A Local-to-Global Exercise Paradigm, Early Stretching and Mobilization

Eric presents an exercise prescription paradigm that moves from local treatment of the shoulder, to regional work on the whole upper quarter, to global attention to biopsychosocial needs and general health. The levels can be mixed rather than followed in order. Locally, a 2019 systematic review supports Mulligan techniques, though no single manual therapy approach is favored, and treatment intensity should match the pain the patient has agreed to accept. There is low-level evidence for low-level laser therapy. Goniometer measurements give the patient immediate feedback that the discomfort of stretching is producing range of motion. The demonstrated stretch series covers flexion with clasped hands, hands behind the head for the anterior and posterior capsule, a side-lying stretch working the hand behind the back for the rotator interval, and assisted abduction. Holds start at about 30 seconds and build toward longer holds when the capsule is the limiting tissue. Mobilizations should not be single-plane only, and the sternoclavicular and scapulothoracic joints may also need attention.