Adhesive capsulitis is a debilitating shoulder condition characterized by pain, restricted range of motion (ROM), and significant functional limitations. Conventional treatment primarily targets the glenohumeral joint, often neglecting the role of regional interdependence, particularly the thoracic spine's influence on shoulder mobility. Emerging evidence suggests that thoracic spine mobility plays a crucial role in optimizing shoulder mechanics, yet its therapeutic application in adhesive capsulitis remains underexplored. This study aims to investigate the additional effects of thoracic spine mobilization combined with glenohumeral joint mobilization, providing a more comprehensive rehabilitation approach to enhance pain relief, ROM, and functional outcomes.
A randomized controlled trial (RCT) will be conducted over one year at the Rehabilitation Department of Fauji Foundation Hospital (FFH) after obtaining ethical approval. Participants diagnosed with adhesive capsulitis will be selected through non-probability purposive sampling based on predefined inclusion and exclusion criteria. Subjects will be randomly assigned to either the experimental group receiving thoracic spine mobilization alongside glenohumeral joint mobilization or the control group receiving glenohumeral joint mobilization alone. Randomization will be conducted using the coin toss method and block randomization to ensure balanced subject distribution.
Outcome measures include the Numeric Pain Rating Scale (NPRS) for pain assessment, the Shoulder Pain and Disability Index (SPADI) for functional disability evaluation, and a goniometer for ROM measurement. Baseline and post-treatment scores will be statistically analyzed using SPSS to determine intervention effectiveness. By integrating thoracic spine mobilization into standard treatment, this study seeks to refine clinical rehabilitation protocols, improve functional recovery, and enhance patient outcomes. Findings may contribute to evidence-based practice, supporting the inclusion of thoracic spine mobilization in treatment guidelines for adhesive capsulitis.
• Both male and female patients with a primary complaint of unilateral or bilateral shoulder pain
Pain has persisted for at least 3 to 4 months
Decreased shoulder ROM observed, including external shoulder rotation, abduction, internal rotation, and flexion
Age range between 40 to 65 years
• Patients if they had any shoulder pain resulting from systematic disease such as Rheumatoid Arthritis (morning stiffness > 1 hour, multiple small joints pain/swelling) Infection, Tumors, and conditions like myelopathy (Hoffman's sign).
Recent shoulder joint fracture/ trauma.
Thoracic Outlet Syndrome (Roos test).
The presence of Cervical radiculopathy (Spurling's test)
Parallel
Thoracic spine mobilization with Glenohumeral joint mobilization
Procedure/SurgeryThoracic spine mobilization: Central posterior-anterior (PA) oscillatory mobilizations in prone position; 30 repetitions per set, with a 1-minute rest between 2 sets. Glenohumeral joint mobilization: Oscillatory techniques, 2-3 oscillations per second for 30 seconds, repeated for 5 sets.
Glenohumeral joint mobilization only
Procedure/SurgeryGlenohumeral joint mobilization only Technique: Oscillatory mobilizations, 2-3 oscillations per second for 30 seconds, repeated for 5 sets.
Pain Intensity
Pain intensity will be checked by Numeric pain rating scale NPRS, where patient will rate pain from 0 to 10, 0 being no pain and 10 means worst pain.
Functional disability
Shoulder Pain and Disability Index (SPADI) used to assess functional disability and it is 13-question survey (5 pain, 8 disability) on a 0-100 scale, where 0 is best (no pain/difficulty) and 100 is worst (severe pain/complete disability), indicating higher scores mean greater impairment; it's interpreted by looking at general ranges (0-20 mild, 21-40 moderate, etc.) and tracking changes (a 10-20 point shift suggests clinical significance) to gauge treatment effectiveness.
Shoulder Range of Motion
Goniometer used to measure shoulder joint range of motion.
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