Physiotherapy Research International
Physiother. Res. Int. (in press)
Published online in Wiley InterScience
(www.interscience.wiley.com) DOI: 10.1002/pri.353
Assessment of the importance
of glenohumeral peripheral mechanics
by practicing physiotherapists
KENNETH KIRBY Duke University, Durham, North Carolina, USA
CHRIS SHOWALTER Maitland Australian Physiotherapy Seminars, Cutchogue, New
York, USA
CHAD COOK Division of Physical Therapy, Duke University, Durham, USA
ABSTRACT Background and Purpose. Physiotherapists develop clinical reasoning theories and applied manual therapy skills through a variety of educational exposures. No
studies have assessed the importance of selected theories such as the convex–concave rule,
capsular pattern and scapulohumeral rhythm during clinical decision-making by physiotherapists. The present study investigated which variables physiotherapists considered were
associated with the importance of these theories during practice and investigated physiotherapists’ perception of translational motion biomechanics of the glenohumeral (GH)
joint. Method. Six hundred and sixty physiotherapists in the USA volunteered to participate in this study. Using ologit regression analyses, the identifier themes and clinical
background characteristics were associated with importance of peripheral biomechanics
in manual therapy application and reliability/validity of the scapulohumeral rhythm theory
in predicting pathological sequences of the shoulder complex. An intraclass correlation
coefficient (ICC) was used to determine agreement regarding necessary translation of the
GH joint for normal movement. Results. The majority of physiotherapists indicated that
all theories were important or very important during treatment decision-making and
reported frequent utilization. Regression models identified that the importance placed on
peripheral biomechanics was negatively influenced by academic qualification (bachelors
and masters degrees) and gender (men were less likely to report that scapulohumeral
rhythm was a reliable/valid predictor of shoulder pathology). ICC values identified excellent agreement among clinicians regarding translational motion. Conclusions. The importance of biomechanics of the periphery for use, validation and frequency was based heavily
on adoption of selected theories of glenohumeral movements despite evidence that suggests
the theories lack validity. Copyright © 2007 John Wiley & Sons, Ltd.
Key words: capsular pattern, convex–concave, ologit, peripheral biomechanics, shoulder
Copyright © 2007 John Wiley & Sons, Ltd
Physiother. Res. Int. (in press)
DOI: 10.1002/pri
Kirby et al.
INTRODUCTION
Physiotherapists develop clinical reasoning
theories and applied manual therapy skills
through a variety of educational exposures,
including academic degree programmes,
clinical residency and fellowship training,
continuing education and informal individual mentoring (Boissonnault et al., 2004). In
the USA, manual therapy interventions,
including mobilization or manipulation for
peripheral and spinal joints, are a standard
inclusion in physiotherapists’ education curricula according to the Normative Model of
Physical Therapist Professional Education
(American Physical Therapy Association,
2004) and accreditation criteria for physiotherapist education programmes (Commission on Accreditation in Physiotherapy
Education, 2004).
Physiotherapy interventions are based
upon measurements from many clinical
tests collected during the evaluation process
(Riddle, 1992; Kaltenborn, 1993). Passive
physiological and accessory motion testing
by orthopaedic manual therapists are
frequently employed to determine appropriate treatment choices (Kaltenborn, 1993;
Roubal et al., 1996). Passive physiological
movements are fundamental techniques of
clinical judgement in determining joint
stiffness and corresponding treatment
(Battie et al., 1994) while accessory motions
involve the articular movements of roll,
spin and glide (Kaltenborn, 1993). Many
physiotherapy disciplines base their manual
treatment techniques on selected theories of
peripheral mechanics, educational models
learnt in the classroom and continuing education settings (Boissonnault and Bryan,
2005).
Prevalent theories associated with glenohumeral (GH) movements, germane to
selection of treatment interventions of the
Copyright © 2007 John Wiley & Sons, Ltd
shoulder include the theory of convex–
concave rule of arthrokinematics, Cyriax’s
capsular pattern and the scapulohumeral
rhythm theory. These theories have been
purported as useful in diagnosis and essential for subsequent treatment of musculoskeletal related maladies (Cyriax, 1947;
Hoppenfeld, 1976; Kaltenborn, 1980;
Cyriax, 1982; Magee, 1987; Corrigan and
Maitland, 1988; Reid, 1992; Donatelli, 1997;
Neumann, 2002).
MacConaill (1953) was one of the first to
investigate intra-articular joint kinematics,
based on theoretical movements between
articular surfaces. Terminology was introduced to describe a predictable movement
pattern based on the contact of the articular
surface of the distal (moving) segment on
the articular surface of the proximal (stable)
segment. Slide, also called ‘glide’, occurred
when a single point on one articular surface
contacts multiple points on another articular
surface. Roll, also called ‘rock’, occurred
when multiple points along one rotating
articular surface contacted multiple points
on another articular surface. Spin occurred
when a single point on one articular surface
rotates on a single point on another articular
surface.
Based on MacConaill’s observations,
Kaltenborn (1980) advocated the use of
the convex–concave rule to describe intraarticular kinematics during manual therapy.
In summary, this rule purports that concave
articular surfaces moving on convex surfaces will roll and glide in the same direction, whereas the movement of convex
surfaces on concave will result in roll and
glide in the opposite directions (Baeyens et
al., 2000). In essence, this theory states that
the surface geometry of a joint determines
the accessory movement pattern during
physiological movement. Therefore, examination and treatment are guided by the joint
Physiother. Res. Int. (in press)
DOI: 10.1002/pri
Importance of glenohumeral peripheral mechanics
geometry and variations are considered
either abnormal or inappropriate.
Cyriax (1982) established the concept of
capsular patterns as an essential element of
soft tissue examination. He proposed that all
synovial joints demonstrated range of motion
loss in proportional plane-based movements
when certain pathologies existed, which
solely affected the joint capsule. For the GH
joint, Cyriax (1982) proposed the following
pattern of plane-based loss of range: external rotation limited at a greater rate than
abduction, which in turn is limited at a
greater rate than internal rotation. He emphasized looking for the capsular pattern during
passive range of motion testing because this
would help the clinician implicate the structure responsible for the limited movement,
namely the joint capsule.
A widely cited study on the kinematics
of the shoulder (Inman et al., 1944) stated
that GH joint abduction/flexion occurs concurrently with scapular upward rotation, an
observation now referred to as ‘scapulohumeral rhythm’. Inman et al. (1944) also
stated that this natural timing or kinematic
rhythm was fairly constant throughout most
of GH abduction, occurring at a ratio of 2 : 1
(for every 3° of shoulder abduction, 2° occur
by GH abduction and 1° occurs by scapular
upward rotation). Considering this, a full arc
of shoulder abduction (180°) is the result of
120° of GH abduction and 60° of scapular
upward rotation.
At present, we know of no studies that
have investigated the prevalence and estimated importance of these theories during
clinical decision-making by physiotherapists. Because teaching these theories and
subsequent manual therapy treatment interventions involves preparation that is
enhanced during clinical education experiences (Boissonnault et al., 2004) and is significantly influenced by the assigned clinical
Copyright © 2007 John Wiley & Sons, Ltd
instructor (Boissonnault and Bryan, 2005)
we felt that practising physiotherapists
would most appropriately reflect the current
trends of use. Now that recent literature
regarding the theories of selected intervention methods is available (Harryman et al.,
1990; Brossmann et al., 1996; Winters
et al., 1997a; Winters et al., 1997b; Conroy
and Hayes, 1998; Bang and Deyle, 2000;
Hsu et al., 2002; Lewis et al., 2005) and
since considerable differences in how
manual intervention is integrated into professional practice exists, we were interested
in investigating two primary objectives.
First, we planned to investigate which variables physiotherapists consider are associated with the importance of peripheral
biomechanics in determination of use, validation and frequency of use during practice.
Second, we endeavoured to investigate
physiotherapists’ perception of translational
motion biomechanics of the GH joint in a
non-pathological individual that would
identify if clinicians agree on a specific
amount of translational motion.
METHOD
Sample
Six hundred and sixty (660) practising bachelors, masters and doctoral-trained physiotherapists participated in this study (Table
1). The physiotherapists were voluntary participants of a continuing education course
that focused on peripheral manual therapy
techniques. The courses were not part of an
organized degree-granting process and primarily addressed Maitland/Australian based
methods of assessment and treatment. The
course was the first in a series of four manual
therapy courses and was the only course that
focused solely on peripheral manual therapy
methods.
Physiother. Res. Int. (in press)
DOI: 10.1002/pri
Kirby et al.
TABLE 1: Demographic background of survey
respondents
Age (years)
Mean
Standard deviation
Range
Gender
Male
Female
Missing
Experience (years)
0–5
6–10
11–15
16–20
>20
Missing
Physical therapy education
Bachelors
Masters
Doctoral
Certificate
Background
Cyriax
Maitland
McKenzie
Paris
Other — not designated
Osteopathic
Kaltenborn
IAOM*
Mulligan
Grimsby
NAIOMT**
Eclectic
Mean
33.4
7.1
23–60 (8 missing)
301
355
8
327
182
79
35
24
13
survey was administered during the pre-registration period, prior to the initiation of the
coursework or discussion of the manual
therapy philosophy. Pre-course administration of the survey reduced the potential of
bias regarding peripheral biomechanical
constructs and allowed subjects to record
their responses based on present knowledge
of the selected theories of the GH joint. The
physiotherapists were provided with written
instructions requesting that they answer the
questions to the best of their ability. The
survey consisted of 15 questions; the first six
were ordinal Likert-type questions which
included the following.
286
320
53
1
•
17
97
107
30
76
17
17
5
16
5
6
267
•
* International Academy of Orthopedic Medicine.
** North American Institute of Orthopedic Manual
Therapy.
•
•
•
•
How important do you feel the theory of
peripheral biomechanics is (e.g. roll, spin
and slide) in your application of manual
therapy?
How important do you feel the theory of
peripheral biomechanics is (e.g. roll, spin
and slide) in validating manual therapy?
How often do you consider, or use roll,
spin and slide during your manual therapy
treatment?
How reliable/valid do you feel the
convex–concave theory is in predicting
articular motion of the GH joint?
How much translational motion (in mm)
is needed for normal shoulder function in
abduction, flexion and extension?
How reliable/valid do you feel the scapulohumeral rhythm theory is in predicting
pathological sequences in the shoulder
complex?
Procedure
Each consecutive course participant was
recruited to participate voluntarily in the
survey. The data collected were part of
information gathered to focus the educational material toward gaps in knowledge
from the participants of the course. The
Copyright © 2007 John Wiley & Sons, Ltd
The remaining questions were associated
with frequency of manual therapy course
attendance, manual therapy background or
discipline, educational degree, years of practice experience, age and gender. Manual
therapy background is exposure or completion of a manual therapy continuing educa-
Physiother. Res. Int. (in press)
DOI: 10.1002/pri
Importance of glenohumeral peripheral mechanics
tion group within or outside the USA, which
has influenced the participant’s assessment
and treatment. Background does not reflect
membership within a nationally sponsored
organization such as the Association of
Chartered Physiotherapists in Orthopaedic
Medicine (ACPOM), Society of Orthopaedic Medicine (SOM), or the American
Academy of Orthopedic Manual Physical
Therapists (AAOMPT).
All data were collected and coded to
ensure confidentiality. A blinded data
administrator processed the data using SPSS
Version 11.0.1 and participated in the statistical analysis. The database was approved by
the Duke University Institutional and Ethics
Review Board.
Statistical analysis
Using SPSS Version 11.0.1, descriptive and
inferential statistical analyses were performed. Descriptive statistics were used to
outline the frequencies of manual therapy
course attendance, manual therapy background or discipline, gender and educational
degrees, and the mean years of practice
experience and age of the participants. Two
separate ologit regression analyses were performed using the dependent variable question ‘How important do you feel the theory
of peripheral biomechanics is (e.g. roll, spin
and slide) in your application of manual
therapy?’ and the dependent variable question ‘How reliable/valid do you feel the
scapulohumeral rhythm theory is in predicting pathological sequences in the shoulder
complex?’ An ologit (maximum likelihood
ordered logit regression) regression analysis
fits ordered logit models of an ordinal (polytomous) dependent variable against the
selected independent variable questions.
Independent variables can exist using any
form of data; those variables that are nominal
Copyright © 2007 John Wiley & Sons, Ltd
and ordinal are dummy coded allowing individualized association to the dependent variable. Since the dependent variable question
values consist of ranks without order, the
actual values taken on by the dependent
variable are irrelevant except that larger
values are assumed to correspond to probability of changing one lower Likert choice to
one ‘higher’ outcome, and vice versa (Field,
2001).
Since the question associated with ‘How
much translational motion (in mm) is needed
for normal shoulder function in abduction,
flexion, and extension?’ involved ratio data,
a model 2.1 intraclass correlation coefficient
(ICC) was used to determine inter-rater reliability among the respondents. Although no
standards exist that determine acceptable
reliability, values close to 1.0 represent stronger reliability, whereas values closer to 0.0
represent weak reliability.
RESULTS
Descriptive findings
The majority (81.6%) of the participants
indicated that the theory of peripheral biomechanics (e.g. roll, spin and slide) was
‘very important’ or ‘important’ in their
application of manual therapy. Only five participants (0.8%) of the 660 identified the
theory of peripheral mechanics as ‘not
important’. Furthermore, a large proportion
(73.1%) of participants indicated that the
theory of peripheral biomechanics (e.g. roll,
spin and slide) was ‘very important’ or
‘important’ in validating manual therapy,
and (88.7%) of the participants reported
they ‘frequently’, ‘somewhat frequently’ or
‘sometimes’ consider or use roll, spin and
slide during their manual therapy treatment.
Slightly over 70% of the participants felt that
the convex–concave theory is ‘very reliable’
Physiother. Res. Int. (in press)
DOI: 10.1002/pri
Kirby et al.
or ‘somewhat reliable’ in predicting articular
motion of the GH joint. Lastly, 77.4% of the
participants felt that the scapulohumeral
rhythm theory is ‘very reliable’ or ‘somewhat reliable’ in predicting pathological
sequences of the shoulder complex.
Inferential finding, ologit regression
The model fit value for the first ologit regression using the dependent variable ‘How
important do you feel the theory of peripheral biomechanics is (e.g. roll, spin and slide)
in your application of manual therapy?’ was
significant (p ≤ 0.0001; χ2 test = 445.9). The
Nagelkerke pseudo R2 was 0.59, indicating
that the goodness of fit within this model
was good. The Nagelkerke pseudo R2 measures the explanatory power of the model, a
similar concept to the regression coefficient
in a linear model (Long, 1997). The first
ologit regression yielded four significant
results. First, the likelihood that therapists
who indicated that peripheral biomechanics
was important was influenced by their academic degree. Both bachelor’s and master’s
level clinicians were less likely to report the
importance of use of roll spin and slide
during treatment application than doctoraltrained clinicians (p ≤ 0.0001). Second,
those who felt that the theory of peripheral
biomechanics was important for validation
of manual therapy were also more likely to
consider the use of peripheral biomechanics
as ‘important’; specifically, those who
reported ‘very important’ (p < 0.0001; χ2
test = −4.64) and ‘important’ (p = 0.004; χ2
test = −1.86). Several variables approached
but did not meet significance, including
‘How reliable/valid do you feel the convex–
concave rule is in the predicting articular
motion of the GH joint?’ (p = 0.053; χ2 test
= 3.84) and those who reported a North
American Institute of Orthopedic Manual
Physiotherapy (NAIOMPT) background (p
= 0.059; χ2 test = 2.42). Both were positively
associated with use. The first ologit regression results are outlined in Table 2.
The model fit value for the second ologit
regression was significant (p ≤ 0.0001; χ2
test = 159.1). The Nagelkerke pseudo R2 was
0.26, also indicating that the goodness of fit
within this model was fair. The second ologit
regression using the dependent variable
‘How reliable/valid do you feel the scapulohumeral rhythm theory is in predicting pathological sequences in the shoulder complex?’
yielded two significant results. First, men
were less likely to report that scapulohumeral
rhythm was a reliable/valid predictor of
shoulder pathology (p = 0.007; χ2 test =
0.476). Additionally, those who felt that the
TABLE 2: Ologit regression 1: ‘How important do you feel the theory of peripheral biomechanics is (e.g.
roll, spin and slide) in your application of manual therapy?’
Variable
B
SE
Wald χ2
Bachelor’s degree
Master’s degree
Importance of peripheral biomechanics in validating manual
therapy (‘very important’)
Importance of peripheral biomechanics in validating manual
therapy (‘important’)
16.44
16.34
−4.64
0.407
0.385
0.676
1630.1*
1799.2*
47.2*
−1.86
0.638
8.5**
* Indicates level of significance p ≤ 0.05; ** indicates level of significance p0.0001; only variables that were
significant (p ≤ 0.05) are reported. B = Beta; SE = Standard Error.
Copyright © 2007 John Wiley & Sons, Ltd
Physiother. Res. Int. (in press)
DOI: 10.1002/pri
Importance of glenohumeral peripheral mechanics
TABLE 3: Ologit regression 2: ‘How reliable/valid do you feel the scapulohumeral rhythm theory is in predicting pathological sequences in the shoulder complex?’
Variable
B
SE
Wald χ2
Male gender
Importance of peripheral biomechanics in validating manual therapy
(‘very important’)
0.467
−1.72
0.176
0.624
7.31**
7.59**
* Indicates level of significance p ≤ 0.05; ** indicates level of significance p ≤ 0.0001; only variables that
were significant (p ≤ 0.05) are reported. B = Beta; SE = Standard Error.
theory of peripheral biomechanics was
important for validation of manual therapy
were also more likely to consider the use of
peripheral biomechanics as ‘important’, specifically those who reported ‘very important’ (p ≤ 0.0001; χ2 test = −1.72) were
significantly likely to report that scapulohumeral rhythm is very reliable/valid at predicting shoulder pathology. NAIOMPT
background approached significance (p =
0.074; χ2 test = 1.59) and was positively associated with reliability of the scapulohumeral
rhythm but no other variables approached
significance. The second ologit regression
results are presented in Table 3.
The Model 2.1 ICC (model 2.1) was significant (p ≤ 0.0001) and provided an average
measure of 0.866 (95% CI = 0.84 to 0.88).
This finding suggests that there is strong
agreement among clinicians regarding their
assessment of translational motion (in mm)
needed for normal shoulder function.
DISCUSSION
The findings of this study indicate that physiotherapists support the importance of key
theories associated with peripheral shoulder
biomechanics for practice use and validation. The majority of the surveyed participants reported that the theory of peripheral
biomechanics associated with the convex–
concave rule (e.g. roll, spin and slide) is
Copyright © 2007 John Wiley & Sons, Ltd
important or very important in validating
manual therapy; while a similar number feel
that the convex–concave theory is at least
‘somewhat reliable’ in predicting articular
motion of the GH joint. A majority also felt
that the scapulohumeral rhythm theory is
somewhat or very reliable in predicting
pathological sequences of the shoulder
complex. Nearly all of the participants
claimed they consider, or use roll, spin and
slide as least sometimes during their manual
therapy treatment. Furthermore, the clinicians demonstrated strong agreement about
the quantity of translational motion needed
for normal shoulder function.
Our study found that clinicians’ preconcept of available translation within the
GH joint demonstrates excellent agreement.
This finding is promising since the GH joint
frequently exhibits translatory-only movements during pathology and an understanding of normal available movement is essential
to recognize pathological conditions (Howell
et al., 1988; Paletta et al., 1997; Matsen
et al., 1998; Baeyens et al., 2000). During
pathology, it is common for the humerus to
translate anteriorly and/or superiorly in the
GH joint (Harryman et al., 1990; Brossmann
et al., 1996). Harryman et al. (1990) suggested that this phenomenon is associated
with asymmetric tightening of the posterior
capsule, which results in translation of the
humeral head in the opposite direction of the
Physiother. Res. Int. (in press)
DOI: 10.1002/pri
Kirby et al.
limited capsule. Because translation is an
essential element of accessory mobilizations, and since proper dosage should be
considered important during treatment, this
finding is promising. We know of no studies
that have investigated force dosage or a
similar form of quantitative assessment at
the shoulder but according to our findings,
clinicians should expect to produce similar
linear values regarding distance.
Recent information has suggested that
evidence to support the convex–concave
theory for the GH joint, is poor (Howell et
al., 1988; Paletta et al., 1997; Matsen et al.,
1998; Baeyens et al., 2000). Although joint
mobilization techniques have demonstrated
benefit for patients with various shoulder
pathologies it is questionable whether these
benefits require the specificities of the
convex–concave rule. Selected authors have
reported that mobilization techniques are
preferable to physiological stretching because
the movements provide a precise stretch to
the restricted aspect of the capsule (when
pre-positioned in the restricted position)
with less subsequent pain, less force and less
compression on painful structures (Johns
and Wright, 1962; Lundberg, 1969; Conroy
and Hayes, 1998). End range mobilizations,
irrespective of the convex–concave rule,
have long been advocated for improvement
of range of motion (Wadsworth, 1986;
Edmond, 1993). End range mobilizations
that engage the restricted aspect of the
capsule do lead to multi-directional improvements in range of motion for patients
with adhesive capsulitis or other conditions
associated with range of motion losses
(Vermeulen et al., 2000). These findings
suggest that selection of manual therapy
technique that focuses on a specific direction
based solely on the convex–concave rule
may not yield values any better than the
antagonistic direction at the shoulder.
Copyright © 2007 John Wiley & Sons, Ltd
A methodical evaluation of the existence
of a capsular pattern of the shoulder as proposed by Cyriax has not yet been performed;
however, several studies have identified
variability of a capsular pattern of the shoulder (Warner et al., 1996; Donatelli, 1997;
Winters et al., 1997b; Rundquist et al., 2003;
Rundquist and Ludewig, 2004). Cyriax
(1978) initially proposed that pathology in
the shoulder results in range of motion loss
in proportional patterns based on a ratio (3
to 2 to 1), external rotation is limited more
than abduction that is limited more than
internal rotation proportionally. He used
this ratio to differentiate between losses of
motion secondary to bony, muscle, or capsular changes. Donatelli (1997) described a
‘modified capsular pattern’ where external
rotation at 0° was more restricted than external rotation at 90° of shoulder abduction followed by internal rotation at 90° of shoulder
abduction. In contrast, Warner et al. (1996)
found that external rotation at 0° was more
restricted than internal rotation at 90° and
than external rotation at 90°. If indeed these
considerable variations exist in the proposed
capsular pattern, then the ability to differentiate losses of motion secondary to bony,
muscle or capsular changes is questionable.
Since the time of Inman’s work in 1944,
several studies have examined the kinematics of shoulder abduction with emphasis of
motion in the scapular plane (Freedman and
Munroe, 1966; Poppen and Walker, 1976;
Bagg and Forest, 1988; Paletta et al, 1997;
Mandalidis et al., 1999) and on motion while
lifting different loads (McQuade and
Schmidt, 1998). These studies reported variations in Inman’s original work. For example,
Bagg and Forrest (1988) reported a mean
GH to scapular rotation of 3.29 : 1 between
21° and 82° of abduction, 0.71 : 1 between
82° and 139° of abduction, and 1.25 : 1
between 139° and 170° of abduction.
Physiother. Res. Int. (in press)
DOI: 10.1002/pri
Importance of glenohumeral peripheral mechanics
However, Inman’s classic ratio of 2 : 1
remains a valuable maxim regardless of the
differing ratios reported in literature, due to
its ease of remembrance and ability to help
clinicians visualize the relationship between
the humerus and scapula during the full
range of shoulder abduction.
rized their approach on a background or discipline in which they were not versed or
skilled in. Many indicated that their approach
did not follow one specific background and
selected ‘eclectic’. The possibility exists that
one’s exposure to a particular manual therapy
model included incorrect or misinformation,
thus reducing the purity of the model.
Limitations of the study
CONCLUSIONS
The findings of this survey were drawn from
participants of one manual therapy continuing education programme in the USA. This
particular approach does not focus heavily on
biomechanical theories such as the convex–
concave rule or capsular pattern theory
during peripheral manual therapy assessment
and treatment. The possibility exists, though
unlikely according to the level of importance
most clinicians placed on the theory of peripheral biomechanics, that the participants of the
course selected this particular manual therapy
continuing education course based on this
reason. Nearly 82% of the survey respondents indicated that the theory of peripheral
biomechanics was important in their application of manual therapy, a figure that supports
adherence to biomechanical principles. Furthermore, these findings are limited to US
clinicians and generalization to non-US clinicians is inappropriate.
Because the majority of clinicians selected
the higher Likert-type categories, the chance
of meeting significance for each variable
was reduced. An ologit regression requires
relatively moderate dispersion of selections
across all Likert-type categories for improved
sensitivity. Consequently, some of the variables that approached or did not meet significance may have been significant if more
participants had indicated that biomechanics
were not important during their clinical
decision-making. Additionally, it is likely
that many of the course participants catego-
Copyright © 2007 John Wiley & Sons, Ltd
The findings of our study demonstrate the
physiotherapists agree on the available translation of motion in the GH joint but make
clinical decisions based on selected biomechanical principles that may lack validity.
Basing decision solely on biomechanical
theories may result in techniques that are not
optimal for patient improvement. Because
the majority of clinicians identify the use of
these principles, the risk of a sub-optimal
outcome is disconcerting. Future research
should investigate whether clinicians can
accurately detect peripheral biomechanics as
determined by 3-D motion analysis research.
Additionally, future investigation whether
peripheral biomechanical findings in the
clinic are reflective of preconceived translational motion is worth exploration.
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