Range of Motion, Manual Therapies, Shoulder Joint Disorder
Conditions
Keywords
shoulder, Glenohumeral Internal Rotation Deficit (GIRD), joint play, muscular activity
Brief summary
Interventions including glenohumeral mobilization, sleeper stretches, and thoracic manipulation have been proposed for individuals with loss of shoulder range of motion (ROM). However, the effect of these interventions on shoulder ROM, joint translation, and muscular activity have not been studied in combination.
Detailed description
Forty individuals with a loss of internal rotation (IR) ROM will be recruited and randomized to one of two interventions at the first session: either posterior glenohumeral mobilization or internal rotation sleeper stretching. At the second visit, all participants will undergo a thoracic manipulation (T3-4 segment) followed by a repeat of either the sleeper stretch or glenohumeral mobilization.
Interventions
OTHERposterior glide mobilization
The participant will be positioned supine on a plinth, with their scapula stabilized against a firm wedge on the table, and the shoulder joint in the resting position (approx. 55 degrees abduction, 30 degrees horizontal adduction, and slight external rotation). With the extremity held in the same position, the researcher will then apply a grade III (into tissue stretch) PG mobilization. This will consist of five 30-second bouts of sustained gr III posterior glide mobilizations.
OTHERSleeper stretch
All participants randomized to the stretching group will perform five 30-second holds of the sleeper stretch. This is performed by lying on the side to be stretched, elevating the upper arm to 90° on the support surface with the elbow bent 90°, then passively internally rotating the shoulder with force provided by with the opposite arm.
Individuals will then undergo a single supine grade V thrust manipulation. All manipulations will take place at the T3-4 segment. If a cavitation (pop) is not heard or felt by either the subject or examiner, a second thrust will be performed.
Sponsors
University of Hartford
Study design
Allocation
RANDOMIZED
Intervention model
SEQUENTIAL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Masking description
Assessment of electromyographic (EMG) activity, IR ROM pre-post intervention, and glenohumeral translation via ultrasound will be performed by a blinded assessor.
Intervention model description
All participants will undergo a single intervention during the first session, and then combined thoracic manipulation and a repeat of the prior intervention at the second session.
Eligibility
Sex/Gender
ALL
Age
18 Years to 60 Years
Healthy volunteers
No
Inclusion criteria
* loss of IR of 15 degrees of greater compared to contralateral shoulder
Exclusion criteria
* currently neck/upper back pain, * history of spinal fractures, * numbness/altered sensation of the arms or legs, * whiplash injury within the prior 6 weeks, * infections of the spine, * currently pregnant/possibly pregnant, * known osteoporosis, * Rheumatoid arthritis, * previous spine surgery, * currently receiving Workman's Compensation, * any pending litigation regarding a neck or shoulder injury, * history of oral corticosteroids in the prior 6 months, * history of shoulder fractures, * Current treatment for cancer, * Prior history of cancer involving the spine/shoulder, * any history of coagulation disorders. * Individuals with a history of shoulder surgery will reviewed on a case by case basis.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in shoulder IR ROM | Pre intervention to immediate (within 5 minutes) post intervention | Shoulder IR ROM measured with a goniometer |
| Change in posterior shoulder translation (mm) | Pre intervention to immediate (within 5 minutes) post intervention | maximum posterior translation of the humeral head assessed with ultrasound imaging (mm) |
| Change in infraspinatus electromyographic activity (%MVIC) | Pre intervention to immediate (within 5 minutes) post intervention | activity of the infraspinatus muscle during posterior translation, assessed as a percentage of the maximal voluntary isometric contraction (MVIC) |
Countries
United States
Outcome results
None listed