Manual Therapy and Therapeutic Exercise for Common Orthopedic Conditions and Functional Mobility: Summary 55
Therapeutic Exercise for Shoulder Impingement: • Stretching: Upper trapezius, pectoralis minor, posterior shoulder • Strengthening: Wall push-ups, shoulder extension in prone, external rotation, resisted shoulder protraction, scapular retraction strengthenign Research shows that adding manual therapy to exercise programs results in clinically significant improvements in pain, functional capacity, and scapular range of motion. CASE STUDY JS is a 26-year-old male who suffered a right tibial plateau fracture in a snowboarding incident. The patient presents with: • Significant right-sided limp • Lacking 15° of active knee extension (passive to 9°) • Visible quadriceps atrophy, especially in vastus medialis • Struggles with dynamic control of end-range knee extension Appropriate interventions include: • Anterior gliding of the tibia on the fixed femur to increase extension • Long axis distraction with external rotation of the proximal tibia to facilitate the screw-home mechanism necessary for full knee extension Conclusion This comprehensive course integrates evidence-based manual therapy techniques with therapeutic exercise progressions for common orthopedic conditions affecting the knee, ankle, hip, and shoulder. By understanding the biomechanics of each joint, applying appropriate manual techniques, and prescribing targeted exercises, clinicians can optimize patient outcomes and functional mobility. The combination of manual therapy and therapeutic exercise creates synergistic effects that exceed what either intervention could achieve alone.
LEARNING TIP! Given the primary role of the shoulder, the arthrokinematics of the joint are considered to be open chain and therefore the convex humeral head moves on the concave glenoid with roll and glide happening in opposite directions.
Below are specific arthrokinematics of various shoulder movements: • Flexion : Superior roll, inferior glide of humeral head • Abduction : Superior roll, inferior glide of humeral head • Internal Rotation : Posterior roll/spin, anterior glide • External Rotation : Anterior roll/spin, posterior glide Scapulohumeral Function Elevation of the arm requires synchronous input from both scapulothoracic and scapulohumeral muscles, with scapulothoracic muscles positioning the scapula. Shoulder Osteoarthritis (OA) Shoulder OA is the degradation of the glenohumeral articular cartilage affecting subchondral bone and the shoulder capsule. Expert opinion indicates that physical therapy can often be effective in decreasing pain, restoring function, and avoiding surgery. Manual Therapy and Exercise for Shoulder OA Use individual pain, strength deficits, and ROM to guide the plan. A “trial and error” approach is helpful as no one intervention is best supported by research. Joint mobilizations and long axis distraction can improve joint play and accessory motion, reduce pain, and improve function. ADHESIVE CAPSULITIS Adhesive capsulitis, also known as frozen shoulder, is characterized by a generalized inflammatory reaction leading to scarring of the joint capsule . Adhesive capsulitis progresses through sequential stages including freezing, frozen, and thawing. The most effective intervention is corticosteroid injections, but evidence supports mobilizations and exercise as well. SHOULDER IMPINGEMENT There is evidence for combined manual therapy and therapeutic exercise approaches: Manual Therapy for Shoulder Impingement: • PA glides to thoracic spine • Inferior and posterior glides to glenohumeral joint • Soft tissue techniques including contract/relax • Grade III and IV mobilizations to multiple joints (glenohumeral, scapulothoracic, sternoclavicular, AC joint, and cervical spine)
WORKS CITED https://qr2 .mobi/manual-therapy
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