Facebook Pixel
Brookbush Institute Logo
Preview

Acromioclavicular (AC) Joint Posterior to Anterior Manual Mobilization

Learn how to perform posterior to anterior manual mobilization of the Acromioclavicular (AC) joint quickly and safely with this video guide. Discover the step-by-step techniques and get the results you need!

27 likes

Transcript

00:05 - 00:07This is Brent of the Brookbush Institute, and in this video we're going to go over a joint
00:07 - 00:11based manual therapy technique, If you're watching this video I'm assuming you're
00:11 - 00:14watching it for educational purposes, and that you are a licensed professional
00:14 - 00:20with joint based techniques within your scope. That means osteopath's chiropractors,
00:20 - 00:24physical therapists, you're probably all in the clear. Physical therapy assistants,
00:24 - 00:28athletic trainers, massage therapists, you need to check with your governing body
00:28 - 00:32in your state or region to see whether this is within your scope of practice.
00:32 - 00:36Personal trainers this is definitely not within your scope of practice. Of course
00:36 - 00:41all professions could use this video for purely educational purposes to help with
00:41 - 00:46learning biomechanics, anatomy, and of course palpation. In this video we're
00:46 - 00:51going to go over posterior to anterior well as superior to inferior, clavicle on
00:51 - 00:56acromion mobilization. So this is our acromioclavicular joint mobilizations.
00:56 - 00:58I'm going to have my friend Melissa come out, she's going to help me demonstrate.
00:58 - 01:03Now these are great joint mobilizations I want you to keep in your back pocket, and
01:03 - 01:08I know a lot of individuals don't do these mobilizations on a regular basis,
01:08 - 01:12but they are great for putting the finishing touches on regaining optimal
01:12 - 01:19mobility, or optimizing the quality of motion of the shoulder girdle. And that
01:19 - 01:24we have some research to kind of back this up. Research on the shoulder,
01:24 - 01:27specifically shoulder dysfunction and things like impingement syndrome, kind of
01:27 - 01:32show this propensity of the scapula to adopt an excessively downwardly
01:32 - 01:36rotated and anteriorly tipped position. If we think about what that would do to
01:36 - 01:44the arthrokinematic of the AC joint, it would push the acromion shelf anterior
01:44 - 01:51and inferior to the clavicle. So now the question is is how do we get it back, and
01:51 - 01:54I know some of you guys are thinking well you just push the scapula up and
01:54 - 01:58you push the scapula back and that makes a lot of sense, and it does make a
01:58 - 02:04lot of sense if it wasn't for the fact that the scapula is kind of big, and this
02:04 - 02:08is what that mobilization would look like. If we had some crazy way of
02:08 - 02:11stabilizing the clavicle, which we just kind of don't have a good way to
02:11 - 02:15stabilize the clavicle. The easier way to do this from a technique standpoint is
02:15 - 02:20to actually move the clavicle on a scapular that's being stabilized by
02:20 - 02:24the table. The only thing we have to consider now is we have to reverse the
02:24 - 02:29direction of our mobilisation, so rather than going superior and posterior with
02:29 - 02:36our scapula, we're going to go inferior and anterior with our clavicle, So what
02:36 - 02:39would that look like? Well first things first
02:39 - 02:43with all of our joint mobilizations, knowing your anatomy and having some
02:43 - 02:49palpation skills are very very helpful. I had suggested in another video that
02:49 - 02:55maybe even outline the clavicle, and you just outlined the clavicle you know with
02:55 - 02:59your with your partner with your colleague in a class, you know grab grab
02:59 - 03:03some people to practice on. I'm not suggesting you do this with every
03:03 - 03:07patient, but I know you know where your collarbone is, but try to identify the
03:07 - 03:13entire flattened S shape of the clavicle, and get a good visual model of what that
03:13 - 03:18looks like. See if you can feel the ends of the clavicles right, you'll notice
03:18 - 03:23that usually the proximal side of the clavicle is a lot more prominent than
03:23 - 03:26the distal side, which I guess works against us for the acromioclavicular
03:26 - 03:32joint mobilizations. But if you feel the entire distal end you'll notice that
03:32 - 03:36it's usually a little easier to get your fingers posterior to the joint, than it is
03:36 - 03:42to try to get your fingers anterior to the the AC joint, or at least the
03:42 - 03:49anterior to the distal end of the acromion, or clavicle rather. So once you
03:49 - 03:55find this border, what I want you to do is keep tracing that border until you
03:55 - 04:03feel this line that seems to indent around the distal clavicle, that is your
04:03 - 04:07joint line. Once we find that joint line we're back in the same place we've been
04:07 - 04:09in with all of our joint mobilizations where now we just have to figure out
04:09 - 04:15which direction we want to go, and we have a good chance of actually feeling
04:15 - 04:20our first resistance barrier, our first point of motion of arthrokinematic
04:20 - 04:25motion. Now this is glide as well as the end of arthrokinematic motion or the
04:25 - 04:31end of glide, and if we start with our our superior to inferior glides here, and
04:31 - 04:33I'm just going to move kind of kind of off to the side
04:33 - 04:40here. I can even keep one thumb right on the joint line and the acromion shelf,
04:40 - 04:45and use the other thumb, try to get my hands in here, use the other thumb to
04:45 - 04:51push straight superior to inferior on that clavicle, and make sure you use your
04:51 - 04:57thumb pad guys here not your fingertip, we don't want to poke at a joint that's
04:57 - 05:02that's never a good idea. Think about always using the broadest surface area
05:02 - 05:07you can. Right i'm going to go this way, you okay Melissa. You guys just got to be
05:07 - 05:10careful on these techniques, when you straighten out your arms it's really
05:10 - 05:16easy just keep knocking people in the head, and nobody likes that. So I have my
05:16 - 05:20thumb on the joint line, I can feel first point at which it moves, which which
05:20 - 05:23comes on pretty fast in this little joint, there's not a lot of motion there;
05:23 - 05:28and then I push all the way down until I feel end range, there we go, back off to
05:28 - 05:3350% and I can do whatever graded mobilization I'd like. Let's say grade
05:33 - 05:38three here, I'm going to back off the where I first felt that resistance and
05:38 - 05:47then go all the way down 50%, back to the beginning, and go from the beginning to
05:47 - 05:5450%, and if I can I'm going to straighten out my arms and just use my trunk to do
05:54 - 05:59this mobilization. Now I'm going to warn you guys we've been real careful with
05:59 - 06:05our technique up to this mobilization, there are joint mobilizations that just
06:05 - 06:11don't lend themselves very well to great body mechanics and great posture, which
06:11 - 06:16is why you have to be perfect on all of your other mobilizations. So that when
06:16 - 06:21you get to a mobilization like this where it is really really hard to have
06:21 - 06:26great mechanics, if you wear yourself down a little bit on this technique
06:26 - 06:32you're okay because the rest of the day you have perfect posture, and you're not
06:32 - 06:37really using the strength of your hands you're just using your bodyweight. Now
06:37 - 06:42this one I can use a little bit better technique
06:42 - 06:47than posterior to anterior, this is where things get really really tricky, because
06:47 - 06:52obviously if I was going to go posterior to anterior and have a great body
06:52 - 06:56position I would somehow be able to get my arms straight down this way through
06:56 - 07:02the table, and I can't go through tables, I don't know anybody who can. So what we
07:02 - 07:08end up having to do is kind of this like flip up technique with our wrists,
07:08 - 07:11alright which is it's going to get tough if you had to do a bunch of these
07:11 - 07:16throughout a day. But granted that we don't use this technique all the time
07:16 - 07:21you should be able to to get away with it here and there, and all you're going
07:21 - 07:28to do is put your thumb behind the distal end of the clavicle just like we
07:28 - 07:33talked about you finding, when we were talking about palpation here, so find the
07:33 - 07:38joint line, you're going to have to scoot over quite a bit so that this arm ends
07:38 - 07:42up straight next to your patient's head, because if you try to get this arm
07:42 - 07:46straight once again you just end up banging them in the head, or you end up
07:46 - 07:50putting your arm down on their face, also not okay.
07:50 - 07:56Clients don't seem to like going back and forth over the top of their face,
07:56 - 08:03probably not great customer service. So get your dummy thumbs set up guys,
08:03 - 08:07alright so I'm going to use my inside thumb as my dummy thumb here, and then
08:07 - 08:14I'm going to try to like I said kind of use that flip-up technique. Now before I
08:14 - 08:20did this flip-up technique I should have found my first resistant barrier, find
08:20 - 08:27the end and then back off to 50%, this time we'll do a grade four, I'll stay
08:27 - 08:33right there and I'm just kind of flipping my thumbs up, right I'm just
08:33 - 08:38doing this, takes a little bit of practice. This one you might want to grab
08:38 - 08:43a couple extra colleagues when you're practicing this technique, make sure you
08:43 - 08:48do both of their shoulders and get as much practice as you possibly can,
08:48 - 08:52and of course if I'm doing my grade four mobilizations, I'm doing
08:52 - 08:57one two two two oscillations per second, and I'm going to keep going until
08:57 - 09:02I feel a reduction in arthrokinematic stiffness. As I mentioned in the
09:02 - 09:08beginning of this video if we're going to go back to like a more reliable
09:08 - 09:13objective measure, I would probably use something like end range shoulder
09:13 - 09:17flexion, and this is gross shoulder flexion not just glenohumeral shoulder
09:17 - 09:20flexion. But do they get a hundred and eighty degrees, can they get their arm
09:20 - 09:25all the way down to the table shoulder flexion. Or maybe I use external rotation
09:25 - 09:30and see and see to make sure that they've got all the way to 90-95 degrees,
09:30 - 09:34which is going to include not only glenohumeral motion but posterior
09:34 - 09:39tipping of the scapula as well, to see if I got some loosening up of the AC joint.
09:39 - 09:44So just real quick - to recap that mobilization before we're going to our
09:44 - 09:49close-up recap. You guys are going to have to get real good at finding the
09:49 - 09:54distal border of the clavicle. Pretty easy to do our superior to inferior
09:54 - 10:00mobilization but you're going to have to scoot over, and probably use one arm
10:00 - 10:07straight right parallel to their face, and probably one thumb is going to end
10:07 - 10:13up being like a dummy thumb and a feeler, and then the other hand you can pretty
10:13 - 10:18much use your trunk to get that superior to inferior mobilization. The posterior
10:18 - 10:23to anterior mobilization a little trickier, it is easy enough to get your
10:23 - 10:28thumb behind the clavicle, but then to get both thumbs and to create a
10:28 - 10:34posterior to anterior direction, you end up doing this flip-up technique which is
10:34 - 10:41going to take a little practice. Obviously is not great on our own body
10:41 - 10:46mechanics, so I wouldn't recommend doing this all day every day as your go-to
10:46 - 10:53technique for everybody, but it does work in a pinch. Guys try these techniques,
10:53 - 10:59stay tuned for the close-up recap. So for a close-up recap of the superior to
10:59 - 11:04inferior and posterior to anterior clavicle on acromion
11:04 - 11:11mobilisations. First just palpate your clavicle, find the end of your clavicle
11:11 - 11:17the distal end. Now the distal end is usually not quite as prominent as the
11:17 - 11:21proximal end if you've done the sternal sternoclavicular joint mobilization
11:21 - 11:29before, but it's usually prominent enough that if you take your time and
11:29 - 11:37investigate you'll notice that it drops off into the flat acromion, you can
11:37 - 11:43definitely feel a little bump when going from acromion shelf back onto the
11:43 - 11:50clavicle; and that of course is the somewhat spherical end of the clavicular
11:50 - 11:55bone there. It's definitely a little bit more spherical in the
11:55 - 12:00posterior aspect. If I'm doing my superior to inferior mobilization then I
12:00 - 12:06might use this hand as my my feeler, we talked about kind of placing any free
12:06 - 12:12fingers or hand that we have on the joint line so we can feel the amount of
12:12 - 12:16glide happening, and of course if I put this finger here I can I can just push
12:16 - 12:22like this and feel joint motion. Once I started doing the mobilization I want to
12:22 - 12:27use the the largest surface I can. So we're not going to poke at the joint, but
12:27 - 12:33we're going to use a thumb pad like this, I'm going to straighten up my arm, I
12:33 - 12:37could use thumb over thumb technique but I'm actually going to leave this thumb
12:37 - 12:42here so that I can feel that joint line, and then straighten out my arm find that
12:42 - 12:48first resistance barrier, find the end of athrokinematic range, back off to 50% and
12:48 - 12:54of course then I can just use my torso to get a nice oscillation here, one to
12:54 - 12:58two oscillations per second. Now the harder technique I kind of explained to
12:58 - 13:02you guys was the posterior to anterior, because you have to use this kind of
13:02 - 13:10flipping wrist technique. It is easier to get on the posterior aspect of the
13:10 - 13:15clavicular bone that's not too hard, and of course you could leave a finger on
13:15 - 13:17the joint line or you could end up using both
13:17 - 13:23fingers to do this flipping up technique, to get your posterior to anterior
13:23 - 13:31direction. Now with this technique it is very tough to kind of identify your
13:31 - 13:37first resistance barrier, your end range, back off the 50% and stay there, that's
13:37 - 13:42going to take some practice. With this particular technique I would definitely
13:42 - 13:50find more than a couple colleagues to practice getting the direction right on
13:50 - 13:55that mobilization, and of course with all of these mobilizations you can test
13:55 - 14:00which one is most effective. For example I could do this then test and range
14:00 - 14:04shoulder flexion, and then I could test this one and do end range shoulder
14:04 - 14:07flexion again and see which one works better. So there you have it
14:07 - 14:12assess, address, reassess. Make sure that every time you choose a joint based
14:12 - 14:17manual therapy technique it is based on an assessment, and that you return to
14:17 - 14:21that assessment after you finish the intervention, to see if it was effective
14:21 - 14:26for the individual, the patient or client that you had in front of you. Ensure that
14:26 - 14:31you continue to learn your Anatomy because your Anatomy is going to help
14:31 - 14:36you with your hand placement, with understanding what a joint can do, with
14:36 - 14:41understanding what you may gain from this particular technique. And of course
14:41 - 14:46practice, you have to practice these techniques hopefully not for the first
14:46 - 14:51time on a patient or client who just walked in the door. If you can, find a
14:51 - 14:56more senior instructor or mentor to give you some really good hands-on
14:56 - 15:03instruction. Use your peers for some good feedback, and of course always look for
15:03 - 15:09live education to help with your manual therapy techniques. I know these videos
15:09 - 15:15make education very convenient, but there is no substitute for learning manual
15:15 - 15:19therapy in a live setting. I look forward to talking to you guys again
15:19 - 15:21soon.
15:27 - 15:29

Comments

Guest

3 Certifications, 165+ Courses, 500+ videos, and so much more!

The Brookbush Institute (BI) continues to improve affordability, access, flexibility, and convenience to the highest-quality education.

The Bl is the only approved/accredited certification and continuing education course provider with a true monthly membership model (cancel anytime).

This reduces the initial cost of education to just 3-5% of comparable education, improving access to complete, continue, or just "try" education with low financial risk. Don't get fooled by great marketing to make a large purchase for potentially sub-optimal education. Become a member, and find out why we think this is the way education should be!


or
Sign Up with Email Address
Already Have an Account? Sign In