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Shoulder Mobilizations

Shoulder Mobilizations. Anterior-Posterior GH Mobilization (High Grade). Position pt. supine with humerus to be mobilized at the edge of the table PT to stabilize the pt.’s distal extremity, while placing other hand over the anterior proximal humerus

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Shoulder Mobilizations

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  1. Shoulder Mobilizations

  2. Anterior-Posterior GH Mobilization (High Grade) • Position pt. supine with humerus to be mobilized at the edge of the table • PT to stabilize the pt.’s distal extremity, while placing other hand over the anterior proximal humerus • PT then provides a force in an A-P direction, starting with grade 1 and working up to grade 4 as pt. tolerates • Parameters: 8-10 reps (at each grade) – hold each mob for 3 seconds • Note: The pt.’s arm should be abducted to the barrier in motion OR to the pt.’s first point of pain, but then backed off until pain free (if taken to the point of pain, the force generated by the PT should be less then if no pain present)

  3. Anterior-Posterior GH Mobilization

  4. A-P GH Mobilization (Low Grade) • Position pt. supine with humerus to be mobilized at the edge of the table, pt.’s forearm and hand resting on their stomach • PT will use both hands (fingertips on anterior humeral head and thumbs on posterior humeral head) • PT then provides a force in an A-P direction, starting with grade 1 and working up to grade 3 as pt. tolerates • Parameters: 8-10 reps (at each grade) – hold each mob for 3 seconds

  5. A-P GH mobilization (Low Grade)

  6. AC A-P Mobilization • Pt. lies supine with side to be mobilized towards the edge of the table • PT places one hand under the shoulder, over the scapula to stabilize it – The pisiform of the other hand is placed directly over the distal end of the clavicle at the AC jt., perpendicular to the table so the force is directed straight down • PT then provides a force in an A-P direction, starting with grade 1 and working up to grade 4 as pt. tolerates • Parameters: 8-10 reps (at each grade) – hold each mob for 3 seconds

  7. AC A-P Mobilization

  8. AC Inferior Mobilization • Pt. positioned supine with arms at the side • PT sits at the head of the pt. with both thumbs positioned over the superior surface of the distal clavicle, adjacent to the AC Jt. • PT then provides a force in an superior to inferior direction, starting with grade 1 and working up to grade 4 as pt. tolerates • Parameters: 8-10 reps (at each grade) – hold each mob for 3 seconds

  9. AC Inferior Mobilization

  10. Inferior GH Glide in Abduction • Pt. lies supine with side to be mobilized towards the edge of the table, arm abducted off the side of the table • Pt.’s neck is laterally flexed toward the side receiving the mob (to slacken the nerves) • PT stands in lunge position superiorly to the pt.’s shoulder: one hand grasps around pt.’s elbow (holding it in slight flexion), the web space of the other hand is around the proximal humerus • PT then provides a force to the proximal humerusin an inferior direction, while simultaneously abducting further starting with grade 1 and working up to grade 4 as pt. tolerates • Parameters: 8-10 reps (at each grade) – hold each mob for 3 seconds • Note: The pt.’s arm should be abducted to the barrier in motion OR to the pt.’s first point of pain, but then backed off until pain free (if taken to the point of pain, the force generated by the PT should cause no more than minor discomfort)

  11. Inferior GH Glide in Abduction

  12. Inferior GH Glide in Flexion • Pt. lies supine with side to be mobilized towards the edge of the table • PT stands in lunge position superiorly to the pt.’s shoulder: one hand grasps around pt.’s distal humerus (holding the elbow in 90 degrees flexion), the web space of the other hand is around the proximal humerus • PT then provides a force to the proximal humerus in an inferior direction, while simultaneously flexing further starting with grade 1 and working up to grade 4 as pt. tolerates • Parameters: 8-10 reps (at each grade) – hold each mob for 3 seconds • Note: The pt.’s arm should be flexed to the barrier in motion OR to the pt.’s first point of pain, but then backed off until pain free (if taken to the point of pain, the force generated by the PT should cause no more than minor discomfort)

  13. Inferior GH Glide in Flexion

  14. Clavicle Rotation • Pt. positioned supine with arms at the side • Stand near the pt.’s shoulder, facing towards the clavicle • Gently grip the middle of the clavicle using your thumbs on the inferior surface and fingertips on the superior surface • Apply a gentile mobilization force using a rocking or “wiggling” motion through repetitive wrist flexion and extension to impart rotation of the clavicle on its long axis • Parameters: 8-10 reps each grade (up to grade 3)

  15. Clavicle Rotation

  16. FABER P-A mobilization • Pt. starts prone with arm to be mobilized flexed, abducted, and ER (Forehead resting on the dorsum of the hand) • PT stands by the head of the pt. on the side to be mobilized. PT places the thumbs and web spaces of both hands on the posterior proximal humerus, fingers are wrapped around the anterior surface • PT then provides a P-A force starting with grade 1 and working up to grade 4 as pt. tolerates • Parameters: 8-10 reps (at each grade) – hold each mob for 3 seconds • Note: The pt.’s arm should be flexed/Abdto the barrier in motion OR to the pt.’s first point of pain, but then backed off until pain free (if taken to the point of pain, the force generated by the PT should cause no more than minor discomfort)

  17. FABER P-A mobilization

  18. GH External Rotation • Pt. lies supine with side to be mobilized towards the edge of the table, arm is abducted up to 90 degrees (as pt. can tolerate) and elbow is flexed to 90 degrees • PT stands facing the pt.’s head and stabilizes the pt.’s elbow with one hand, while grasping the wrist with the other (grasp bony prominences at the elbow and wrist) • PT slowly externally rotates the pt.’s shoulder until pt. discomfort or tissue resistance is met; hold for 3-5 seconds and then back off. • Repeat up to 30x, and try to move the shoulder a little further each time as the tissues relax. * Note: Encourage the pt. to completely relax as much as possible!

  19. GH External Rotation

  20. GH Internal Rotation • Pt. lies supine with side to be mobilized towards the edge of the table, arm is abducted up to 90 degrees (as pt. can tolerate) and elbow is flexed to 90 degrees • PT stands facing the pt.’s feet and stabilizes the pt.’s elbow with one hand, while grasping the wrist with the other (grasp bony prominences at the elbow and wrist) • Note: May have to stabilize the pt.’s shoulder girdle instead of holding at elbow if compensation occurs • PT slowly internally rotates the pt.’s shoulder until pt. discomfort or tissue resistance is met; hold for 3-5 seconds and then back off. • Repeat up to 30x, and try to move the shoulder a little further each time as the tissues relax. * Note: Encourage the pt. to completely relax as much as possible!

  21. GH Internal Rotation

  22. GH Horizontal Adduction • Pt. lies supine on the table with the uninvolved side toward the edge of the table; Pt.’s involved arm is place in 80-90 degrees of shoulder flexion and 90 degrees of elbow flexion • PT stands on pt.’s uninvolved side, facing the pt. PT grasps the pt.’s involved side at the posterior/medial elbow, and uses the heel of the other hand to stabilize the pt.’s scapula • The technique involves first stabilizing the scapula and then horizontally adduct the shoulder until the barrier is felt. Once the barrier is felt, PT then provides a posterior force starting with grade 1 and working up to grade 4 as pt. tolerates. As motion is gained, horizontally adduct the shoulder further until a new barrier is felt • Parameters: 8-10 reps (at each grade) – hold each mob for 3 seconds * Note: Be careful not to flex the pt.’s shoulder past 90 degrees to avoid creating an impingement at the shoulder

  23. GH Horizontal Adduction

  24. GH Longitudinal Distraction • Pt. lies supine with the shoulder to receive treatment at the edge of the treatment table • PT stands on the side to receive treatment, facing towards the pt.’s head. Stabilize the pt.’s forearm against the PT’s side. PT’s medial arm cups the middle to proximal humerus and lateral arm cups laterally around the humeral head. • The PT gently distracts the humerus by pulling toward their body, imparting an oscillatory force (30-50x) once distracted. *Note: Make sure the PT moves his whole body to provide the distraction force, do not just pull with arms

  25. GH Longitudinal Distraction

  26. P-A GH Mobilization • Pt. lies prone with arm to be mobilized toward the edge of the table in 90 degrees of abduction (off the table), elbow flexed with some glenohumeral internal rotation. • PT grasps the pt.’s distal humerus, allowing forearm to hang down toward the ground. Heel of proximal hand is placed against the posterior humeral head with elbow locked. • PT then provides a P-A force by moving their body/trunk down through their locked out elbow, starting with grade 1 and working up to grade 4 as pt. tolerates • Parameters: 8-10 reps (at each grade) – hold each mob for 3 seconds

  27. P-A GH Mobilization

  28. Scapular Elevation-Depression • Pt. is sidelying (facing the PT) with shoulder and elbow flexed and forearm resting on clinician’s forearm • PT: Lower hand is placed around the inferior angle of the scapula with the thumb and forefinger along lateral and medial scapula borders. Upper hand grasps the spine of the scapula, cupping the heel of the hand anteriorly over the clavicle • PT mobilizes scapula superior and inferior by using trunk to provide the key force through the arms. PT starts with grade 1 and works up to grade 4 as pt. tolerates • Parameters: 8-10 reps (at each grade) – hold each mob for 3 seconds *Note: Pt. must completely relax scapula musculature.

  29. Scapular Elevation-Depression

  30. Scapular Protraction - Retraction • Pt. is sidelying (facing the PT) with shoulder and elbow flexed and forearm resting on clinician’s forearm • PT: Lower hand is placed around the inferior angle of the scapula with the thumb and forefinger along lateral and medial scapula borders. Upper hand grasps the spine of the scapula, cupping the heel of the hand anteriorly over the clavicle • PT mobilizes scapula medially and laterally by using trunk to provide the key force through the arms. PT starts with grade 1 and works up to grade 4 as pt. tolerates • Parameters: 8-10 reps (at each grade) – hold each mob for 3 seconds *Note: Pt. must completely relax scapula musculature.

  31. Scapular Protraction - Retraction

  32. Translational Glenohumeral Mobilization • Pt. lies supine with the arm to be mobilized toward the edge of the table with the arm abducted to 90 degrees • PT stands to the side that will be mobilized and supports the pt.’s forearm against their side. Both hands grasp the glenohumeral joint at the site of articulation with the thumbs on the superior-anterior surface, and the fingers wrapped around the posterior-inferior aspect of the joint. • A short lever-arm translational glide is imparted to the glenohumeral joint in anterior, posterior, superior, and inferior directions. *Note: You may add a distraction force to produce more tension through the glenohumeral joint capsule

  33. Translational Glenohumeral Mobilization

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