It can be difficult to treat people with a shoulder musculoskeletal disorder causing limited shoulder range of motion. There are many ways to conservatively treat these individuals; such as using soft tissue massage (STM), joint mobilizations (JM), muscle strengthening, stretching, proprioceptive neuromuscular facilitation (PNF), modalities, etc. A multitude of treatments can limit progress when used all at once or when they are not warranted. I found an article that focused on treating individuals with soft tissue restriction from muscle as opposed to individuals with capsular restrictions by using STM and PNF.
Prior to treatment, the researchers measured glenohumeral range of motion in supine with the shoulder abducted to 45 degrees and again at 90 degrees shoulder abduction. They defined individuals with muscular restrictions as individuals with an increase in external rotation range from 45 to 90 degrees shoulder abduction. A capsular restriction presented as individuals with a decrease in external rotation from 45 to 90 degrees shoulder abduction and were not deemed suitable for this type of treatment.
1. They first treated subjects with soft tissue massage to the subscapularis muscle with the subject supine and their shoulder abducted to 45 degrees and externally rotated to 20-25 degrees. They poked around the armpit for areas of tissue restrictions and either used sustained pressure or slow deep strokes for 7 minutes.
2. Then they maintained the shoulder in the same position and completed contract-relax PNF to the subscapularis and internal rotators of the shoulder. The subject was instructed to complete a maximal isometric internal rotation contraction against resistance for 7 seconds and then maximally externally rotated. The externally rotated position was help for 15 seconds. This was repeated 5 times.
3. Finally, the subject was instructed to complete 5 repetitions of the flexion-abduction-external rotation PNF pattern actively with manual facilitation.
(Click the link for access to the article)
Design: Randomized-controlled 2-group pretest-posttest, multivariate study of patients with shoulder musculoskeletal disorders
Purpose: To evaluate the immediate effect of soft tissue mobilizations with Proprioceptive Neuromuscular Facilitation to increase glenohumeral external rotation at 45 degrees of shoulder abduction and overhead reach.
Methods: Twenty subjects (10 male, 10 female) with limited glenohumeral external rotation and overhead reach for a duration of 1 year or less were assessed. The glenohumeral external rotation was measured supine with the shoulder at 45 degrees abduction and overhead reach was measured from the tip of the middle finger on the wall to the floor. The experimental group was treated with STM to the subscapularis and PNF to the rotators. The control group received 10 minutes of resting supine on the treatment table.
Results: The experimental group significantly increased external rotation range by 16.4 degrees and the overhead reach by 9.6 cm.
Limitations: This was a single session so the study does not allow for conclusions on effects beyond 1 visit. The study also did not compare different treatment interventions so other outcomes may be similar for other techniques.
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