Author Names
Keramat, K. U. & Habib, A.
Reviewer Name
Emily LaPlante, LAT, ATC, SPT
Reviewer Affiliations
Duke University School of Medicine, Doctor of Physical Therapy Division
Paper Abstract
Introduction: The shoulder movement is dependent upon the integrated motion of many joints including Acromio-Clavicular Joint (ACJ). Chronic shoulder pathologies are likely to stiffen the
ACJ and mobilization may reverse the effects. The current study aimed to study the effects of mobilization of ACJ on the shoulder ROM in healthy asymptomatic participants with restricted
shoulder ROM.
Material & Methods: This single-subject quasi-experimental study recruited 30 healthy subjects with an equal proportion of males and females who had restrictions in the ROM. The mean age
(SD) of the participant was 22.60 (±1.16 years), height 5.52 (±0.21) meter, weight 63.30 (±12.78) kg and Body Mass Index 22.22 (±3.84) kg/m2. Outcome measuring tools were shoulder range of
motion (abduction, flexion, internal rotation, external rotation) and functional movements of reaching up behind the back and reaching down behind the neck. Acromioclavicular joint
mobilization pre-intervention and post-intervention measurements of all variables were compared.
Results: The measurement of functional movements and all the ROM improved significantly from their baseline measurements following the ACJ mobilization. The mean change (±SD) in
RBTB was 2.94 (±2.05), RBTN was 3.20 (±1.50), flexion was 6.53(±6.03), abduction was 8.83(±7.72), internal rotation was 7.60(±5.71), external rotation was 3.5(±5.80). The change was
marked in RBTN (19.5%) and RBTB (17.9%).
Conclusion: ACJ mobilization acutely improves the shoulder range of motion in healthy subjects. ACJ is therefore recommended for trials on prevention and rehabilitation of the shoulder.
Key Words: prevention of shoulder injury, sports physiotherapy, shoulder injury, shoulder rehabilitation
NIH Risk of Bias Tool:
Quality Assessment Tool for Before-After (Pre-Post) Studies with No Control Group
1. Was the study question or objective clearly stated?
-Yes
2. Were the eligibility/ selection criteria for the study population prespecified and clearly described
-Yes
3. Were the participants in the study representative of those who would be eligible for the test/ intervention in the general or clinical population of interest?
-No
4. Were all eligible participants that met the prespecified entry criteria enrolled?
-Yes
5. Was the sample size sufficiently large to provide confidence in the findings?
-No
6. Was the test/ service/ intervention clearly described and delivered consistently across the study population?
-Yes
7. Were the outcome measures prespecified, clearly defined, valid, reliable and assessed consistently across all study participants?
-Yes
8. Were the people assessing the outcomes blinded to the participants’ exposures/ interventions?
-No
9. Was the loss to follow up after baseline 20% or less? Were those lost to follow up accounted for in the analysis?
-Yes
10. Did the statistical methods examine changes in outcome measures from before to after the intervention? Were statistical tests done that provided p values for the pre-to-post changes?
-Yes
11. Were the outcome measures of interest taken multiple times before the intervention and multiple times after the intervention?
-No
12. If the intervention was conducted at a group level, did the statistical analysis take into account the use of individual level data to determine effects at the group level?
-Cannot determine, not reported, not applicable
Key Finding #1
Statistically significant change (P< 0.05) occurred in all ranges of motion. (specifically internal and external rotation)
Key Finding #2
ACJ mobilizations can effectively address limitations in functional movements of reaching up behind the back and reaching down behind the neck.
Please provide your summary of the paper
A pretest-posttest design was used to test the effect of ACJ mobilization on shoulder range of motion – particularly with internal and external rotation. A total of 30 participants were
recruited with 10 male and 10 female participants all who were undergraduate students of a DPT program. Participants were asked to use their dominant arm to reach up and behind the
back and to reach down behind the neck with non-dominant hand. The distance between the hands in fists was measured, three measurements were taken and averaged. In addition,
internal and external rotation of the dominant side were both measured in the supine position and the average of 2 trials was taken. Following pretest measurement – ACJ mobilization was
applied by a physiotherapist for a total of 5-10 oscillations per minute and at least 3 times. The force was applied in an anterior to posterior direction and held for 10 seconds. Following the
ACJ mobilization, the participants were retested. Statistically significant change (P< 0.05) occurred in all ranges of motion.
Please provide your clinical interpretation of this paper. Include how this study may impact clinical practice and how the results can be implemented.
Based on the results of the study, it is possible for ACJ mobilizations to address limitations in functional movements of the shoulder including reaching up behind the back and reaching
down behind the neck. In addition, significant change was seen with internal and externation rotation at the shoulder. All participants were asymptomatic and had no history of shoulder
injury. Further studies look at a wider patient population including varying activity levels, shoulder pain or previous injury.
