Combined Effects of Glenohumeral Mobilization, Stretching, and Thoracic Manipulation on Shoulder Internal Rotation Range of Motion.
Brian T Swanson, Marissa Hagenbruch, Bernardine Lapaan and 1 others
PMID 38699673WHAT IT FOUND
Adding thoracic manipulation before shoulder mobilization or stretching reduced range of motion gains compared to doing the shoulder techniques alone.
For stiff shoulders, perform posterior glide mobilization or sleeper stretches independently to maximize internal rotation.
Key findings
01Posterior glide mobilization and sleeper stretches both significantly improved internal rotation range of motion when performed alone.
02Adding thoracic manipulation before shoulder interventions resulted in significantly smaller gains in internal rotation range of motion than performing the shoulder interventions alone.
03Thoracic manipulation alone did not produce a statistically significant increase in internal rotation range of motion.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
The participants had non-clinical shoulder stiffness and reported very low levels of pain, so results may differ for patients with painful shoulder pathology. The study did not screen for bony limitations (like humeral torsion) that could restrict range of motion regardless of soft tissue treatment. Muscle activity was only measured in the infraspinatus, leaving the role of other shoulder muscles in the reduced range of motion unknown. Thoracic manipulation was applied at a single specific spinal level (T3-4), which differs from clinical practice where therapists often target symptomatic or stiff segments. The study was a pilot with a small sample size, limiting the generalizability of the findings.
Declared interests
The work was supported by a University of Hartford Greenberg Junior Faculty Grant.
The easy way to misread this
Do not conclude that thoracic manipulation is ineffective for all shoulder conditions. The study only examined its effect on immediate range of motion gains in non-painful stiff shoulders. It does not rule out benefits for pain reduction or other functional goals.