■ ST compression with contacts at midclavicle & medial-inferior scapula may also be considered SHOULDER 2096_Tab01_033-048 7/1/09 2:58 PM Accessory Motion Technique: S/T Medial & Lateral Glide x x SHOULDER 2096_Tab01_033-048 7/1/09 S/T Superior/Inferior Glides S/T Compression With Physiologic Motion 38 2:58 PM Page 38 x S/T Upward & Downward Rotation Sternoclavicular Mobilization Techniques Page 39 Sternoclavicular (S/C) Glides Indications: 39 Patient: ■ Supine with arm in neutral & supported by pillows with hand placed over abdomen; may pre-position with arm in elevation to point of restriction during inferior glides or horizontal abd for posterior glides Clinician: ■ Stand to side of pt ■ Position forearms in direction of mobilization ■ Mobilizing contact: Thumb-over-thumb or hypothenar-eminence-over-thumb contact made as follows: ■ Posterior glide: Contact is on anterior surface of proximal clavicle ■ Inferior glide: Contact is on superior surface of proximal clavicle ■ Superior glide: Contact is on inferior surface of proximal clavicle SHOULDER 2096_Tab01_033-048 7/1/09 2:58 PM ■ Any condition in which mobility of clavicle or scapula relative to thoracic wall is reduced &/or painful ■ Posterior glide for horizontal abd ■ Inferior glide for elevation ■ Superior glide for return to neutral ■ An alternate technique may involve compression Accessory Motion Technique: Page 40 ■ With thumb in direct contact with clavicular head, mobilizing thumb or hypothenar eminence elicits force in posterior, inferior, or superior directions Accessory With Physiologic Motion Technique: SHOULDER 7/1/09 2096_Tab01_033-048 Pt sitting & clinician standing on contralateral side Pt actively moves into the direction of greatest restriction During active mov’t, clinician mobilizes SC joint in direction of restriction t/o entire ROM Alternate technique involves compression with contacts over clavicle & scapula t/o entire ROM 40 2:58 PM ■ ■ ■ ■ S/C Inferior Glide S/C Superior Glide S/C Inferior Glide With Physiologic Motion SHOULDER 2096_Tab01_033-048 41 7/1/09 2:58 PM Page 41 S/C Posterior Glide Glenohumeral Mobilization Techniques Page 42 Glenohumeral (G/H) Distraction Indications: ■ To improve motion in all directions 2:58 PM Patient: ■ Supine with arm in neutral or may pre-position with arm at point of restriction Sitting or standing on ipsilateral side facing cephalad Stabilizing contact: Grasps lateral aspect of distal humerus Mobilizing contact: Drape hand with a towel & place in pt’s axilla Mobilization strap may be applied to proximal humerus & around clinician’s gluteals Accessory Motion Technique: ■ Laterally-directed force applied through mobilizing hand or strap as stabilizing contact provides counterforce at distal humerus, thus producing a short-arm lever Accessory With Physiologic Motion Technique: SHOULDER 2096_Tab01_033-048 7/1/09 ■ ■ ■ ■ ■ ■ ■ ■ Pt supine & clinician standing on ipsilateral side Pt actively moves into direction of greatest restriction During active movment, clinician applies distraction force through mobilizing hand t/o entire ROM Clinician must be prepared to follow the extremity through its excursion of motion 42 Clinician: Page 43 G/H Distraction x G/H Inferior Glide Indications: ■ To improve elevation of G/H joint ■ Combined ext, add, IR position indicated when there are restrictions &/or pain with this combined mov’t pattern Patient: ■ Supine or sitting with arm in neutral or may pre-position with arm at point of restriction Clinician: ■ Sitting or standing on ipsilateral side facing cephalad ■ Stabilizing contact: Drape hand with a towel & place in pt’s axilla ■ Mobilizing contact: Grasps distal humerus with pt’s forearm held between clinician’s arm & body SHOULDER 43 2:58 PM 7/1/09 2096_Tab01_033-048 G/H Distraction With Physiologic Motion Accessory Motion Technique: Page 44 ■ While maintaining all contacts, clinician rotates trunk away from pt, producing inferior glide against pressure from stabilizing contact in pt’s axilla ■ When mobilizing out of neutral, an inferiorly directed force is applied over lateral aspect of proximal humerus while stabilization is provided at elbow with pt in supine or sitting ■ Alternate technique: Clinician can stand alongside pt’s head, with mobilizing hand on superior aspect of humerus to impart an inferior glide G/H Inferior Glide With Physiologic Motion x G/H Inferior Glide x x SHOULDER 2096_Tab01_033-048 7/1/09 ■ Pt sitting or standing with shoulder in ext, add, IR elbow flexed & forearm held by uninvolved hand ■ Clinician on ipsilateral side with mobilizing hand contact or mobilization strap at pt’s forearm just distal to flexed elbow t/o entire ROM ■ Stabilizing hand contact within pt’s axilla ■ Inferior glide performed while pt moves with assistance of clinician & uninvolved hand into greater degrees of motion 44 2:58 PM Accessory With Physiologic Motion Technique: G/H Posterior Glide Page 45 Indication: ■ To improve ER & abd Patient: 45 Clinician: ■ Technique 1: Standing on ipsilateral side facing cephalad ■ Stabilizing contact: Holds arm in neutral or placed under scapula in lieu of wedge ■ Mobilizing contact: Palm contacts humeral head ■ Technique 2: Standing on ipsilateral side facing caudally ■ Stabilizing contact: Pt’s arm brought into elevation to point of restriction & held between clinician’s arm & body ■ Mobilizing contact: Both hands wrapped around proximal humerus with thumbs contacting the anterior humerus within the axilla Accessory Motion Technique: ■ Technique 1: With contacts in place, a posterolateral glide is performed ■ Technique 2: With contacts in place, a posterior glide (followed by anterior glide) may be applied at the end range of available motion in single or combined planes of elevation SHOULDER 2096_Tab01_033-048 7/1/09 2:58 PM ■ Supine with wedge to stabilize scapula posteriorly & bolster supporting elbow in flexed position, hand on abdomen; may pre-position with arm at point of restriction Accessory With Physiologic Motion Technique: 2:58 PM G/H Posterior Glide Technique #1 x 7/1/09 x SHOULDER 2096_Tab01_033-048 G/H Posterior Glide With Physiologic Motion 46 Page 46 ■ Pt sitting or standing ■ Clinician standing on contralateral side with mobilizing hand, or mobilization strap, over anterior humeral head & stabilizing contact over scapula ■ Pt actively moves into elevation in the direction of greatest restriction ■ During active mov’t, clinician applies a posterolaterally directed force over humerus while stabilizing scapula t/o entire ROM G/H Anterior Glide Page 47 Indications: ■ To improve IR, flex, & ext Patient: 47 Clinician: ■ Technique 1: Standing on ipsilateral side facing cephalad ■ Stabilizing contact: Holds arm in neutral ■ Mobilizing contact: Hypothenar eminence of mobilizing hand contacts posterior aspect of humeral head ■ Technique 2: Standing on ipsilateral side ■ Stabilizing contact: Contacts anterior aspect of distal clavicle & scapula just proximal to glenoid fossa.

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