Adhesive Capsulitis
Conditions
Brief summary
This randomized controlled trial aims to compare the effects of scapular proprioceptive neuromuscular facilitation (PNF) alone versus PNF combined with latissimus dorsi myofascial release on pain, range of motion, and functional disability in patients with stage II adhesive capsulitis; a condition characterized by capsular stiffness, pain, and restricted shoulder mobility, with outcomes assessed using NPRS, goniometry, and SPADI over a 6-week intervention period.
Detailed description
Participants diagnosed with stage II adhesive capsulitis will be randomly allocated into two groups. The experimental group will receive latissimus dorsi myofascial release combined with scapular proprioceptive neuromuscular facilitation (PNF) hold-relax technique, while the control group will receive scapular PNF hold-relax technique only. Both interventions will be administered for 6 weeks, with 3 sessions per week. Outcome measures will include Numeric Pain Rating Scale (NPRS) for pain intensity, goniometry for shoulder range of motion, latissimus dorsi length test for muscle tightness, and Shoulder Pain and Disability Index (SPADI) for functional disability. Data will be analyzed using IBM SPSS version 26.
Interventions
OTHERMyofascial release+ Scapular Proprioceptive Neuromuscular Facilitation (PNF) hold-relax technique
Participants in the experimental group will receive a combination of latissimus dorsi myofascial release (MFR) and scapular proprioceptive neuromuscular facilitation (PNF) using the hold-relax technique. Myofascial release will be applied to the latissimus dorsi muscle with the patient positioned in side-lying (affected side up) or supine with the shoulder in flexion. The therapist will apply slow, sustained pressure along the posterior axillary fold and lateral border of the scapula, following the muscle fibers toward the thoracolumbar fascia. The technique will include sustained pressure, longitudinal gliding, and passive shoulder elevation until a tissue resistance barrier is reached. Each stretch will be maintained for 90-120 seconds, with a total MFR duration of approximately 10-15 minutes per session. Following MFR, scapular PNF will be performed using the posterior elevation to anterior depression pattern. The hold-relax technique will involve isometric contractions of 5-7 seco
OTHERScapular PNF hold-relax only
Participants in the control group will receive scapular proprioceptive neuromuscular facilitation (PNF) using the hold-relax technique without the addition of myofascial release. The intervention will follow the scapular posterior elevation to anterior depression pattern. Each repetition will include an isometric contraction lasting 5-7 seconds followed by a passive stretch of 10-15 seconds. A total of 3 sets with 5 repetitions per set will be performed in each session, with an overall duration of approximately 20 minutes. In addition, a hot pack will be applied to the affected area for 10-15 minutes prior to the exercise session to promote muscle relaxation. Treatment sessions will be conducted three times per week for a duration of 6 weeks.
Sponsors
Ibadat International University, Islamabad
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Masking description
Outcome assessor will be blinded to group allocation.
Intervention model description
Two-arm parallel group randomized controlled trial
Eligibility
Sex/Gender
ALL
Age
35 Years to 70 Years
Healthy volunteers
No
Inclusion criteria
* 1\. Age between 35 and 70 years. * Both male and female participants. * Stiffening (Stage II) phase of frozen shoulder. * Pain intensity ≥ 4/10 on NPRS during shoulder movement. * Unilateral shoulder involvement. * Presence of capsular pattern:ER \> ABD \> IR limitation * Apley's Scratch Test * Limited both ROMs * Symptom duration between 3 and 9 months.(Di Mascio et al., 2024)
Exclusion criteria
* Secondary adhesive capsulitis due to trauma or surgery * History of shoulder fracture or dislocation. * Bilateral frozen shoulder. * Active systemic inflammatory or neurological disease * Recent intra-articular corticosteroid injection (within last 3 months) * Current anticoagulation therapy or bleeding disorders. * Pregnant females.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Pain Intensity | baseline to 6 weeks | Numeric Pain rating scale(NPRS) will be used. It is the numeric version of visual analogue scale used to assess the intensity of pain. The 11-point numeric scale ranges from '0' representing one pain extreme (e.g. "no pain") to '10' representing the other pain extreme. it has moderate to excellent reliability and good validity |
| Shoulder Range of Motion (ROM) | baseline to 6 weeks | Measured using a universal goniometer. Shoulder flexion, abduction, external rotation, and internal rotation will be assessed at baseline and at 6 weeks. |
| Latissimus Dorsi Length Test | baseline to 6 weeks | It is used to check the tightness of latissimus dorsi muscle. The patient is in supine lying with knees bend and back flattened to the floor, arm elevated overhead. if there is tightness of this muscle person's unable to flexed his arm by 180° and compensated by arching its back also with the help of goniometer measurement starts with axis at the humeral head , stationary arm midline to the body and moveable arm parallel to the longitudinal axis of the humerus a normal full length muscle allows the arms to touch the table while shortened muscle not allow them to touch the table. |
| Shoulder Pain and Disability Index (SPADI) | baseline to 6 weeks | The Shoulder Pain and Disability Index (SPADI) is a self-administered questionnaire used to assess pain and functional disability associated with shoulder conditions. It consists of 13 items divided into two subscales: pain (5 items) and disability (8 items). Each item is scored on a scale from 0 to 10, where 0 indicates no pain or difficulty and 10 indicates the worst pain or maximum difficulty. The total score is calculated by averaging the scores of both subscales and converting them into a percentage ranging from 0 to 100, with higher scores indicating greater pain and disability. |
Countries
Pakistan
Contacts
CONTACTHufsa Naseer, DPT, MS-PT MSK
CONTACTFatima Amjad, DPT, MS-PT Sports, PHD Scholar
Outcome results
None listed