When treating a patient with adhesive capsulitis after performing a particular mobilization, is it better to follow up with passive range of motion of the corresponding direction or have the patient perform active range or active assistive range?
Answer
I think both are appropriate, and I will typically do both of those things. Using that newly gained range of motion is important. After I do my mobilizations, I may do some passive range. Then, when I have them at the end-range or in that new range of motion I say, “hold your arm right there. Do not let me move you.” That's when I work on alternating isometrics. Depending on their reactivity, now I may have them do active range with or without resistance to try to facilitate the muscles in that new range of motion. That sort of falls in line with strengthening in the new range of motion. These patients must utilize that mobility. If we do not do something to help facilitate their strength and to utilize and maintain that motion, these patients may gain 20 degrees during our session then come back later that week or the next and be back to where they started. In other words, we gain it during the session, but they do not maintain it. Strengthening in the new range of motion is a big component of helping them maintain that range of motion.
David Nolan, PT, DPT, MS, OCS, SCS, CSCS
Dr. Nolan is an Associate Clinical Professor at Northeastern University in the Department of Physical Therapy, Movement and Rehabilitation Sciences as well as a Graduate Lecturer in the College of Professional Studies in the transitional Doctor of Physical Therapy Program at Northeastern University. He is also a Lecturer at Harvard Medical School in the Physical Medicine and Rehabilitation. David is also a Clinical Specialist at the Mass General Sports Physical Therapy Service and the Director of the MGH / Northeastern University Sports Physical Therapy Residency Program.
David is a board certified Orthopedic Clinical Specialist and Sports Clinical Specialist through the American Board of Physical Therapy Specialties and a Certified Strength and Conditioning Specialist through the National Strength and Conditioning Association. In 2019, Dr. Nolan was the recipient of the Lynn Wallace Clinical Educator Award from the American Academy of Sports Physical Therapy. He is a past recipient of the “Excellence in Clinical Teaching” award from the New England Consortium of Academic Coordinators of Clinical Education as well as the award for Outstanding Achievement in Clinical Practice by the Massachusetts Chapter of the APTA. In 2022, Dr. Nolan received the Richard Kessler Memorial Award from the APTA of Massachusetts. Dr. Nolan was also honored with the APTA Academy of Physical Therapy Education's Distinguished Mentor in Residency/Fellowship Education Award in the same year.
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