GRADED MOBILIZATION VERSUS SHORTWAVE DIATHERMY WITH STRETCHING FOR PAIN AND RANGE OF MOTION IN ADHESIVE CAPSULITIS
Main Article Content
Keywords
adhesive capsulitis; joint mobilization; shortwave diathermy; SPADI; randomized.
Abstract
Background: Adhesive capsulitis causes painful progressive restriction of shoulder movement. Both joint mobilization and deep-heating modalities + stretching are used; direct comparisons are limited.
Objective: To compare the effect of graded (high-grade/end-range) mobilization + stretching versus shortwave diathermy (SWD) + stretching in stage-II adhesive capsulitis.
Methods: Experimental randomized allocation of 60 subjects (30 per group). Group A: graded mobilization + stretching. Group B: SWD (27.12 MHz, contraplanar pads, 20 min) + stretching. Outcomes: Visual Analogue Scale (VAS), active/passive ROM (flexion, abduction, external/internal rotation) by goniometer, and Shoulder Pain and Disability Index (SPADI). Assessments: baseline and after 4 weeks. Statistics: paired t / Wilcoxon (within-group), unpaired t / Mann-Whitney U (between-groups); SPSS v16.
Results: Both groups improved significantly from baseline on VAS, ROM and SPADI (within-group p<0.001). Between-group comparisons showed greater gains for the mobilization group in abduction (post-treatment p=0.0309; difference p=0.0120) and external rotation (post p=0.0172; difference p=0.0002). VAS between-group differences were not statistically significant (pre p=0.3077; post p=0.0604; diff p=0.2226). SPADI had baseline and post differences (pre p=0.0045; post p=0.0064) but the change (difference) between groups was not significant (p=0.7938).
Conclusion: Both interventions reduced pain and improved ROM and function; graded mobilization + stretching produced significantly greater improvements in shoulder abduction and external rotation compared with SWD + stretching.
References
2. Oatis CA. Kinesiology — The mechanics and pathomechanics of human movement. Lippincott Williams & Wilkins; 2004. p.126-136.
3. Norkin CN, Levangie PK. Joint Structure and Function. 3rd ed. Jaypee Brothers; 2001. p.196-225.
4. Kisner C, Colby LA. Therapeutic Exercise: foundations and techniques. 4th ed. Jaypee Brothers; 2003. p.322-323,224,181-183.
5. Galarraga B. Adhesive Capsulitis of the shoulder: a review article. CPD Rheumatology 2002;3(2):54-58.
6. Bunker TD. Frozen shoulder: unravelling the enigma. Ann R Coll Surg Engl 1997;79:210-213.
7. Brue S, Valentin A, Forssblad M, Werner S, Mikkelsen C, Cerulli G. Idiopathic adhesive capsulitis of the shoulder: a review. Knee Surg Sports Traumatol Arthrosc 2007;15:1048-1054.
8. Johnson AJ, Godges JJ, Zimmerman GJ, Ounanian LL. The effect of anterior versus posterior glide joint mobilization on external rotation range of motion in patients with shoulder adhesive capsulitis. JOSPT 2007 Mar;37(3):88-99.
9. Guler-Uysal F, Kozanoğlu E. Comparison of early response to two methods of rehabilitation in adhesive capsulitis. Swiss Med Wkly 2004;134:353-358.
10. Wadsworth CT. Frozen Shoulder. Physical Therapy 1986 Dec;66(12):1878-1883.
11. Anton HA. Frozen shoulder. Canadian Family Physician 1993;39:1773-1779.
12. Nilufer B, Mustafa B, Sedar T. Shoulder Adhesive Capsulitis and shoulder range of motion in type II diabetes mellitus: association with diabetic complications. J Diab Comp 1999;13:135-140.
13. Manske RC, Prohaska D. Diagnosis and management of adhesive capsulitis. Curr Rev Musculoskelet Med 2008;1:180-189.
14. Robertson VJ, Ward AR, Jung P. The effect of heat on tissue extensibility: a comparison of deep and superficial heating. Arch Phys Med Rehabil 2005;86:819-825.
15. Leung MSF, Cheing GLY. Effects of deep heating and superficial heating in the management of frozen shoulder. J Rehabil Med 2008;40:145-150.
16. Nicholson GG. The effects of passive joint mobilization on pain and hypomobility associated with adhesive capsulitis of the shoulder. JOSPT 1985;6(4):238-246.
17. Hsu et al. Changes in Abduction and Rotation Range of Motion in Response to Simulated Dorsal and Ventral Translational Mobilization of the Glenohumeral Joint. Phys Ther 2002;82(6):554-556.
18. Vermeulen HM, Rozing PM, Obermann WR, le Cessie S, Vliet Vlieland TPM. Comparison of High-Grade and Low-Grade mobilization techniques in adhesive capsulitis: randomized controlled trial. Phys Ther 2006;86(3):355-368.
19. Vermeulen HM, Obermann WR, Burger JB, Kok GJ, Rozing PM, van den Ende CM. End-range mobilization techniques in adhesive capsulitis: multiple-subject case report. Phys Ther 2000;80(12):1204-1213.
20. Johnson AJ, Godges JJ, Zimmerman GJ, Ounanian LL. (same as #8).
21. Griggs SM, Antony AHN, Green A. Idiopathic adhesive capsulitis: a prospective functional outcome study of nonoperative treatment. J Bone Joint Surg Am 2000;82-A(10):1398-1407.
22. McClure P, Balaicuis J, Heiland D, Broersma ME, Thorndike CK, Wood A. Randomized controlled comparison of stretching procedures for posterior shoulder tightness. JOSPT 2007;37(3):108-114.
23. Bulgen DY, Binder AI, Hazelman BL, Dutton J, Roberts S. Frozen shoulder: evaluation of three treatment regimens. Ann Rheum Dis 1984;43:353-360.
24. Carlsson MA. Assessment of chronic pain: reliability & validity of the VAS. Pain 1983;16:87-101.
25. Langley GB, Sheppeard H. The visual analogue scale: its use in pain management. Rheumatol Int 1985;5:145-148.
26. Hayes K, Walton JR, Szomor LZ, Murrell AC. Reliability of five methods for assessing shoulder ROM. Aust J Physiother 2001;47:289-294.
27. Carette S, Moffet H, Tardif J, Bessette L, Morin F, Fremont P, et al. Intra-articular corticosteroids, supervised physiotherapy, or combination in adhesive capsulitis. Arthritis Rheum 2003;48(3):829-838.
28. Kim JS, Dailey JR. Biostatistics for Oral Healthcare. 1st ed. Blackwell Munksgaard; 2008. p.45-46.
29. Carrie MH, Lory TB. Therapeutic Exercises: moving toward function. 2nd ed. p.664.
30. Donatelli RA. Physical Therapy of the Shoulder. 4th ed. Churchill Livingstone; 2004. p.416.
31. Wyke BD. The neurology of joints. Ann R Coll Surg Engl 1966;41:25-50.
32. Low J, Reed A. Electrotherapy Explained: principles & practice. 3rd ed. Lippincott Williams & Wilkins; 2000. p.282,294.
33. Cameron MH. Physical Agents in Rehabilitation: research and practice. 3rd ed. p.153-155.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Aquil Shaik K
Assistant Professor, Indira College of Physiotherapy, Nanded- 431606, Affiliated to MUHS, Nashik, Maharashtra
Mahantesh Biradi
Associate Professor, BVV Sangha’s College of physiotherapy, SNMC Campus, Navanagar, Bagalkot- 587103, Affiliated to RGUHS, Bangalore (Karnataka)
Syed Zubair Ahmed
Professor, Royal College of Physiotherapy, Sayne Khurd, Malegaon- 423203, Nashik Affiliated to MUHS, Nashik, Maharashtra