For all those who have had a ☃️ frozen shoulder or 🎓 Physios who want some insight into mobilisation of the shoulder to help with this debilitating problem that so many go through.
I have our patient Joanne who has not one but TWO ‼️ frozen shoulders, complicated by OA, rotator cuff tears, label tears and years of stiffness. Tough one but awesome to see changes and improvement already.
Mobilisation 1️⃣ Caudal glides to mobilise mostly the inferior capsule and help improve physical abduction ROM.
Mobilisation 2️⃣ AP glides in some abduction with traction to mobilise mostly the posterior part of capsule - helps improve overall ROM. Watch the pain levels and follow up with the rehab strengthening work to help with pain relief and structural support.
Mobilisation 3️⃣ AP glides in abduction with external rotation. I like doing a AP glide in maximal available external rotation below the “bad pain” and then a static AP then mobilizing them into external rotation. in some abduction with traction to mobilise mostly the posterior part of capsule - helps improve overall ROM. Watch the pain levels and follow up with the rehab strengthening work to help with pain relief and structural support.
Mobilisation 4️⃣ AP glides in abduction with external rotation - using a SEATBELT. This gives me a few hand or so to help with positioning and external rotation, as well as giving my hands a break! 🙂 If you set up the towel right it can be more comfortable for the patient too.
Mobilisation 5️⃣ AP glides into flexion now to help with overhead ROM into flexion. It’s always easier when some one like this who has reasonable range. When people are in the acute or ❄️ freezing phase of frozen shoulder it’s harder to mobilise. Doesn’t mean you don’t do Physio it’s just that you will have to go easier and it will take a bit longer than in the ☀️ thawing phase. ☝️ Make sure the traction is on with good hand contact all around so they relax with the posterior glide.
And remember, little gains in Physio are big gains in life for the patient 😉
Mobilisation 6️⃣ AP glides into internal rotation on the LEFT side this time. Almost the same MRI findings left and right yet 2 different shoulders. Always trust the patients symptoms and signs first before you try to diagnose from an MRI. With the left shoulder we need to do different manual mobilisation and focus on the strength of her external rotation too with her pain and weakness in the rotator cuff.
Have a look at the differences in ROM and pain symptoms between the left and the right.
The mobilisation work has really helped and now she can do more things in life and with less pain, like putting her hands on hips. The little things are important! This is where as a Physio you can make a real impact and difference in people’s lives. 😇 👉 BUT, mobilisation is only half the job. These shoulders need strengthening, movement pattern retraining and stability. 💯. 👀 Watch out for the exercises coming up in our shoulder program segment soon!
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5 июл 2019
