Physiotherapy
Evidence For Techniques
There have been several reviews of literature conducted within the last 15 years to assess the effectiveness of clinical treatments in an attempt to define a standard treatment procedure (Nevaser et.al, 2010; Green et.al, 2010; Cleland et.al, 2002). However, all reviews concluded similarly that there is a significant lack of overall evidence to guide treatment and no evidence that isolated physical therapy is of any benefit. Two separate Level 1 studies found no significant benefits from physical therapy treatment in Adhesive Capsulitis compared to control groups (Carrette et.al, 2003; Bulgen et.al, l984). Main issues with body of research is that most studies have small sample sizes with huge variation in methodical quality, length of follow up, heterogeneity of population and identification of specific stages of the condition. Despite this, physical therapy is the first line of treatment prescribed for this condition and lower level studies have reported significant benefits (Diericks et.al, 2004; Griggs et.al, 2000).
Routine management in clinical setting involves prescription of NSAIDs for pain relief in conjuction with physiological and accessory shoulder movements to reduce adhesions and contractures. Below is a description of one method presented by Hannafin and Chiaia stepping through therapy applied in 3 stages of condition (2000). This is also reiterated in other texts and treatment based papers (Walters et.al, 2007; Kisner, 2010).
Routine management in clinical setting involves prescription of NSAIDs for pain relief in conjuction with physiological and accessory shoulder movements to reduce adhesions and contractures. Below is a description of one method presented by Hannafin and Chiaia stepping through therapy applied in 3 stages of condition (2000). This is also reiterated in other texts and treatment based papers (Walters et.al, 2007; Kisner, 2010).
STAGE 1
Goals of therapy - interrupt cycle of inflammation and pain - daily activity modification - pain limited ROM - patient education STAGE 2 : FREEZING Goals of therapy - decrease inflammation and reduce pain - minimise capsular restriction - Activity modification to manage painful activities |
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During Therapy Postural training to discourage thoracic kyphosis and a forward humeral head position during forward elevation. Gentle passive joint mobilizationand hydrotherapy to stimulate joint mechano receptors and decrease nociceptive input (Owens-Burkhart, 1991) Modalities TENS for pain management (Rhind et.al; 1982) Chyrotherapy to reduce inflammation (Wadsworth, 1986) During Therapy Joint mobilizations and glides Home Exercises Passive ROM Pendulum exercises |
Pendulum Exercises completed within pain free ranges
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STAGE 3 : FROZEN Goals of therapy - Minimise capsular adhesions and restriction of movement - Reducing pain and inflammation |
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During Therapy Passive joint glides for mobility of capsule Shoulder through abduction, adduction, flexion and extension Proprioceptive neuromuscular facilitation Soft tissue mobilization of the subscapularis and pectoralis minor Additional Home Exercises Shoulder internal/external rotation ROM scapula, stretching and self mobilization |
i) caudal glide of humerus occurs as the person leans away from the fixed arm
ii) posterior glide of the humerus occurs as the patient shifts his weight downward between the fixed arms
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ii) posterior glide of the humerus occurs as the patient shifts his weight downward between the fixed arms
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_STAGE 4 : THAWING
Goals of therapy - Continue increasing ranges of motion - Retrain abnormal scapulohumeral rhythm mechanics - Restoration of full function |
_ During Therapy
Prolonged low-load stretching with active warm up Mobilization with movement (MWM) techniques to retrain muscle function for proper tracking of the humeral head Modalities Heat (promote relaxation of musculature) |
i) external rotation with posterolateral glide of humeral head while patient pushes arm to end-range with cane
ii) internal rotation with inferior glide of humerus while patient pulls hand up the back using towel
ii) internal rotation with inferior glide of humerus while patient pulls hand up the back using towel
Furthering Research Areas
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Analgesic nerve block to relieve muscle guarding of subscapularis muscle in freezing stage has in the past, been achieved using a locally injected anesthetic (bupivacaine) injection. Gulick and collegues have achived similar results using uninvasive electrical stimulation to assist mobility of shoulder (2007).
Analgesic nerve block to relieve muscle guarding of subscapularis muscle in freezing stage has in the past, been achieved using a locally injected anesthetic (bupivacaine) injection. Gulick and collegues have achived similar results using uninvasive electrical stimulation to assist mobility of shoulder (2007).