The shoulder: Arthritis

Technique:

The patient lies supine and brings the ipsilateral hand on to the forehead.
The therapist stands on the affected side, facing the patient, and holds the elbow.
The other hand is either on the sternum (1) or on the lateral border of the scapula (3).
The arm is now gently elevated in a sagital plane (flexion of the shoulder) until the endfeel is reached.
By pushing the elbow further backwards towards the head of the patient, the capsule of the joint is stretched.
In this way the inferior recess of the capsule, where most of the adhesions lie, is elongated.

The hand on the sternum prevents the patient from avoiding the stretch by curving the trunk. The forearm can rest on the head (eventually with a small pillow between both.
The capsular stretching is done in elevation.
As this is a combined movement, the rotations improve simultaneously with the increase in abduction range.
Stretching is by a continuous pressure gently intensified for a few seconds, then slackened off slightly for a little while and increased again.
Endfeel is paramount: it should be ligamentous; there is no muscular resistance nor increase in pain.
The procedure is also not a manipulation, and any tendency to 'jerk' should be avoided.
The manoeuvre is repeated for as long as the patient can stand and is followed by a full rest, in which the arm is brought down, avoiding pain by axial traction.

=> Stretching can be combined with hold-relax techniques: the patient is asked to give active counter pressure and relax which results in a better relaxation during the push.

=> Sometimes instead of the sternum, the lateral border of the scapula is fixed which may be more comfortable to the patient.

back to the capsular pattern / General Principles Treatment