Shoulder Joint Mobilization (Anterior to Posterior)

Shoulder Joint Mobilization (Anterior to Posterior)

This is Brent of the Brookbush Institute, and in this
video we’re going to go over a joint based manual therapy technique. If you’re
watching this video I’m assuming you’re watching it for educational purposes, and
that you are a licensed professional with joint based techniques within your
scope. That means osteopath’s. chiropractors, physical therapists, you’re probably all
in the clear. Physical therapy assistants, athletic trainers, massage therapist’s you
need to check with your governing body in your state or region, to see whether
this is within your scope of practice. Personal trainers this is definitely not
within your scope of practice. Of course all professions could use this video for
purely educational purposes to help with learning biomechanics, anatomy, and of
course palpation. In this video we’re going to go over anterior to posterior
humerus on glenoid fossa mobilization, commonly known as a shoulder AP. I’m
going to have my friend Melissa come out, she’s going to help me demonstrate. Now
if I’m doing this mobilization, chances are I’ve already done some sort of
functional movement assessment like the overhead squat assessment, or I’ve seen
that wall shoulder mobility test that kind of looks like our serratus anterior
activation, that is also a great functional exam.
We’ll probably follow that up with goniometery, something like internal and
external rotation of the humerus, and then last I’m going to want to check
passive accessory motion to see if there is arthrokinematic stiffness. Now we do
have to be careful using this technique with the shoulder, the shoulder has a
propensity to become both hypermobile that is too flexible, and hypomobile that’s
stiff. Now we only want to mobilize those individuals who have stiffness, somebody
who is too flexible who gets this mobilization done, we might actually
exacerbate their symptoms or actually make them worse. The last thing we want
to do is take somebody who’s too flexible, and make them even more
flexible.. So now you’ve done your assessment, you determined that there is
arthrokinematic stiffness and you’re ready to do this mobilization, how do I
place my hands? Well that all requires a little bit of knowledge of anatomy and
palpation. Alright so the first thing I would recommend finding is just the
acromion shelf, so the acromion shelf is that big bony shelf that kind of sits
right between all of the muscle of the deltoid. So if
you make a little muscle for me there Melissa good job, alright you guys see
this like dent right here, this dent between her anterior middle and
posterior right, that makes like a little ‘U’ this way, that dent that is the
acromion shelf. So you can have somebody kind of do this, get your fingers down on
that bone, now go ahead and explore the edges of that bone, explore the edges of
the acromion shelf. You need the person to stay nice and relaxed, good there we
go nice and relaxed, so make sure their arm is supported by the table. Once
you’ve felt through the acromion shelf you can actually start to feel like a
divot underneath it, you can almost get your fingers underneath it, and then if
you keep going down the arm this way a little bit you’ll start to be able to
sink your fingers around the humeral head. Now the humeral head obviously is
the most proximal portion of our humerus bone, and that’s going to be where we
want to get our hands so we can do this mobilization. Although we’re going to
place our hand on the interior portion of the humerus
I do recommend having a good idea of where all of the humeral head lies, like
being able to get your hands on the posterior humeral head, kind of feeling
how it goes down into the the neck of the humerus as you sink past the
deltoids, and keep moving distally. What you’ll notice about the anterior portion
of the humerus is it’s a lot more bumpy, so you have the greater and lesser
tubercle there, and then you also have this ropey thing, this really thick rope
and what that is is the biceps tendon. The reason I bring this up is that it’s
something that we don’t really want to press on. If you really gear into
somebody’s bicep tendon while you’re doing this mobilization it’s going to
hurt, if they have impingement syndrome it might be because it’s inflamed, even
if they don’t have shoulder problems you’re just doing this on your your
partner or your practice partner, or one of your colleagues, or perhaps a mentor
or teacher that you’re practicing on, you start gearing down on their their
biceps tendon, it’s going to hurt no matter what, so we want to kind of know
where that is so we can stay away from it; and once you have the whole kind of
idea of where the humerus is I’m going to ask you to try to put, or at least
imagine putting the humeral head right in the palm of your hand like so. Now you
can use these fingers to kind of wrap yourself around the rest of the humerus
and the acromion shelf, which might come in handy when we start trying to find
the beginning of arthrokinematic motion, and the end of arthrokinematic motion. Now what I usually do with this hand is I’m going to have
Melissa who’ll be inside of my bicep, I’m going to hold her elbow like this, and
now I have good control of abduction adduction, and a little control over
flexion and extension. I could probably even internally rotate and externally
rotate a little bit, like I have good control over arm. I’m going to use this
hand again, put my palm down right over the anterior portion of her humerus, and
then notice that once I’m in position guys my trunk -my chest is over my hands.
So again I’m not going to manhandle this right, this is not how we do a mobilization that
would actually get really tiring if let’s say Melissa was twice my size
which would make her absolutely huge, but if she was a very large person or had a
very large arm, let’s say I’m working on like a professional football player or
something, that would, this would be almost impossible. You need to get used
to using your body mechanics and save your own body, perhaps even before you
think about saving the body of your patient because you got to do this all
day. Alright because if you’re seeing eight, nine, ten, twelve, twenty patients a day, you need to
have good mechanics and and save your joints. So again I just have my client or
patient reach in grab the inside of my bicep, I grab underneath their elbow, I
have to control this hand over the anterior portion of the humerus, I’m just
thinking about putting the humeral head right in the palm of my hand. Since I’m
using such a broad surface area I don’t usually have that problem with the
biceps tendon, if I do I try to put the biceps tendon
between my thenar eminence, all right so most of my pressure is coming here and the
biceps tendon is falling in this groove here. I’m now just going to use the
weight of my trunk to kind of find okay there’s the first resistance barrier, and
that’s going to come on real quick with the shoulder and then I’m going to find
the end, alright you got to be careful with the shoulder. Shoulder like I said
is a very mobile joint, so if you press too hard you’re going to push right out
of the glenoid fossa; not that you’re just locating the shoulder, but you will
push the humeral head onto the posterior lip of the glenoid fossa, and if you can
do that really easily then this is probably not somebody who needs this mobilization.
The people who need this mobilization are the ones you press into and you feel
like you have something to press into, there seems to be a certain amount of
stiffness almost like you’re pushing into the back of a leather strap, like a
like a leather belt. Alright so beginning, feel like if I go
any further than this all right like I’m going to start pushing through. Now I’m
going to back off to 50% and we’ve talked about there’s a lot of different
protocols out there guys, and I just asked you to follow through with
whatever protocol that you learned. I use generally the Maitland protocols for
grade three and grade four mobilizations, If we’re talking about getting mobility
here and this isn’t like a pain dominant patient. So we’ll go to 50%, and then I
can either do back off to where was my first resistance barrier, to 50% and do
my grade threes which is that higher amplitude mobilization, or I can find my
50% and do my small amplitude mobilizations right at that resistance
barrier, making this a little higher intensity. Now I’m going to do this until
I feel a reduction in joint stiffness, and then the most important thing as
I’ve said throughout all these videos is I’m going to reassess. Alright so to go
through that just one more time guys. Hand on inside of bicep, I got her elbow,
I’m going to take her to where I need herin abduction, adduction,
more flexion, more extension, wherever you guys feel like you need to be to
work through that stiffness. The palm of my hand goes over the humeral head, the
anterior surface of the humeral head, trying to put the biceps tendon between my thenar groove there, find
the first resistance barrier, the end, back off to 50%, and then do whatever
grade I think is appropriate. I have my hand around Melissa’s elbow, and her hand
is up around my arm, although I know you can’t see that you saw that in the
previous shot. You guys can see Melissa’s acromion shelf here, and then you guys
should be able to palpate around the acromion shelf to define the subacromial
space which is going to feel like a depression, then as I mentioned before
you should take some time to try to palpate through the relaxed deltoid, to
kind of outline the humeral head as it goes down into the the neck of the
humerus here, but once you find the humeral head now we can place our palm
on top of the anterior face of the humeral head, and I kind of mentioned
before if you kind of strum across this way you’ll feel a big rope like tendon
there, that’s the biceps tendon. I would put that in your inner thenar groove
so that you don’t place undue pressure, and now I can kind of feel like there
you go there’s your first first little bit of motion of the humeral head, and I
can push down until the end of her glenohumeral motion there, and then back
off to 50%, and then I can either go from initial resistance to 50% for some
grade threes or maybe I can stay at 50% for grade 4’s,
but notice I’m using a nice wide palm getting a lot of surface area, and trying
to keep any direct pressure off that biceps tendon for this joint
mobilization. I’m doing my one to two oscillations per second for 30 seconds
plus until I feel a reduction in arthro- kinematic stiffness, and of course i’m
going to reassess. If i did one set and got a little reduction, I could maybe
pull further into flexion see if I run into more stiffness. I could pull further
out into abduction do another set and see if I run into more stiffness, as I
have a lot of control over Melissa’s arm here. So guys make sure you take the time
to palpate the humeral head through the deltoid, palm over anterior face, biceps
tendon in thenar groove. Make sure you feel for initial movement or first
resistance barrier, and end of arthro- kinematic range, and follow through with
your protocols. So there you have it assess, address, reassess. Make sure that
every time you choose a joint based manual therapy technique it is based on
an assessment, and that you return to that assessment after you’ve finished
the intervention, to see if it was effective for the individual, the patient
or client that you had in front of you. Ensure that you continue to learn your
Anatomy because your Anatomy is going to help you with your hand placement, with
understanding what a joint can do, with understanding what you may gain from
this particular technique. And of course practice, you have to practice these
techniques, hopefully not for the first time on a patient or client who just
walked in the door. If you can, find a more senior instructor or mentor to give
you some really good hands-on instruction, use your peers for some good
feedback, and of course always look for live education to help with your manual
therapy techniques. I know these videos make education very convenient, but there
is no substitute for learning manual therapy in a live
setting. I look forward to talking to you guys again soon,

16 Replies to “Shoulder Joint Mobilization (Anterior to Posterior)”

  1. Great video, Brent. Really informative and detailed (as per usual). Good inclusion of side camera angle to show correct & safe hand placement 👍

  2. Great communication skills! I'd like to know; when I'm working for end range motion of shoulder flexion, i prefer using the mobilisation strap as I find hand placement quite awkward, since at end range it generally becomes a PA accessory mobilisation. What is your view on this technique?

  3. Its great the fact that you separate the professions that are correct to use your information video once of course they understand it as a physiotherapist and kinesiologist thank you !!

  4. great video as always! I would be interested in knowing IF a Serratus Anterior strain can contribution to shoulder dysfunction causing the shoulders to come forward? I strained my SA 2 weeks ago and its still quite tender and in spasm. Since then i have started my shoulder feels like its in a more forward position and has started to click on overhead movements along with other muscles around the shoulder becoming tight.

  5. Great information, my only concern is the incidental contact zone might be uncomfortable for both client and therapist.

  6. Please sir. Can you help me in my one side shoulder problem it makes crackling sound and i always feel imbalance in my right or left shoulder plz send me some link of your exercise video thanks

  7. too much talking…so many techniques he can show for 13 minuts….at least 5 with full explanations during this performance

  8. I will reprinted your series of animation into Chinese and posted it on a local forum,

    Now,i just need to confirm whether you allow me to do so,if you MIND what i did,please tell me,thanks

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