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Shoulder Manual Therapy

Lab Handout

Retraction Force Progressions

Retraction – Force Progressions Patient Position: Seated comfortable, upright posture Therapist Position: Standing

Patient Position: Seated comfortable, upright posture

Therapist Position: Standing on either side of patient, shoulder width or staggered stance, elbows positioned in line with force as pictured

Stabilization: Right hand thenar eminence stabilizing over CT region (can be more specific based on patient response)

Opposite Hand: C grip over patient mandible

Repeated movement with overpressure: Patient actively performs end range retraction, at end of movement therapist applies overpressure, 50% through CT region, and 50% through mandible

Retraction Mobilization: Therapist takes patient to end-range retraction, stabilizes with hand over mandible, and performs a P to A mobilization through thenar eminence of hand over CT region

Indication: Patient platues or there is no effect on symptoms with patient generated forces

Retraction Force Alternatives (Progressions)

Retraction – Force Alternatives (Progressions) Patient Position: Supine, upper thoracic spine off edge of plinth

Patient Position: Supine, upper thoracic spine off edge of plinth

Therapist Position: Standing to one side of patient

Stabilization: Right hand supporting patient head, C grip over mastoid processes. Head stabilized against therapist upper thigh

Opposite Hand: C grip over patient mandible

Repeated movement with overpressure: Patient actively performs end range retraction, at end of movement therapist bends knees to allow gravity to bring the cervical spine into further retraction while opposite hand applies overpressure on mandible directly toward floor

Indication: Patient does not tolerated loaded position, but responds favorably to unloaded and has platued or no effect on symptoms with patient generated forces

loaded position, but responds favorably to unloaded and has platued or no effect on symptoms with

Retraction / Extension Therapist

Overpressure

Retraction / Extension Therapist Overpressure Patient Position: Supine, upper thoracic spine off edge of plinth Therapist

Patient Position: Supine, upper thoracic spine off edge of plinth

Therapist Position: Half kneeling to one side of patient

Stabilization: Right hand supporting patient head, C grip over mastoid processes.

Opposite Hand: Fingers over mandible. Therapist elbow on this arm should be more relaxed down

Repeated movement Therapist applies slight distraction, retracts cervical spine, and takes patient into full extension. Slight side to side rotation is performed by therapist to increase extension

Indication: Patient does not tolerated loaded position, but responds favorably to unloaded and has platued or no effect on symptoms with

patient generated forces. This technique is often needed for slow to respond

posterior derangements

on symptoms with patient generated forces. This technique is often needed for slow to respond posterior

Lateral Flexion With Overpressure / Mobilization

Lateral Flexion With Overpressure / Mobilization SB Therapist Overpressure Patient Position: Seated, upright posture

SB Therapist Overpressure

Patient Position: Seated, upright posture

Therapist Position: Standing behind patient

Stabilization: Right hand resting on patient shoulder, thumb lateral to spinous process of T1

Opposite Hand: Elbow resting on shoulder, hand on lateral aspect of head

Repeated movement: Patient performs slight retraction, and the lateral flexion. Therapist applies 50/50 overpressure between the two hands

Direction of Force: Right mobilizing hand directing force through spinous process toward opposite axilla. Left hand pushing further into side bending

Indication: Patient platuea or no effect with seated lateral flexion (after sagittal plane has been exhausted)

bending Indication: Patient platuea or no effect with seated lateral flexion (after sagittal plane has been

Rotation With Overpressure / Mobilization

Rotation With Overpressure / Mobilization Patient Position: Seated, upright posture Therapist Position: Standing behind

Patient Position: Seated, upright posture

Therapist Position: Standing behind patient

Stabilization: Left hand resting on patient shoulder, thumb lateral to spinous process of T1

Opposite Hand: Wrapped around patient mandible, fingers on transverse processes just above opposite hand’s thumb

Repeated movement: Patient performs slight retraction, and rotation. At end range therapist applies 50/50 overpressure by rotating body for right rotation, and providing overpressure with thumb of left hand

Direction of Force: Right UE into right rotation, left hand line of force directly lateral

Indication: Patient platuea or no effect with seated rotation (after sagittal plane has been exhausted)

directly lateral Indication: Patient platuea or no effect with seated rotation (after sagittal plane has been

Median Nerve Tension Test

Median Nerve Tension Test Shoulder Girdle Depression Finger / Wrist Extension Shoulder ER Elbow Extension

Shoulder Girdle Depression

Median Nerve Tension Test Shoulder Girdle Depression Finger / Wrist Extension Shoulder ER Elbow Extension

Finger / Wrist Extension

Median Nerve Tension Test Shoulder Girdle Depression Finger / Wrist Extension Shoulder ER Elbow Extension

Shoulder ER

Median Nerve Tension Test Shoulder Girdle Depression Finger / Wrist Extension Shoulder ER Elbow Extension

Elbow Extension

Median Nerve Tension Test Shoulder Girdle Depression Finger / Wrist Extension Shoulder ER Elbow Extension

Ulnar Nerve Tension Test

Ulnar Nerve Tension Test 1. Shoulder girdle depression (with your elbow) 2. Shoulder Abduction to 90

1. Shoulder girdle depression

(with your elbow)

2. Shoulder Abduction to 90 degrees

3. Wrist / Finger Extension / Radial Deviation

4. Elbow Flexion

5. Shoulder Abduction

2. Shoulder Abduction to 90 degrees 3. Wrist / Finger Extension / Radial Deviation 4. Elbow

RadialNerve Tension Test

RadialNerve Tension Test • Pt diagonal on bed • Depress shoulder girdle with thigh • Elbow

Pt diagonal on bed

Depress shoulder girdle with thigh

Pt diagonal on bed • Depress shoulder girdle with thigh • Elbow Extension • Wrist /

Elbow Extension

Wrist / Finger Flexion

Ulnar Deviation

shoulder girdle with thigh • Elbow Extension • Wrist / Finger Flexion • Ulnar Deviation •

Shoulder Abduction

shoulder girdle with thigh • Elbow Extension • Wrist / Finger Flexion • Ulnar Deviation •

GH Joint Pure Distraction

GH Joint – Pure Distraction • Indication: pain relief, general to improve all motions • Open
GH Joint – Pure Distraction • Indication: pain relief, general to improve all motions • Open

Indication: pain relief, general to improve all motions

• Indication: pain relief, general to improve all motions • Open Pack Position • Stabilize pt

Open Pack Position

Stabilize pt forearm against your torso

Left hand close to joint line

Shift your weight from front leg to rear leg to assess

GH Joint Inferior Glide

GH Joint – Inferior Glide • Open Pack Position • Stabilize pt forearm against your torso

Open Pack Position

Stabilize pt forearm against your torso

Left hand just distal to acromion

Knees bent, staggered stance with same leg back (ie left leg back with left hand

mobilizing)

Elbow in line with force (inferior)

Slight distraction

Shift your weight from rear leg to front leg to assess and mobilize

Indication: Improve abduction or flexion

• Shift your weight from rear leg to front leg to assess and mobilize • Indication:

GH Joint Lateral Glide

GH Joint – Lateral Glide • Open Pack Position • Stabilize pt forearm against your torso

Open Pack Position

Stabilize pt forearm against your torso

Mobilizing hand on medial aspect of

humerus

Elbow in line with force (lateral)

Belt around your torso makes this more efficient

Indication: Considered general technique, not specific, may improve horizontal adduction

makes this more efficient • Indication: Considered general technique, not specific, may improve horizontal adduction

GH Joint Lateral Glide and Thrust

GH Joint – Lateral Glide and Thrust • Patient shoulder 90 degrees of flexion with elbow

Patient shoulder 90 degrees of flexion with

elbow flexed

Staggered stance

Hand over hand technique on proximal medial aspect of humerus

Your chest makes contact with lateral

humerus, and head off to side of elbow

Shift your weight from front leg to rear leg to assess

HVLA technique delivered at end range

Indication: General, may improve several

front leg to rear leg to assess • HVLA technique delivered at end range • Indication:

GH Joint Inferior Thrust

GH Joint – Inferior Thrust • Open Pack Position • Stabilize scapula with fist into table

Open Pack Position

Stabilize scapula with fist into table

Patients elbow is against your thigh

Your opposite hand grasps distal

radius

Take up the slack by rotating your torso to the left

HVLA delivered by rotating your torso

Indication: increase Abduction or Flexion

rotating your torso to the left • HVLA delivered by rotating your torso • Indication: increase

GH Joint Anterior Glide

GH Joint – Anterior Glide • Open Pack Position • Pad under coracoid process • Patients

Open Pack Position

Pad under coracoid process

Patients humerus stabilized against your thigh

Hypothenar eminence contact

just distal to acromion

Gentle distraction

Apply posterior to anterior force toward floor (don’t need much

force)

Indication: Increase ER or Ext

• Apply posterior to anterior force toward floor (don’t need much force) • Indication: Increase ER

GH Joint Posterior Glide

• Open Pack Position • Apply slight distraction • Step inside technique: • Anterior to
• Open Pack Position
• Apply slight distraction
• Step inside technique:
• Anterior to posterior to assess mobility
hypothenar eminence Contact
• Indication: Increase IR and/or flexion
• Step outside technique: thenar
eminence contact

GH Joint Posterior Glide

GH Joint – Posterior Glide • 90 degrees shoulder flexion • Very slight horizontal adduction •

90 degrees shoulder flexion

Very slight horizontal adduction

Hand over hand technique on patient

elbow

Bring your elbows in tight with your chest close to patient’s humerus

Bend knees to exert an anterior to

posterior force

HVLA take up slack and thrust at end point

Indication: Increase IR and/or flexion

an anterior to posterior force • HVLA take up slack and thrust at end point •

GH Joint Inferior Glide, End Range FLEX

GH Joint – Inferior Glide, End Range FLEX • End range shoulder flexion, come off 5

End range shoulder flexion, come off 5 degrees

Bilateral hand contact just distal

to acromion

Staggered stance

Apply slight distraction

Inferior glide is performed by shifting weight from rear leg to front leg

Indication: Increase end-range

flexion

• Inferior glide is performed by shifting weight from rear leg to front leg • Indication:

GH Joint Inferior Glide, End Range ABD

GH Joint – Inferior Glide, End Range ABD • End range shoulder abduction, come off 5

End range shoulder abduction, come off 5 degrees

Stabilize patient forearm against your torso

Non-mobilizing hand supports patient’s elbow

C grip just distal to acromion

Staggered stance

Apply slight distraction

Inferior glide is performed by shifting weight from rear leg to front leg

Indication: Increase end-range abduction

Inferior glide is performed by shifting weight from rear leg to front leg • Indication: Increase

GH Joint Posterior Glide, End Range IR

GH Joint – Posterior Glide, End Range IR • End range shoulder IR, come off 5

End range shoulder IR, come off 5 degrees

Stabilize patient elbow against your distal anterior thigh

Thenar eminence over anterior humerus

Apply slight distraction

Posterior glide is performed directly toward floor

*this can be combined with contract-relax techniques

Indication: Increase end-range IR

directly toward floor • *this can be combined with contract-relax techniques • Indication: Increase end-range IR

Thoracic Thrust Techniques

Thoracic Thrust Techniques • Patient seated • Therapist behind patient with one knee up on stool

Patient seated

Therapist behind patient with one knee up on

stool

Patient’s arm drapes over therapist knee

Left hand depresses shoulder girdle and applys lateral glide at CT junction

Simultaneously instruct patient to shift weight toward your knee to side bend the torso

Right hand wraps around chin and grasps transverse processes above

Take up slack with left hand medially and

inferiorly

Slight global distraction

Rotation right into mechanical barrier, and HVLA delivered 50/50 between hands

Indication: Multiple mechanical /

neurophysiological effects

barrier, and HVLA delivered 50/50 between hands • Indication: Multiple – mechanical / neurophysiological effects

Thoracic Thrust Techniques

Thoracic Thrust Techniques • Patient seated all the way back on plinth • Therapist behind patient

Patient seated all the way back on plinth

Therapist behind patient

Table height adjusted so therapists chest is slightly above CT junction

Towel roll between chest and CT junction

Patient interlocks fingers around lower cervical spine

Therapist LIGHTLY grasps patient forearms as pictured

Bring patient back into your chest and perform scoop technique to take up the slack

Therapist adducts shoulders and at the moment mechanical barrier is engaged, an HVLA in performed by therapist extending knees

Indication: Multiple mechanical / neurophysiological effects

an HVLA in performed by therapist extending knees • Indication: Multiple – mechanical / neurophysiological effects

AC Joint Anterior Glide

AC Joint – Anterior Glide • Shoulder abducted 90 degrees • Flex index finger as shown

Shoulder abducted 90 degrees

Flex index finger as shown

Contact posterolateral clavicle

with middle phalynx

up
up

Glide clavicle anterior on acromion

Indication: Lacking end range

shoulder motion with pain /

restriction at AC joint

Glide clavicle anterior on acromion • Indication: Lacking end range shoulder motion with pain / restriction

SC Joint - Distraction

SC Joint - Distraction • Patient side lying with affected side up • Therapist grasps lateral

Patient side lying with affected side up

Therapist grasps lateral clavicle with

hand over hand technique

Therapist created compression between sternum and hands on lateral clavicle

Therapist extends knee to create distraction between the clavicle and sternum

Indication: general, lacking end range shoulder motion with pain /

restriction at SC joint

the clavicle and sternum • Indication: general, lacking end range shoulder motion with pain / restriction

SC Joint Superior, Inferior, Anterior, Posterior

SC Joint – Superior, Inferior, Anterior, Posterior • Indications: Inferior to increase abduction or flexion,
SC Joint – Superior, Inferior, Anterior, Posterior • Indications: Inferior to increase abduction or flexion,

Indications: Inferior to increase abduction or flexion, Anterior to increase protraction, Posterior to increase retraction

Indications: Inferior to increase abduction or flexion, Anterior to increase protraction, Posterior to increase retraction

SC Joint Protraction and Retraction

SC Joint – Protraction and Retraction • All ST techniques: pillow between you and patient •
SC Joint – Protraction and Retraction • All ST techniques: pillow between you and patient •

All ST techniques: pillow between you and patient

Create slight compression between your chest and patients anterior shoulder

Mobilize by shifting body weight not moving your hands

exclusively

Indication: increase ST mobility in intended directions

shifting body weight – not moving your hands exclusively • Indication: increase ST mobility in intended

SC Joint Elevation / Depression and Upward

Rotation

SC Joint – Elevation / Depression and Upward Rotation • Shift weight from left foot to

Shift weight from left foot to right foot for elevation

• Shift weight from left foot to right foot for elevation • Side bend your torso

Side bend your torso right to upwardly rotate scapula

• Shift weight from left foot to right foot for elevation • Side bend your torso