Manual Therapy of shoulder

When it comes to manual therapy, several terms need to be defined. Articulation, swing, distraction, manipulation, and mobilization describe specialized types of passive movement. Manual therapy is defined in the Physiotherapy Practice Guide as “skillful hand movements aimed at improving tissue extensibility; increase range of motion; induce relaxation; mobilize or manipulate soft tissues and joints; modulate pain; and reduce swelling, inflammation or soft tissue restriction. "

The articulatory techniques are derived from the osteopathic literature. They are defined as a passive movement applied gently and rhythmically to gradually stretch contracted muscles, ligaments, and capsules. They include gentle techniques designed to stretch the joint in each of the joint's intrinsic planes of motion. The force used during joint techniques is usually a prolonged stretch towards tissue restriction or limitation. Oscillatory techniques were best defined by Maitland, who described oscillations as passive joint movements, which can be of small or large amplitude and applied anywhere in a range of motion, and which can be performed while the joint surfaces are in motion. distracted or compressed. The four degrees of oscillation are as follows: degree I is a small-amplitude movement that occurs at the beginning of an interval; Grade II is a large-amplitude movement performed within the range, but without reaching the limit of the range; Grade III is a movement of great amplitude up to the limit of an interval; and degree IV is a small-amplitude movement performed at the limit of an interval. Grades I and II are primarily used for neurophysiological effects and involve no detectable resistance. Grades III and IV are designed to initiate mechanical changes in tissues and activate tissue resistance.

Distraction is defined as “separation of surfaces of a joint by extension without injury or dislocation of the parts.” Distraction techniques are designed to separate the joint surface attempting to stress the capsule.

Manipulation is defined by Dorland’s Illustrated Medical Dictionary as “skillful or dextrous treatment by the hand. In physical therapy, the forceful passive movement of a joint beyond its active limit of motion.” Maitland  described two manipulative procedures. Manipulation is a sudden movement or thrust, of small amplitude, performed at a speed that renders the patient powerless to prevent it. Manipulation under anesthesia is a medical procedure used to restore normal joint movement by breaking adhesions.

Mobilization is defined as “the making of a fixed or ankylosed part movable, or restoration of motion to a joint.” To the clinician, mobilization is passive movement that is designed to improve soft tissue and joint mobility. It can include oscillations, articulations, distractions, and thrust techniques. Mobilization, in this chapter, is defined as a specialized passive movement, attempting to restore the arthrokinematics and osteokinematics of joint movement.

Mobilization includes articulations, oscillations, distractions, and thrust techniques. The techniques are built on active and passive joint mechanics and are directed at the periarticular structures that have become restricted secondary to trauma and immobilization. These same techniques can be effective tools in assessment of specific joint impairments.

Soft tissue mobilization (STM) is as defined by Johnson: “STM is the treatment of soft tissue with consideration of layers and depth by initially evaluating and treating superficially proceeding to bony

prominence, muscle, tendon, and ligament.”

Mobilization techniques can be performed as physiologic movements or accessory movements. Physiologic movements are movements of the humerus in the body planes (e.g., flexion, extension, abduction, adduction, and external and internal rotation). Accessory movements are movements of the humerus within the joint that include roll, spin, glide, slide, distractions, and oscillations.

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