Manual Therapy Techniques for the Shoulder

8/8/2019 Manual Therapy Techniques for the Shoulder

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Shoulder AbductionGrades IV IV+

Patient position: Supine

Therapist position Proximal hand: Reach under

patient and grasp the uppertrapezius muscle; forearm liesalong medial border of scapula.

Distal hand: Grasp the distalhumerus in a position to stabilizethe elbow joint.

Mobilization technique Use the proximal hand to stablize

the scapula and prevent shouldershrugging.

Bring patients arm intoabduction to find resistance.Apply small amplitude abduction

mobilizations (2-3) within thisresistance.


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Shoulder External RotationGrades IV IV+

Patient position

Supine, shoulder abducted andelbow flexed to 90, upper armresting on plinth

Therapist position Proximal hand: Grasp the distal

humerus; lay forearm acrossanterior shoulder for stabilization

Distal hand: Grasp wrist and holdin a neutral position

Mobilization technique Bring patients arm into external

rotation to find resistance. Applygraded mobilizations (~10) withinresistance.

May be performed in variousdegrees of abduction based onpatient symptoms and response


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Shoulder Internal RotationGrades IV IV+

Patient position

Supine, shoulder abducted andelbow flexed to 90, upper armresting on plinth

Therapist position Proximal hand: Grasp the distal

humerus; lay forearm acrossanterior shoulder for stabilization

Distal hand: Grasp wrist and holdin a neutral position

Mobilization technique Bring patients arm into internal

rotation to find resistance. Applygraded mobilizations (~10) withinresistance.

May be performed in variousdegrees of abduction based onpatient symptoms and response


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Shoulder Horizontal FlexionGrades IV IV+

Patient position

Supine, shoulder and elbowflexed to 90

Therapist position Proximal hand: Place the heel of

one hand under the medial border

of scapula for stabilization Distal hand: Grasp wrist and hold

in a neutral position Tuck patients elbow into your

shoulder crease

Mobilization technique Small amplitude mobilizations

into HF are applied: 1) Alonghumeral shaft, or 2) In a directiontoward the opposite shoulder.

Used independently or together


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Glenohumeral JointAP Glides in Abduction (Grades III IV)

Patient position

Supine, shoulder off plinth inabduction, elbow flexed to 90

Therapist position Distal hand: Grasp the patients

distal humerus and elbow; hold

patients forearm against yours Proximal hand: Heel of hand

placed against anterior humeralhead

Mobilization technique Graded AP mobilization is applied

through your mobilizing armagainst the humeral head.

May be performed in variousdegrees of GH ABD and HF basedon patient symptoms andresponse


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Glenohumeral JointCaudal Glides in Abduction (Grades III IV)Patient position



distal humerus and elbow; hold

patients forearm against yours Proximal hand: 1 st web space or

heel of hand placed against headof humerus (adjacent to acromion)

Mobilization technique Graded mobilization is applied

through your mobilizing hand toglide the humeral head caudally.

Elbow may be held stationary, orcarried on line with humerus orfurther distally depending onirritability


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Glenohumeral JointCaudal Glides in Full Flexion (Grade IV)

Patient position



upper arm with the lateral border

of index finger against humeralhead and thumb into axilla; holdpatients arm against your side.

Proximal hand: Heel of handplaced along the lateral border of

scapulaMobilization technique Graded mobilization is applied

through your mobilizing hand toglide the humeral head caudally.

Scapula is stabilized using firmpressure along the lateral border.


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Acromioclavicular JointCaudal Glides


Therapist position Place the tips of both thumbs on

the superior surface of theclavicle adjacent to the AC joint;spread fingers out for stability.

Position forearms in line with thecaudal movement at the AC joint.

Mobilization technique Graded oscillatory mobilization is

applied by your arms, actingthrough stable thumbs.

Pad of your outer thumb shouldfeel the joint motion (feel for thestationary acromion process).


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Clavicle Rotation(Wiggle)


Therapist position Stand near the patients shoulder,

facing towards the clavicle. Gently grip the mid clavicle using

your thumbs on the inferior edge

and finger tips superiorly.Mobilization technique Apply a gentle mobilization force

using a rocking or wigglingmotion through repetitive wristflexion and extension.

Works as a nice easing techniquefollowing direct AC and/or SCjoint mobilizations.

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Manual Therapy Techniques for the Shoulder