title: The immediate effects of soft tissue mobilization with proprioceptive neuromuscular facilitation on glenohumeral external rotation and overhead reach.
abstract: METHODS
  Randomized controlled 2-group. pretest-posttest, multivariate study of patients with shoulder musculoskeletal disorders.
  
  
  OBJECTIVE
  The purpose of this study was to evaluate the immediate effect of soft tissue mobilization (STM) with proprioceptive neuromuscular facilitation (PNF) to increase glenohumeral external rotation at 45 degrees of shoulder abduction and overhead reach.
  
  
  BACKGROUND
  It is postulated that limitation in glenohumeral external rotation, when measured at 45 degrees of shoulder abduction, represents subscapularis muscle flexibility deficits and is associated with the inability to fully reach overhead. No research, however, is available to demonstrate whether intervention strategies intended to improve subscapularis flexibility and glenohumeral external rotation range of motion at 45 degrees of shoulder abduction will improve a patient's ability to reach overhead.
  
  
  METHODS
  Twenty patients (10 males, 10 females; age range, 21-83 years) with limited glenohumeral external rotation and overhead reach of 1 year duration or less served as subjects. The subjects were randomly assigned to a treatment group, which consisted of soft tissue mobilization to the subscapularis and proprioceptive neuromuscular facilitation to the shoulder rotators, or a control group. Goniometric measurements of glenohumeral external rotation at 45 degrees abduction and overhead reach were taken preintervention and immediately postintervention for the treatment group or at prerest and postrest periods for the control group.
  
  
  RESULTS
  The treatment group improved by a mean of 16.4 degrees (95% confidence interval [CI, 12.5 degrees-20.3 degrees) of glenohumeral external rotation, as compared to less than a 1 degree gain (95% CI, -0.2 degrees-2.0 degrees) in the control group (P < .0005). Overhead reach in the treatment group improved by a mean of 9.6 cm (95% CI, 5.2-14.0 cm) in comparison to a mean gain of 2.4 cm (95% CI, -0.8-5.6 cm) for the control group (P = .009).
  
  
  CONCLUSIONS
  These findings suggest that a single intervention session of STM and PNF was effective for producing immediate improvements in glenohumeral external rotation and overhead reach in patients with shoulder disorders.
authors.affiliation: Department of Physical Therapy, School of Allied Health Professions, Loma Linda University, Loma Linda, CA, USA. Joseph.J.Godges@kp.org
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Godges
authors.forename: Melodie
authors.initials: M
authors.lastname: Mattson-Bell
authors.forename: Donna
authors.initials: D
authors.lastname: Thorpe
authors.forename: Drashti
authors.initials: D
authors.lastname: Shah
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009469:Neuromuscular Junction / Q000502:physiology*; D026741:Physical Therapy Modalities / Q000379:methods*; D011434:Proprioception / Q000502:physiology*; D016059:Range of Motion, Articular / Q000502:physiology*; D012399:Rotation; D012785:Shoulder Joint / Q000503:physiopathology*; D016896:Treatment Outcome