Joint Mobilization: Glenohumeral, Acromioclavicular and Sternoclavicular Joints

Introduction

This course describes joint mobilizations for the shoulder joint, acromioclavicular (AC) joint, and sternoclavicular (SC) joint. Several terms and definitions have been used to describe the "mobilizations" (e.g. mobilisations) that are taught in this course. The Brookbush Institute uses a conventional definition of "mobilization" that includes low amplitude, low-velocity, oscillatory techniques intended to reduce the stiffness of joints exhibiting a decrease in passive accessory range of motion (a.k.a. arthrokinematic motion and specifically glide or slide). Note, the term "manipulation" is reserved for high-velocity techniques taught in a separate set of courses.

This course includes mobilization techniques that intend to improve excessive stiffness of the shoulder joint, AC joint, and SC joint, reduce scapular dyskinesis (altered shoulder blade motion), improve shoulder range of motion (ROM), and reduce upper extremity dysfunction. For example, alterations in scapular motion have been correlated with shoulder impingement syndrome (SIS), mobilization of scapular joints has been correlated with improvement in shoulder ROM, and improvements in shoulder ROM have been correlated with a reduction in pain, improvements in function, and performance enhancement. These techniques may also be used in an integrated approach for upper body dysfunction (UBD) including sternocostal pain, upper thoracic pain, AC joint pain, frozen shoulder (post-acute phase), lateral epicondylitis (tennis elbow), and postural dysfunctions including rounded shoulder posture. Several studies even demonstrate that adding these mobilizations to conventional medical and therapeutic interventions may have a significant positive influence on short-term and long-term outcomes.

The techniques in this course are recommended for all clinical human movement professionals (physical therapists, physical therapy assistants, athletic trainers, massage therapists, chiropractors, occupational therapists, etc.) with the intent of developing an evidence-based, systematic, integrated, patient-centered, and outcome-driven approach.

Techniques Covered in this Course:

• Shoulder Joint Mobilization
• Acromioclavicular (AC) Joint Mobilization
• Sternoclavicular (SC) Joint Mobilization

Related Courses

Additional Joint Mobilization Courses

• Joint Mobilizations: Ankle and Tibiofibular Joints
• Joint Mobilizations: Knee and Hip Joints
• Joint Mobilizations: Lumbar Spine and Sacroiliac Joints
• Joint Mobilizations: Cervical and Thoracic Spine
• Joint Mobilizations: Shoulder, Sternoclavicular, and Acromioclavicular Joints
• Joint Mobilizations: Elbow and Proximal Radioulnar Joints

For an introduction to joint mobilizations and manipulations:

• Joint Mobilization and Manipulation: Introduction
• Joint Mobilization and Manipulation: Reliability
• Joint Mobilizations and Manipulations: Effects
• Joint Mobilization and Manipulation: Risk of Adverse Effects
• Joint Mobilizations and Manipulations: Evidence-based Teaching and Learning

Pre-approved credits for:

• Integrated Manual Therapist (IMT) Certification

Pre-approved for Continuing Education Credits for:

• Athletic Trainers
• Chiropractors
• Occupational Therapists - Intermediate
• Physical Therapists
• Physical Therapy Assistants

This Course Includes:

• AI Tutor
• Study Guide
• Text and Illustrations
• Audio Voice-over
• Research Review
• Technique Videos
• Sample Routine
• Practice Exam
• Pre-approved Final Exam

1. Ajit, D., & Shika, S. (2016). Effects of Mobilization with Movement (MWM) in Shoulder Impingement Syndrome Patients on Acromiohumeral Distance using Ultrasonography. Journal of Exercise Science & Physiotherapy, 12(2).
2. Guimarães, J. F., Salvini, T. F., Siqueira Jr, A. L., Ribeiro, I. L., Camargo, P. R., & Alburquerque-Sendín, F. (2016). Immediate effects of mobilization with movement vs sham technique on range of motion, strength, and function in patients with shoulder impingement syndrome: randomized clinical trial. Journal of manipulative and physiological therapeutics, 39(9), 605-615.
3. Teys, P., Bisset, L., & Vicenzino, B. (2008). The initial effects of a Mulligan's mobilization with movement technique on range of movement and pressure pain threshold in pain-limited shoulders. Manual therapy, 13(1), 37-42.
4. Delgado-Gil, J. A., Prado-Robles, E., Rodrigues-de-Souza, D. P., Cleland, J. A., Fernández-de-las-Peñas, C., & Alburquerque-Sendín, F. (2015). Effects of mobilization with movement on pain and range of motion in patients with unilateral shoulder impingement syndrome: a randomized controlled trial. Journal of manipulative and physiological therapeutics, 38(4), 245-252.
5. Lluch, E., Pecos-Martin, D., Domenech-Garcia, V., Herrero, P., & Gallego-Izquierdo, T. (2018). Effects of an anteroposterior mobilization of the glenohumeral joint in overhead athletes with chronic shoulder pain: A randomized controlled trial. Musculoskeletal Science and Practice, 38, 91-98.
6. Hsu, A. T., Ho, L., Ho, S., & Hedman, T. (2000). Joint position during anterior-posterior glide mobilization: its effect on glenohumeral abduction range of motion. Archives of physical medicine and rehabilitation, 81(2), 210-214.
7. Hsu, A. T., Ho, L., Ho, S., & Hedman, T. (2000). Immediate response of glenohumeral abduction range of motion to a caudally directed translational mobilization: a fresh cadaver simulation. Archives of physical medicine and rehabilitation, 81(11), 1511-1516.
8. Hsu, A. T., Hedman, T., Chang, J. H., Vo, C., Ho, L., Ho, S., & Chang, G. L. (2002). Changes in abduction and rotation range of motion in response to simulated dorsal and ventral translational mobilization of the glenohumeral joint. Physical therapy, 82(6), 544-556.
   • Comparing Interventions
9. Yeole, U. L., Dighe, P. D., Gharote, G. M., Panse, R. S., Shweta, A., & Pawar, P. A. (2017). Effectiveness of movement with mobilization in adhesive capsulitis of shoulder: Randomized controlled trial. Indian Journal of Medical Research and Pharmaceutical Sciences, 4(2), 1-8.
10. Neelapala, Y. R., Reddy, Y. R. S., & Danait, R. (2016). Effect of mulligan’s posterolateral glide on shoulder rotator strength, scapular upward rotation in shoulder pain subjects–a randomized controlled trial. Journal of Musculoskeletal Research, 19(03), 1650014.
11. Çitaker, S., Taşkiran, H., Akdur, H., Arabaci, Ü. Ö., & Ekici, G. (2005). Comparison of the mobilization and proprioceptive neuromuscular facilitation methods in the treatment of shoulder impingement syndrome. The Pain Clinic, 17(2), 197-202.
12. de la Rosa Díaz, I., Lacomba, M. T., Téllez, E. C., del Campo Gómez-Rico, C. D., & Ortega, C. G. (2017). Accessory Joint and Neural Mobilizations for Shoulder Range of Motion Restriction After Breast Cancer Surgery: A Pilot Randomized Clinical Trial. Journal of chiropractic medicine, 16(1), 31-40.
13. Djordjevic, O. C., Vukicevic, D., Katunac, L., & Jovic, S. (2012). Mobilization with movement and kinesiotaping compared with a supervised exercise program for painful shoulder: results of a clinical trial. Journal of manipulative and physiological therapeutics, 35(6), 454-463.
14. Panchal, D. N., & Eapen, C. (2015). Effectiveness of end-range mobilization and interferential current or stretching exercise and moist heat in treatment of frozen shoulder-a randomized clinical trial. International Journal of Current Research and Review, 7(14), 21.
15. Doner, G., Guven, Z., Atalay, A., & Celiker, R. (2013). Evaluation of Mulligan's technique for adhesive capsulitis of the shoulder. Journal of rehabilitation medicine, 45(1), 87-91.
16. Ansari, S. N., Lourdhuraj, I., Shah, S., & Patel, N. (2012). Effect of ultrasound therapy with end range mobilization over cryotherapy with capsular stretching on pain in frozen shoulder-a comparative study. International Journal of Current Research and Review, 4(24), 68.
17. Tanaka, K., Saura, R., Takahashi, N., Hiura, Y., & Hashimoto, R. (2010). Joint mobilization versus self-exercises for limited glenohumeral joint mobility: randomized controlled study of management of rehabilitation. Clinical rheumatology, 29(12), 1439-1444.
18. Diercks, R. L., & Stevens, M. (2004). Gentle thawing of the frozen shoulder: a prospective study of supervised neglect versus intensive physical therapy in seventy-seven patients with frozen shoulder syndrome followed up for two years. Journal of Shoulder and Elbow Surgery, 13(5), 499-502
    • Combining Techniques
19. Satpute, K. H., Bhandari, P., & Hall, T. (2015). Efficacy of hand behind back mobilization with movement for acute shoulder pain and movement impairment: a randomized controlled trial. Journal of manipulative and physiological therapeutics, 38(5), 324-334.
20. Nicholson, G. G. (1985). The effects of passive joint mobilization on pain and hypomobility associated with adhesive capsulitis of the shoulder. Journal of Orthopaedic & Sports Physical Therapy, 6(4), 238-246.
21. Choo, Y. (2019). Effects of Mobilization with Movement Combined with Exercise (EMWM) on ADH, ROM and Functional Performance in Patients with Impingement Syndrome of the Shoulder. Journal of The Korean Society of Integrative Medicine, 7(2), 153-163. Land, H., Gordon, S., & Watt, K. (2019). Effect of manual physiotherapy in homogeneous individuals with subacromial shoulder impingement: A randomized controlled trial. Physiotherapy Research International, 24(2), e1768.
    • Mobilization and stretching
22. Çelik, D., & Kaya Mutlu, E. (2016). Does adding mobilization to stretching improve outcomes for people with frozen shoulder? A randomized controlled clinical trial. Clinical rehabilitation, 30(8), 786-794.
23. Manske, R. C., Meschke, M., Porter, A., Smith, B., & Reiman, M. (2010). A randomized controlled single-blinded comparison of stretching versus stretching and joint mobilization for posterior shoulder tightness measured by internal rotation motion loss. Sports Health, 2(2), 94-100.
24. Tyler, T. F., Nicholas, S. J., Lee, S. J., Mullaney, M., & McHugh, M. P. (2010). Correction of posterior shoulder tightness is associated with symptom resolution in patients with internal impingement. The American journal of sports medicine, 38(1), 114-119.
25. Bang, M. D., & Deyle, G. D. (2000). Comparison of supervised exercise with and without manual physical therapy for patients with shoulder impingement syndrome. Journal of Orthopaedic & Sports Physical Therapy, 30(3), 126-137.
    • Mobilization, exercise, stretching, and….
26. Senbursa, G., Baltacı, G., & Atay, A. (2007). Comparison of conservative treatment with and without manual physical therapy for patients with shoulder impingement syndrome: a prospective, randomized clinical trial. Knee surgery, sports traumatology, arthroscopy, 15(7), 915-921.
27. Patel, S., Nagrale, S., Dabadghav, R., Bedekar, N., & Shyam, A. (2016). The effect of mulligan mobilization with movement technique on internal rotation range of motion of glenohumeral joint in patient with adhesive capsuilites. Indian J Phys Ther, 3(2), 71-4.
28. Sharad, K. S. "A Comparitive Study on the Efficacy of End Range Mobilization Techniques in Treatment of Adhesive Capsulitis of Shoulder." Indian Journal of Physiotherapy and Occupational Therapy-An International Journal 5, no. 3 (2011): 28-31.
29. Land, H., Gordon, S., & Watt, K. (2019). Effect of manual physiotherapy in homogeneous individuals with subacromial shoulder impingement: A randomized controlled trial. Physiotherapy Research International, 24(2), e1768.
30. Conroy, D. E., & Hayes, K. W. (1998). The effect of joint mobilization as a component of comprehensive treatment for primary shoulder impingement syndrome. Journal of Orthopaedic & Sports Physical Therapy, 28(1), 3-14.
31. Wong, C. K., Strang, B. L., Schram, G. A., Mercer, E. A., Kesting, R. S., & Deo, K. S. (2018). A pragmatic regional interdependence approach to primary frozen shoulder: a retrospective case series. Journal of Manual & Manipulative Therapy, 26(2), 109-118.
    • No Change
32. Yiasemides, R., Halaki, M., Cathers, I., & Ginn, K. A. (2011). Does passive mobilization of shoulder region joints provide additional benefit over advice and exercise alone for people who have shoulder pain and minimal movement restriction? A randomized controlled trial. Physical therapy, 91(2), 178-189.
33. Chen, J. F., Ginn, K. A., & Herbert, R. D. (2009). Passive mobilisation of shoulder region joints plus advice and exercise does not reduce pain and disability more than advice and exercise alone: a randomised trial. Australian journal of physiotherapy, 55(1), 17-23.
34. Romero, C. L., Lacomba, M. T., Montoro, Y. C., Merino, D. P., da Costa, S. P., Marchante, M. J. V., & Pardo, G. B. (2015). Mobilization with movement for shoulder dysfunction in older adults: a pilot trial. Journal of chiropractic medicine, 14(4), 249-258.
35. Ali, S. A., & Khan, M. (2015). Comparison for efficacy of general exercises with and without mobilization therapy for the management of adhesive capsulitis of shoulder-An interventional study. Pakistan journal of medical sciences, 31(6), 1372.
    • Mobilization and Manual Therapy, Tape and US
36. Deshmukh, S. S., Salian, S. C., & Yardi, S. (2014). A comparative study to assess the effectiveness of Soft Tissue Mobilization preceding joint mobilization technique in the management of Adhesive Capsulitis. Indian Journal of physiotherapy and occupational therapy, 8(1), 93.
37. Kuwiboonsilp, W., Sakulsriprasert, P., Pichaiyongwongdee, S., Adisaiphaopan, R., & Mingsoongnern, S. (2015). Immediate Effect of Muscle Energy Technique and Mobilization on External Rotation Angle in Individuals with Shoulder Adhesive Capsulitis. Indian Journal of Physiotherapy and Occupational Therapy-An International Journal, 9(2), 220-226.
38. Kanase, Smita Bhimrao, and S. Shanmugam. "Effect of kinesiotaping with Maitland mobilization and Maitland mobilization in management of frozen shoulder." IJSR 3, no. 3 (2014): 1817-21.
39. Park, S. E., Kim, Y. R., & San Wang, J. (2017). Immediate Effects of Maitland Joint Mobilization with Kinematic Taping on Shoulder Pain, ROM, and Muscle Tone in Subacromial Impingement Syndrome. Journal of International Academy of Physical Therapy Research, 8(3), 1206-1210.
40. Ebadi, S., Forogh, B., Fallah, E., & Ghazani, A. B. (2017). Does ultrasound therapy add to the effects of exercise and mobilization in frozen shoulder? A pilot randomized double-blind clinical trial. Journal of bodywork and movement therapies, 21(4), 781-787.
    • Medical intervention
41. Bergman, G. J., Winters, J. C., Groenier, K. H., Pool, J. J., Meyboom-de Jong, B., Postema, K., & van der Heijden, G. J. (2004). Manipulative therapy in addition to usual medical care for patients with shoulder dysfunction and pain: a randomized, controlled trial. Annals of internal medicine, 141(6), 432-439.
42. Tao, R., Wang, J., Haiqin, L. I., & Xia, L. (2017). The efficacy of buprenorphine combined with joint mobilization in treating periarthritis of the shoulder. Chinese Journal of Physical Medicine and Rehabilitation, 39(2), 137-141.
43. Park, G. Y., Kwon, D. R., Kwon, D. G., & Rim, J. H. (2018). Comparison of Therapeutic Effectiveness Between Shoulder Distention Arthrography With Translation Mobilization and Distention Arthrography Alone in Patients With Frozen Shoulder. Annals of rehabilitation medicine, 42(1), 76.
44. Park, S. W., Lee, H. S., & Kim, J. H. (2014). The effectiveness of intensive mobilization techniques combined with capsular distension for adhesive capsulitis of the shoulder. Journal of physical therapy science, 26(11), 1767-1770.
    • Combination of mobilization techniques
45. Sreenivasu, K., Subramanian, M. B., & Sajeevan, T. (2016). Effectiveness of end range mobilization with scapular mobilization in frozen shoulder. Int Arch Integr Med, 3(8), 53-58
46. Yang, J. L., Jan, M. H., Chang, C. W., & Lin, J. J. (2012). Effectiveness of the end-range mobilization and scapular mobilization approach in a subgroup of subjects with frozen shoulder syndrome: a randomized control trial. Manual therapy, 17(1), 47-52.
47. Rainbow, D. M., Weston, J. P., Brantingham, J. W., Globe, G., & Lee, F. (2008). A Prospective Clinical Trial Comparing Chiropractic Manipulation and Exercise Therapy vs. Chiropractic Mobilization and Exercise Therapy for Treatment of Patients Suffering from Adhesive Capsulitis/Frozen Shoulder. Journal of the American Chiropractic Association, 45(7).
48. Goyal, M., Bhattacharjee, S., & Goyal, K. (2013). Combined effect of end range mobilization (ERM) and mobilization with movement (MWM) techniques on range of motion and disability in frozen shoulder patients: A randomized clinical trial. Journal of Exercise Science and Physiotherapy, 9(2), 74.
    • Comparing Mobilization Techniques
49. Do Moon, G., Lim, J. Y., Da, Y. K., & Kim, T. H. (2015). Comparison of Maitland and Kaltenborn mobilization techniques for improving shoulder pain and range of motion in frozen shoulders. Journal of physical therapy science, 27(5), 1391-1395.
50. Naik, S., Metgud, S., & Heggannavar, A. (2017). Effect of McKenzie method of mechanical diagnosis and therapy (MDT) versus Maitland mobilization in individuals with stage II adhesive capsulitis: A randomized clinical trial. IJAR, 3(8), 362-367.
51. Kumar, A. (2015). A Comparative Study on the Efficacy of Maitland’s Mobilization and Muscle Energy Technique on Frozen Shoulder. Website: www. ijpot. com, 9(4), 39.
52. Suri, S. A., & Anand, M. (2013). Comparative study on the effectiveness of Maitland mobilization technique versus muscle energy technique in treatment of shoulder adhesive capsulitis. Indian Journal of Physiotherapy and Occupational Therapy, 7(4), 1.
53. Hussein, Z. A. (2019). Efficacy of mobilization techniques and range of motion in patients with adhesive capsulitis of the shoulder pain. International Journal of Research in Pharmaceutical Sciences, 10(1), 313-317.
54. Sahay, P., Banerjee, D., Bhushan, V., & Equebal, A. (2016). Long Term Efficacy of Maitland Mobilization Versus Mulligan Mobilization in Idiopathic Adhesive Capsulitis of Shoulder: A Randomized Controlled Trial. Indian Journal of Physiotherapy and Occupational Therapy-An International Journal, 10(4), 91-97.
55. Shrivastava, A., Shyam, A. K., Sabnis, S., & Sancheti, P. (2011). Randomised controlled study of Mulligan's vs. Maitland's mobilization technique in adhesive capsulitis of shoulder joint. Indian journal of physiotherapy and occupational therapy-An international journal, 5(4), 12-5.
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58. Johnson, A. J., Godges, J. J., Zimmerman, G. J., & Ounanian, L. L. (2007). The effect of anterior versus posterior glide joint mobilization on external rotation range of motion in patients with shoulder adhesive capsulitis. journal of orthopaedic & sports physical therapy, 37(3), 88-99.
59. Vermeulen, H. M., Rozing, P. M., Obermann, W. R., Le Cessie, S., & Vliet Vlieland, T. P. (2006). Comparison of high-grade and low-grade mobilization techniques in the management of adhesive capsulitis of the shoulder: randomized controlled trial. Physical therapy, 86(3), 355-368.
60. Talbott, N., & Witt, D. (2016). Sonographic Measurements of Humeral Head Displacement During Posterior Shoulder Mobilizations. Journal of Hand Therapy, 29(3).
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62. Muraki, T., Yamamoto, N., Berglund, L. J., Sperling, J. W., Steinmann, S. P., Cofield, R. H., & An, K. N. (2011). The effect of cyclic loading simulating oscillatory joint mobilization on the posterior capsule of the glenohumeral joint: a cadaveric study. journal of orthopaedic & sports physical therapy, 41(5), 311-318.
63. Agarwal, S., Raza, S., Moiz, J. A., Anwer, S., & Alghadir, A. H. (2016). Effects of two different mobilization techniques on pain, range of motion and functional disability in patients with adhesive capsulitis: a comparative study. Journal of physical therapy science, 28(12), 3342-3349
64. Gong, W., Lee, H., & Lee, Y. (2011). Effects of Gong's Mobilization Applied to Shoulder Joint on Shoulder Abduction. Journal of Physical Therapy Science, 23(3), 391-393.
65. Gong, W., Jeong, H., & Kim, E. (2012). The Effects of Gongrsquo; s Mobilization Applied to the Shoulder Joint on Shoulder Medial Rotation. Journal of Physical Therapy Science, 24(3), 279-281.
66. Gong, W., Park, G., & Kim, C. (2012). Effects of Gong’s mobilization in the side-lying position on shoulder abduction. Journal of Physical Therapy Science, 24(4), 307-309.
    • Systemic Changes
67. Yu, I. Y., Jung, I. G., Kang, M. H., Lee, D. K., & Oh, J. S. (2015). Immediate effects of an end-range mobilization technique on shoulder range of motion and skin temperature in individuals with posterior shoulder tightness. Journal of physical therapy science, 27(6), 1723-1725.
68. Simon, R., Vicenzino, B., & Wright, A. (1997). The influence of an anteroposterior accessory glide of the glenohumeral joint on measures of peripheral sympathetic nervous system function in the upper limb. Manual Therapy, 2(1), 18-23.
69. Ribeiro, D. C., Sole, G., Venkat, R., & Shemmell, J. (2017). Differences between clinician-and self-administered shoulder sustained mobilization on scapular and shoulder muscle activity during shoulder abduction: A repeated-measures study on asymptomatic individuals. Musculoskeletal Science and Practice, 30, 25-33.
70. Ribeiro, D. C., Day, A., & Dickerson, C. R. (2017). Grade-IV inferior glenohumeral mobilization does not immediately alter shoulder and scapular muscle activity: a repeated-measures study in asymptomatic individuals. Journal of Manual & Manipulative Therapy, 25(5), 260-269.
71. Swanson, B. T., Holst, B., Infante, J., Poenitzsch, J., & Ortiz, A. (2016). EMG activity of selected rotator cuff musculature during grade III distraction and posterior glide glenohumeral mobilization: results of a pilot trial comparing painful and non-painful shoulders. Journal of Manual & Manipulative Therapy, 24(1), 7-13.
    • Additional Research
72. Mischke, J. J., Emerson Kavchak, A. J., & Courtney, C. A. (2016). Effect of sternoclavicular joint mobilization on pain and function in a patient with massive supraspinatus tear. Physiotherapy theory and practice, 32(2), 153-158.
73. Makwana, D., & Shah, N. (2016). Immediate effect of end range mobilization on shoulder range of motion and pain in patients with adhesive capsulitis. International Journal of Therapies and Rehabilitation Research, 5(1), 4
74. Guler-Uysal, F., & Kozanoglu, E. (2004). Comparison of the early response to two methods of rehabilitation in adhesive capsulitis. Swiss medical weekly, 134(23-24), 353-358.
75. Kumar, A., Kumar, S., Aggarwal, A., Kumar, R., & Das, P. G. (2012). Effectiveness of Maitland Techniques in idiopathic shoulder adhesive capsulitis. ISRN Rehabilitation, 2012.
76. Buchbinder, R., Youd, J. M., Green, S., Stein, A., Forbes, A., Harris, A., … & Wright, W. J. (2007). Efficacy and cost‐effectiveness of physiotherapy following glenohumeral joint distension for adhesive capsulitis: A randomized trial. Arthritis Care & Research, 57(6), 1027-1037.