"The Effect of Anterior versus Posterior Glide Joint Mobilization on External Rotation range of motion in patients with Shoulder Adhesive Capsulitis."
Typically, External Rotation is the most limited motion in patients with adhesive capsulitis. The traditional manual therapy technique for these patients was an anterior glide mobilization to help increase external rotation ROM. This treatment was well accepted for a number of years because it agrees with the arthrokinematic principles. In recent years, there has been new evidence surfacing about the beneficial effects of posterior mobilizations for this patient population.
In this article, the authors found that using a posterior glide mobilization (Kaltenborn Grade III sustained), with therapeutic ultrasound and upper extremity therapeutic exercises was the most effective for increasing external rotation ROM deficits in patients with adhesive capsulitis. They found that the posterior mobilization group had an average increase of 31.1 degrees of external rotation (after 3 treatment sessions), compared to only 3 degrees average for the anterior mobilization group.
The article also found that patients with adhesive capsulitis often had a decreased rotator cuff interval space, pushing the humeral head anterior/ superior and not allowing normal posterior/ inferior motion. We must remember that at the glenohumeral joint, both anterior and posterior forces must be in coordination for proper stability.
Anatomy and Kinesiology Review:
Superior Glenohumeral Ligament:
Taut in adduction, inferior and a/p translations of the humeral head.
Middle Glenohumeral Ligament:
Taut in anterior translation of the humeral head, especially in 45-60 d. of abduction; external rotation
Inferior Glenohumeral Ligament (has 3 parts):
Axillary pouch: taut in 90 d. abduction, combined with a/p and inferior translations.
Anterior band: taut in 90 degrees abduction and full external rotation; anterior humeral translation.
Posterior band: taut in 90 d. of abduction and full internal rotation.
Taut in adduction; inferior translation of the humeral head; external rotation
Neumann, Donald. Kinesiology of the Musculoskeletal System. 2nd Edition. Mosby Inc., 2012. Print.