The purpose of this randomized controlled study is to investigate the effects of a combined rehabilitation program consisting of Mulligan Mobilization with Movement (MWM), Pain Neuroscience Education (PNE), and core stabilization exercises in individuals with adhesive capsulitis (frozen shoulder).
The main questions this study aims to answer are:
Does the combination of Mulligan mobilization, Pain Neuroscience Education, and core stabilization exercises reduce pain in individuals with adhesive capsulitis? Does this combined intervention improve shoulder range of motion, shoulder function, quality of life, scapular dyskinesis, and pain catastrophizing compared with conventional physical therapy?
Participants diagnosed with adhesive capsulitis will be randomly assigned to one of two groups. The intervention group will receive Mulligan mobilization, Pain Neuroscience Education, and core stabilization exercises, while the control group will receive conventional physical therapy, including TENS, hot-pack application, passive joint mobilization, and stretching exercises. Both groups will participate in treatment sessions three times per week for six weeks. Outcome measures will be assessed at baseline and after completion of the 6-week intervention period.
Adults aged 18 to 65 years
Diagnosis of adhesive capsulitis confirmed by an orthopedic surgeon or a physical medicine and rehabilitation physician
Presence of shoulder pain and limitation of shoulder range of motion
Ability to communicate verbally
MMSE score below 24
Severe cognitive impairment
Severe psychiatric disorders
Active infectious disease
Parallel
Pain Neuroscience Education (PNE)
BehavioralParticipants will receive Pain Neuroscience Education focused on the biopsychosocial nature of pain, central sensitization, the distinction between pain and tissue damage, and strategies to reduce fear of movement. The initial educational session will last approximately 15-20 minutes, followed by 5-10 minute reinforcement sessions throughout the intervention period. Education will be delivered through verbal explanations and interactive discussion.
Mulligan Mobilization With Movement (MWM)
Procedure/SurgeryParticipants will receive Mulligan Mobilization with Movement techniques applied to the glenohumeral joint, including posterolateral glide with active abduction, inferior glide with shoulder flexion, and posterior glide with internal rotation. Mobilizations will be performed within a pain-free range of motion. Each technique will be administered in 3 sets of 10 repetitions with 30 seconds of rest between sets. Treatment will be provided three times per week for six weeks
Core Stabilization Exercises
BehavioralParticipants will perform Dynamic Neuromuscular Stabilization (DNS)-based core stabilization exercises. The program will include diaphragmatic breathing, supine 90/90 positioning, abdominal bracing, and progression to dead bug, bird-dog, and modified plank exercises as tolerated. Exercises will be performed in 2-3 sets of 8-12 repetitions with 10-20 second isometric holds. Progression will occur from stable to unstable surfaces and from static to dynamic activities
Conventional Physical Therapy
Other interventionParticipants in the control group will receive conventional physical therapy consisting of transcutaneous electrical nerve stimulation (TENS) applied at a sensory level for 20 minutes, hot-pack application for 20 minutes, passive shoulder joint mobilization exercises, pendulum exercises, and wand exercises. Treatment sessions will be conducted three times per week for six weeks.
Pain Intensity
Pain intensity during movement will be assessed using the Visual Analog Scale (VAS). Higher scores indicate greater pain intensity.
Shoulder Function
Shoulder pain, function, and patient satisfaction will be evaluated using the Penn Shoulder Score (PSS). Higher scores indicate better shoulder function.
Shoulder Range of Motion
Active shoulder flexion, abduction, internal rotation, and external rotation range of motion will be measured using a goniometer.
Pain Catastrophizing
Pain-related catastrophic thinking will be assessed using the Pain Catastrophizing Scale (PCS). Higher scores indicate greater pain catastrophizing.
Core Stability
Core stability and neuromuscular control will be assessed using the Sahrmann Core Stability Test.
Change in Scapular Dyskinesis
Scapular movement patterns and dyskinesis will be evaluated using the Scapular Dyskinesis Test.
Change in Health-Related Quality of Life
Health-related quality of life will be assessed using the 12-Item Short Form Health Survey (SF-12).
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