Eclectic Strategies for Shoulder Internal Rotation | Modern Manual Therapy Blog

Eclectic Strategies for Shoulder Internal Rotation



Jesse Awenus asked on my facebook page for strategies for shoulder IR, which can be difficult with patients/clients who have very restricted posterior capsules and often found in shoulder impingement.


Here are several treatment strategies I use not only to improve shoulder IR, but to maintain a portion of the improvements hopefully between visits. 


1) Issues in the tissues
  • IASTM/STM to the bony contours of the spine of the scapula
    • Mainly focusing on supraspinatus > infraspinatus, working on lateral to medial and medial to lateral releases
  • Functional Release of the supraspinatus, infraspinatus, and teres minor
    • pt in sitting
    • PT: behind pt
      • assess for restrictions, hold and push anteromedially to lengthen tissues
    • Tech: pt reaches UE across midline in different planes, also internally rotating 
      • the reaching can be oscillations at end range or circumduction with emphasis on IR
      • 5 minutes should suffice unless it improves sooner
  • Functional Release and IASTM/STM to the lateral upper arm
    • improving this area often helps the humerus rotate both internally and externally within the forearm musculature
2) Joint mob/manip - progressing from comfortable/pain free to more aggressive functional release
  • Mulligan posterior glide shoulder MWM
  • posterior glide thrust manipulation, preferably using a drop piece rather than a rolled up towel - much more comfortable! 
    • pt needs at least 90 degrees of comfortable shoulder flexion for this to work well
  • shoulder IR, inferior glide, arm slide
    • one of my favorites! Very effective, but can be also uncomfortable
  • C4-5 downglide/upglide thrust
  • thoracic thrust
3) Assess/treat possible radial nerve limitations
  • to best improve internal rotation focus oscillations at
    • shoulder IR 
    • shoulder abduction
    • elbow extension
  • advanced progression - load into radial nerve stretch, then perform IASTM, STM or joint mobs into posterior glide/inferior glide
4) HEP - the MOST important
  • repeated shoulder extension
    • learned this from one of the MDT Diplomats, and an intern of mine said, "of course it's extension!
    • I normally perform it on the patient first, no one ever thinks it is going to follow the rules of derangement
    • if blocked, it may be painful at first, but if reducible, gets easier and less painful, normally increasing motion and decreasing pain - the hallmark rapid change of any derangement
    • I then teach teach them how to perform it with a lunge
    • perform 10 times/hourly - ALL DAY! 
    • they may also have someone perform it for them
    • don't worry about arthrokinematics, or slight substitution, still works despite it's apparent complete lack of specificity
    • this actually works well for limitations in elevation in all planes as well
  • shoulder circles
    • variation on the "open book"
    • 20 times clockwise, counterclockwise 2-3 times/day works well
  • self radial nerve tensioners
    • 3 sets of 30 second oscillations into shoulder IR 2-3 times/day
Video below! It's epic in length for one of my instructional vids. I fully intended it to be 5-7 minutes, but it's over 17 minutes! Hard to fit in all that content. Will add self radial nerve tensioners and shoulder circles for HEP in the future.





What are some techniques you find helpful for persistent shoulder IR limitations?

8 comments:

  1. Dry needling of TrPs in supra-/infraspinatus, followed by careful stretch and MET/contract-relax of the same muscles. And posterior/inferior glide mobilization.

    I see you frequently use "functional release" and also IASTM. What resources would you recommend if I wanted to learn more about these treatment techniques?

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  2. I do find hold relax to work very well, especially after STM and JM applied to the areas. In New York State, we are not allowed to use dry needling... yet...
    My functional release and STM technique background come from training with usa.edu and ipaconed.com. I teach them locally in Buffalo, NY and also am available for in house courses by contract.

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  3. I live in Norway, so me attending a course is not likely anytime soon - unfortunately. Are there any books or other resources you would recommend, on the subjects? Just to get a basic understanding of it.

    Also, kudos for a great blog with A LOT of great content.

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  4. Continue to be impressed with your videos and techniques. Thanks for sharing

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  5. You may want to try Anatomy Trains, I hear good things about it, and may review it soon, but don't have a copy myself http://www.amazon.com/s/ref=nb_sb_noss_1?url=search-alias%3Daps&field-keywords=anatomy+trains&x=0&y=0

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  6. Thanks! Hopefully my latest 17 min vid didn't raise the bar and readers don't expect that length each time! I get on a roll when speaking, seriously thought the vid was 5-7 minutes!

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  7. Thanks. A lot of material here. I've been using your 'IR supine slide' lately and also given a version of it as part of the HEP. Gotten some great results.

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  8. Thanks, the arm slide is one of my favorites! Aggressive but effective!

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