Assessment and management of shoulder stiffness: a biomechanical approach.

T he problem of motion, as described in Butterfield's The Origin of Modern Science, relates to the 17th-century dilemma of understanding motion or, more specifically, inertia from a mechanistic viewpoint. 1 As we near the 21st century, health care professionals continue to be confronted with the problem of motion or, more specifically, the lack of motion in our patients' joints. Unlike Calileo's contemporaries, today's clinicians are comfortable with biomechanical descriptions of the force, motion, and strength of biologic tissues. However, intellectual hurdles pertaining to motion continually need to be cleared. Despite the fact that restoring functional, painfree range of motion (ROM) to stiff joints is one of the most common clinical endeavors of therapists, there is a great discrepancy among treatment approaches. 2 This may be due in part to the lack of objective clinical comparisons of treatments for shoulder stiffness. It may also be due to the manual therapy approach for managing stiffness, which has evolved from an eclectic set of evaluation and treatment procedures. 3 Consequently, the treatment of patients who have stiff shoulders traditionally comprises a variety of treatments. These vary from ROM activities and soft-tissue/joint mobilization techniques5,6 to continuous passive motion (CPMf,8 and splinting of the shoulder. 9 Hand therapists deal with joint stiffness on a

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