Combined Effects of Manual Therapy on the Shoulder

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

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.

Study Overview

• Status: Completed
• Conditions: Range of Motion; Manual Therapies; Shoulder Joint Disorder
• Intervention / Treatment: Other: Sleeper stretch; Other: thoracic manipulation; Other: posterior glide mobilization

Detailed Description

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.

• Study Type: Interventional
• Enrollment (Actual): 40
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Connecticut
    • West Hartford, Connecticut, United States, 06117
      • University of Hartford

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 60 years (ADULT)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

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.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: TREATMENT
• Allocation: RANDOMIZED
• Interventional Model: SEQUENTIAL
• Masking: SINGLE

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
EXPERIMENTAL: sleeper stretch + thoracic manipulation; 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; 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.; Other: thoracic manipulation; 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.
EXPERIMENTAL: posterior glenohumeral (PG) mobilization + thoracic manipulation; The group will receive a posterior glide mobilization at session #1, and a thoracic manipulation followed by posterior glide mobilization at session #2.	Other: thoracic manipulation; 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.; Other: posterior glide mobilization; 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.

What is the study measuring?

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

Collaborators and Investigators

• Sponsor: University of Hartford

Study record dates

Study Major Dates

• Study Start (ACTUAL): March 31, 2021
• Primary Completion (ACTUAL): June 30, 2021
• Study Completion (ACTUAL): June 30, 2021

Study Registration Dates

• First Submitted: February 22, 2021
• First Submitted That Met QC Criteria: February 25, 2021
• First Posted (ACTUAL): March 2, 2021

Study Record Updates

• Last Update Posted (ACTUAL): July 7, 2021
• Last Update Submitted That Met QC Criteria: July 6, 2021
• Last Verified: July 1, 2021

More Information

Terms related to this study

• Keywords: shoulder; muscular activity; Glenohumeral Internal Rotation Deficit (GIRD); joint play
• Additional Relevant MeSH Terms: Musculoskeletal Diseases; Joint Diseases
• Other Study ID Numbers: PRO2021000105

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No