Joined: March 21, 2006
I believe I was taught this exact technique on a cervical course. If I recall it was first presented by Maitland. I do use it occasionally with success. Do you grip at all through the anterior neck? Or do you simply place your overlapped thumbs over the transverse process?
Your logic sounds very good. If you get JOSPT, check out a 2007 article by Greg Haddick (a Kaiser residency grad in Cali) in which he uses PA mobs and neural glides to resolve a case of shoulder pain. It's a case-report, so take it for what it's worth, but it appears relevant to your situation.
Be firm in your stance with the orthopod. Most know that the c-spine can generate shoulder sx, but they don't know what to do about it. Simply doing a Spurling test doesn't rule it out (which is what most will do) because it has a low sensitivity.
The c-spine can actually produce real pathological problems at the shoulder. The studies I've read suggest anywhere from 20-27% of shoulder compliants to GPs are found to have no significant pathology at the shoulder, but instead have disorders of the neck. Thus the term, "non-specific arm pain" is working its way into the EBM vernacular.
I teach a CEU course on this. It's a "How To" heuristic course (i.e. based on evidence) without getting too obtuse and giving you a migraine or leaving you feel dumb.
If you're interested in knowing more, PM me.
Otherwise, keep up the good work. Hold your ground; your logic and instincts seem solid.
Michael Rinaldi, PT, OCS Avail Consulting, Inc. Rinaldi Physical Therapy
Joined: February 27, 2005
Rwillcott, Yes it is important to acknowledge the massive contribution by Maitland in joint dynamics and treatments. His methods were the basis on which I proceeded to add further value to Mobs. Cm does not rely on Active movement tests , as in maitland , is not defined into grades, and goes on for much longer than maitlands method. The effects are better, particularly where referred events are involved. I don't hold the neck as you described, and use only one thumb on cervical joints. Two is ok , but usually not required ,in that strength , as would be applied with two thumbs overlapping, is rarely needed on the neck. Differernt for lumbar and sometimes thoracic applications, there I may use two at times.