Comparison of High-Grade and Low-Grade Mobilization Techniques in the Management of Adhesive Capsulitis of the Shoulder: Randomized Controlled Trial

Physical Therapy 2006 86: 355-368.

Henricus M Vermeulen, Piet M Rozing, Wim R Obermann, Saskia le Cessie and Thea PM Vliet Vlieland

HM Vermeulen, PhD, is Physical Therapist and Manual Therapist, Department of Physical Therapy, H0-Q, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands

PM Rozing, MD, PhD, is Professor of Orthopaedics, Department of Orthopaedics, Leiden University Medical Center

WR Obermann, MD, PhD, is Radiologist, Department of Radiology, Leiden University Medical Center

S le Cessie, PhD, is Statistician, Department of Medical Statistics, Leiden University Medical Center

TPM Vliet Vlieland, MD, PhD, is Epidemiologist, Departments of Physical Therapy and Rheumatology, Leiden University Medical Center

Background and Purpose: In many physical therapy programs for subjects with adhesive capsulitis of the shoulder, mobilization techniques are an important part of the intervention. The purpose of this study was to compare the effectiveness of high-grade mobilization techniques (HGMT) with that of low-grade mobilization techniques (LGMT) in subjects with adhesive capsulitis of the shoulder.

Subjects: One hundred subjects with unilateral adhesive capsulitis lasting 3 months or more and a 50% decrease in passive joint mobility relative to the nonaffected side were enrolled in this study.

Methods: Subjects randomly assigned to the HGMT group were treated with intensive passive mobilization techniques in end-range positions of the glenohumeral joint, and subjects in the LGMT group were treated with passive mobilization techniques within the pain-free zone. The duration of treatment was a maximum of 12 weeks (24 sessions) in both groups. Subjects were assessed at baseline and at 3, 6, and 12 months by a masked assessor. Primary outcome measures included active and passive range of motion and shoulder disability (Shoulder Rating Questionnaire [SRQ] and Shoulder Disability Questionnaire [SDQ]). An analysis of covariance with adjustments for baseline values and a general linear mixed-effect model for repeated measurements were used to compare the change scores for the 2 treatment groups at the various time points and over the total period of 1 year, respectively.

Results: Overall, subjects in both groups improved over 12 months. Statistically significant greater change scores were found in the HGMT group for passive abduction (at the time points 3 and 12 months), and for active and passive external rotation (at 12 months). A statistically significant difference in trend between both groups over the total follow-up period of 12 months was found for passive external rotation, SRQ, and SDQ with greater change scores in the HGMT group.

Discussion and Conclusion: In subjects with adhesive capsulitis of the shoulder, HGMTs appear to be more effective in improving glenohumeral joint mobility and reducing disability than LGMTs, with the overall differences between the 2 interventions being small. [Vermeulen HM, Rozing PM, Obermann WR, et al. Comparison of high-grade and low-grade mobilization techniques in the management of adhesive capsulitis of the shoulder: randomized controlled trial.]

Key Words: Adhesive capsulitis • Physical therapy techniques • Shoulder • Treatment outcome