Combined Effects of Manual Therapy on the Shoulder

Study Overview
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Brief Summary
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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
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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.

Official Title
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Are There Differences in Range of Motion, Glenohumeral Translation, and Rotator Cuff Activity Following Shoulder Mobilization, Stretching, or Thoracic Manipulation?

Conditions
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Range of Motion, Manual Therapies, Shoulder Joint Disorder

Intervention / Treatment
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* Other: posterior glide mobilization
* Other: Sleeper stretch
* Other: thoracic manipulation


Participation Criteria
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Eligibility Criteria
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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.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 60 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Sequential Assignment
Interventional 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.
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: sleeper stretch + thoracic manipulation<br>The group will receive the sleeper stretch at session #1, and a thoracic manipulation followed by the sleeper stretch at session #2. | Other: Sleeper stretch<br>* 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.<br>Other: thoracic manipulation<br>* 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.<br>|
| Experimental: posterior glenohumeral (PG) mobilization + thoracic manipulation<br>The group will receive a posterior glide mobilization at session #1, and a thoracic manipulation followed by posterior glide mobilization at session #2. | Other: posterior glide mobilization<br>* 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.<br>Other: thoracic manipulation<br>* 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.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in shoulder IR ROM | Shoulder IR ROM measured with a goniometer | Pre intervention to immediate (within 5 minutes) post intervention | 
| Change in posterior shoulder translation (mm) | maximum posterior translation of the humeral head assessed with ultrasound imaging (mm) | Pre intervention to immediate (within 5 minutes) post intervention | 
| Change in infraspinatus electromyographic activity (%MVIC) | activity of the infraspinatus muscle during posterior translation, assessed as a percentage of the maximal voluntary isometric contraction (MVIC) | Pre intervention to immediate (within 5 minutes) post intervention | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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shoulder, Glenohumeral Internal Rotation Deficit (GIRD), joint play, muscular activity