Objective Quantification of Forces Used with Joint Play and Manual Therapy Techniques for the Shoulder

Document Type

Article

Publication Date

6-1-2012

Publication Title

Medicine & Science in Sports & Exercise

ISSN

1530-0315

Abstract

Physical therapists regularly perform joint mobilizations on patients with glenohumeral (GH) hypomobility. Currently, no studies have measured the forces applied by clinicians during GH joint mobilizations leaving a need to objectively document the actual applied forces.

PURPOSE: To examine the forces applied by a clinician during passive range of motion assessments (PRMA).

METHODS: A hand held dynamometer (LafayetteFAB12-0380) recorded force applied during each PRMA on 30 (15 males, 15 females, age 23.4±2.3yrs) subjects. Exclusion criteria: previous shoulder surgery or injury within the last year. Dominant (D) and nondominant (ND) shoulder of each subject were tested with three repetitions of four PRMA: anterior glide (AG), posterior glide (PG), external rotation (ER), and internal rotation (IR). Testing positions were randomized and data collection was blinded from the senior author who performed all PRMA. For ER and IR PRMA, forces were multiplied by the olecranon to ulnar styloid process distance to determine resulting torques. Average forces across the three repetitions for each PRMA were computed along with correlational analyses between each PRMA with height, mass, and body mass index. Separate gender by limb ANOVA were conducted for each PRMA; statistical significance considered α<.05.

RESULTS: No significant relationships for any of the correlational analyses (r= -.27 to .23). No significant differences between genders. No statistically significant differences between limbs for ER (D=15.3±5.0Nm, ND=14.1±3.7Nm, P=.072) and IR (D=13.4±3.4Nm, ND=13.2±3.6 Nm, P=.482) PRMA. For both the AG (D=124.5±15.7kg, ND=131.3±16.7, P=.051) and PG (D=184.2±28.2 kg, ND=148.0±14.7kg P

CONCLUSION: This study provides some objective data quantifying the forces and torques used during PRMA; however, further research is needed quantifying the forces clinicians apply, along with the forces needed to create a plastic deformation in non-contractile tissue with mobilization techniques for individuals with GH hypomobility. In addition, testing was performed on healthy active individuals; the extent to which these results reflect persons with pathological conditions is unknown.

Comments

©2012 The American College of Sports Medicine

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