No studies have evaluated the combination of these two types of treatment before
Adhesive capsulitis, or frozen shoulder, is a condition that causes stiffness and pain in the shoulder joint. It restricts the function and motion of the shoulder, which makes it difficult to perform many activities normally. Frozen shoulder is most common in adults between the ages of 40-65 and those who have had the condition in the past, and its cause is still not well understood. Treating frozen shoulder is a long and difficult process, and there are several different strategies that may be used. One of them is called joint mobilization, in which a physical therapist moves the shoulder in different directions to increase its flexibility and reduce pain. Another is manual stretching exercises, which are stretches that are also performed by a physical therapist for the same purpose. Although these techniques have been supported by medical literature as to be effective, combining the two of them has not yet been studied. Therefore, a study called a randomized-controlled trial (RCT) was conducted on the topic. RCTs are the most powerful type of individual studies available, and they compare two groups of patients that are randomly assigned to different treatments.
Two small groups of patients undergo treatments for six weeks
Individuals with frozen shoulder were recruited to participate in the RCT and evaluated to determine if they fit the necessary criteria. Of the 42 patients that were screened, 26 fit the criteria and were then randomly assigned to either the joint mobilization and stretching group or the stretching exercise alone group. Treatment took place during three sessions each week for six weeks, with patients in the combination group receiving both treatments, while the others only received stretching exercises. The joint mobilization exercises were applied by the physical therapist at a lower rate at first, and their intensity increased further into the treatment sessions. This was dependent on the tolerance and pain of each patient. The therapist completed stretching exercises while the patient lay on the bed in 20-minute sessions of 20 seconds of stretching followed by 10 seconds of rest. In addition, patients in both groups followed a home-exercise program twice a day for the duration of treatment. These consisted of 10 repetitions of stretching and strengthening exercises, and patients were told to continue these for at least one year after treatment. All patients were assessed for pain, disability and flexibility before treatment, immediately afterwards, and then one year later.
Combining both treatments is more effective than stretching exercises alone
Results showed that the patients who received the combination of joint mobilization and stretching exercises experienced better outcomes than those who only had stretching exercises. This was seen in measurements for flexibility, pain, shoulder function and the ability to perform daily activities, and the improvements were present up to one year later. These findings suggest that the addition of joint mobilizations to manual stretching exercises leads to the best possible outcomes for patients with frozen shoulder. All physical therapists are capable of performing both of these techniques, and patients with frozen shoulder are therefore encouraged to seek out their services when deciding what type of doctor to visit for treatment.
-Summarized by Greg Gargiulo
As reported in the August ’16 issue of Clinical Rehabilitation