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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.
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.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| sleeper stretch + thoracic manipulation | Experimental | The group will receive the sleeper stretch at session #1, and a thoracic manipulation followed by the sleeper stretch at session #2. |
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| posterior glenohumeral (PG) mobilization + thoracic manipulation | Experimental | The group will receive a posterior glide mobilization at session #1, and a thoracic manipulation followed by posterior glide mobilization at session #2. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| posterior glide mobilization | Other | 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. |
| 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 |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Brian Swanson, PT, DSc | University of Hartford | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| University of Hartford | West Hartford | Connecticut | 06117 | United States |
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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.
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Assessment of electromyographic (EMG) activity, IR ROM pre-post intervention, and glenohumeral translation via ultrasound will be performed by a blinded assessor.
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| Sleeper stretch | Other | 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. |
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| thoracic manipulation | Other | 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. |
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