Wednesday, September 9, 2009

Challenging the CCR (concave-convex rule) mobilization convictions


Our peer’s classes on mobilization start with explanation of articular anatomy & McConnell joint classifications. It is followed by CCR with technique applications obeying the CCR.

For shoulder mobilization it goes like this:

1. To regain ER – Anteriorly directed glides.
2. To regain ABD – Inferiorly directed glides
3. To regain IR – posteriorly directed glides

Many times conventional wisdom is challenged when the research reports are contra posed. A paper JOSPT (2007) claimed that posteriorly directed joint mobilization technique was more effective than an anteriorly directed mobilization technique for improving external rotation ROM in subjects with adhesive capsulitis. However in groups comprised of both anterior directed glides compatible to CCR and posterior glides opposite to CCR recommendation had a significant decrease in pain.

Reference:

Johnson AJ et al; J Orthop Sports Phys Ther. 2007 Mar;37(3):88-99.


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