The shoulder: Distraction technique

The manoeuvre is done with the patient's arm in the most comfortable position : the patient lies supine, the arm along the side and in slight medial rotation.
The therapist sits at the patient's painful side and places the elbow against his side (eventually with a small cushion in between). He brings one hand deep onto the axilla, the other hand on the outer aspect of the shoulder (acromion-scapula).

The hand in the axilla gives the slight distraction; The direction of the pressure is lateral and slightly anterior and cranial; the force is minimal so that the movement takes place over only a few mm distance.
The other hand stabilizes the scapula and the body of the therapist gives counterpressure at the lateral side of patient's elbow.

The manoeuvre is done gently and rhythmically: The patient is only aware of some painless vibration.
The rhythm changes from quick (about five movements per second) to slow (15 per minute or the rhythm of respiration).
The rhythm should change continuously in order to prevent adaptation of the mechanoreceptors.
Once the treatment is well tollerated the direction of the movement can be changed to antero-posterior.
Later on some degree of lateral rotation or abduction can be added,
so that the distraction is performed at the end of the possible range.

The Shoulder

Distractions