Restoring elevation in stiff and painful shoulders
Range of motion (ROM) deficits in stiff and painful shoulders can be the result of pathology in various soft tissue or periarticular structures, such as fibrosis or inflammatory processes in the joint capsule and the synovium, or pathology of the rotator cuff, especially the subscapularis musle. Generally, the most distinct restriction in ROM is towards external rotation.
When treating patients with this condition, therapists need to carefully consider the dose of stress put on the tissue in terms of intensity, duration and frequency – recently, low-load prolonged and static progressive stretching techniques have been advocated in literature. In this article, the authors argue that conventional methods of mobilizing the shoulder joint into elevation may cause or contribute to inflammation of tissue structures coursing through the subacromial space.
Based on biomechanical literature, it can be speculated that restoration of external rotation ROM could also lead to improvements in elevation in the plane of the scapula, as elevation in planes anterior to the scapular plane is a composite movement requiring a certain amount of external rotation; forcing the shoulder into elevation when mobilizing could thus be avoided.
> From: Donatelli et al., Phys Ther Sport 15 (2014) 3-14. All rights reserved to All rights reserved to Elsevier Ltd. Click here for the Pubmed summary.