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Clinical Pearl Details

July 2013

Cory Woodworth, SDPT -
R. Paul Rouleau, P.T., OCS, COMT, FAAOMPT -

Technique:	Multi-planar joint mobilization to increase functional internal rotation.
Indication:	The purpose of this technique is to increase functional behind-the-back internal rotation. It is a combination of physiological internal rotation and extension, with accessory mobilizations of lateral distraction, inferior glide, and posterior glide.
Positioning:	Place the patient supine with the affected shoulder off the edge of the treatment table. The therapist should be positioned at the patient’s side standing parallel to the patient.
Procedure:	The therapist stabilizes the glenohumeral joint with the medial hand. With the lateral hand on the distal humerus, utilize a contract-relax technique to achieve end-range humeral internal rotation. Now, bring the glenohumeral joint to the extension barrier, once again utilizing contract-relax. We have now achieved maximum extension with internal rotation. The therapist maintains this position by trapping the patient's wrist with the therapist's legs, just above the knees. This position will allow the therapist to impart an appropriately graded inferior glide using his legs. To initiate the accessory mobilizations, the therapist now uses the medial hand to laterally distract the humerus. The therapist then uses his legs to perform an inferior glide by extending the knees bilaterally and gently weight shifting. While maintaining physiological extension with internal rotation, along with the accessory inferior glide and lateral distraction, the therapist's lateral hand glides the humerus posterolaterally in the plane of the joint. Vary the grade of the mobilization(s) according to the irritability and/or limitation of the joint. See figures below for proper positioning.
References:	Lee, DG. A Workbook of Manual Therapy Techniques for the Upper Extremity. Delta, BC: DOPC; 1991.
Figure 1 Figure 2 Figure 3