Effects of two different mobilization techniques on pain, range of motion and functional disability in patients with adhesive capsulitis: a comparative study.
Surabhi Agarwal, Shahid Raza, Jamal Ali Moiz and 2 others
PMID 28174448WHAT IT FOUND
Reverse distraction reduced pain more and improved shoulder abduction and function more than Kaltenborn glides, but both groups also received heat, pendular exercises and stretching, so the mobilization alone cannot be credited.
External rotation and hand-behind-back did not differ between groups.
Key findings
01At the end of treatment, pain during shoulder movement was lower in the reverse distraction group than in the Kaltenborn group, 2.5 versus 5.5 on the visual analogue scale.
02Reverse distraction improved active and passive shoulder abduction more than Kaltenborn glides, but external rotation active and passive range did not differ between groups.
03Self-reported shoulder function increased in both groups, and the final FLEX-SF score was significantly higher with reverse distraction than Kaltenborn glides.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
Read the rest of this summary
You get three full summaries a month, free, and we do not ask for a card. Search, the TL;DRs and your library stay unlimited either way.
What it does not show
The study randomized 30 patients, and 2 left within two weeks; the paper does not clearly state how many were analysed at follow-up. The same therapist delivered all treatment and performed all measurements, and the paper does not report blinding of participants or a placebo control. Both groups received the same conventional physiotherapy, including hot packs, pendular exercises and stretches, so the extra benefit of reverse distraction over Kaltenborn glides cannot be separated from these other treatments. Follow-up was only after 18 sessions over 6 weeks, so long-term durability is unknown. Convenience sampling at one physiotherapy outpatient department limits generalizability. Some baseline demographic variables, including dominant arm, differed significantly between groups, although the authors judged this unlikely to matter clinically. Hand-behind-back reach is not an exact measure of internal rotation, and the pain scale had no gold-standard validity check.
The easy way to misread this
Do not conclude that reverse distraction alone is superior for frozen shoulder. Both groups also received hot packs, pendular exercises and stretches, and the study did not separate the effect of the mobilization from these treatments. Also, reverse distraction did not outperform Kaltenborn glides for external rotation or hand-behind-back reach.