Shoulder Mobilization... Mulligan or Kaltenborn? Who is right?
Reference:: Harryman D, Sidles J, Clark J. Translation of the humeral head on the glenoid with passive glenohumeral motion, The Journal of Bone and Joint Surgery. 1990; (72-A): 1334-1343
Kaltenborn convex/concave rule implies that during gleno-humeral (GH) lateral rotation (at 0 degrees abduction), there is a roll posteriorly and a slide anteriorly
Considering the above mechanical concept, PTs have often performed anterior glides of the humerus in order to improve lateral rotation ROM at the GH joint. Mulligan however emphasizes performing posterior glides in order to improve lateral rotation at the GH joint.
An extensive fresh cadaver study showed that a posterior translation of the humeral head occurs with lateral rotation.
Result:Operative tightening of the posterior capsule on the cadavers (simulating a tight posterior capsule) resulted in a significant increase in anterior translation of the humeral head during arm flexion, horizontal adduction and medial.
Study Conclusion: The above mentioned study provides a biomechanical rationale for performing posterior glide mobilizations to improve lateral rotation or flexion at the GH joint.
Personal Comment:Clinically I have experienced excellent results performing posterior glides to improve GH lateral rotation, medial rotation and elevation, as the posterior capsule is frequently tight!
Posted on: February 12, 2002