Is Position Induced Movement Re-education Helpful on Early Functional Recovery in Acute Adhesive Capsulitis? A Randomised Controlled Trial YC08-YC13
Dr. Sukumar Shanmugam,
Assistant Professor, Department of Neuro-Physiotherapy, Nitte Institute of Physiotherapy/NITTE (Deemed to be University),
Deralakatte, Mangaluru-575018, Karnataka, India.
Introduction: Adhesive Capsulitis (AC) is a common musculoskeletal disorder of shoulder caused by inflammation and adhesion formation in the capsule and periarticular structures. The increased nociception from the shoulder can suppress the movement perception and related functions of shoulder and upper limb. Active range of motion of shoulder may be more painful and limited due to pain, spasm and stiffness. Positioning of shoulder joint in end ranges may activate the mechanoreceptors of muscles, tendon, ligaments, joint capsule which may reduce the nociception and increase the movement perception.
Aim: To compare the effect of Position Induced Movement Re-education (PIMR) combined with Low Level Laser Therapy (LLLT) over active free shoulder exercises with LLLT and Grade-I Maitland Mobilisation adjunct with moist heat therapy in the management of acute adhesive capsulitis of shoulder.
Materials and Methods: A total of 30 subjects diagnosed with stage I AC were randomly allocated in three groups. Group A received PIMR and LLLT, Group B received Codmanâ€™s pendular exercises along with LLLT and Group C received Grade I Maitland Mobilisation and moist heat therapy for five days a week for two consecutive weeks. The pre and post-intervention scores of shoulder joint range of motion and shoulder pain disability index were obtained and analysed.
Results: A statistically significant difference was seen in the shoulder pain and disability index score and shoulder range of motions among three groups with the p-value less than 0.05. The patients treated with position induced movement re-education combined with LLLT showed better improvement in shoulder disability and range of motion scores when mean differences were compared with other two groups using Mann-Whitney U test (for SPADI score) and One-way ANOVA (shoulder range of motions).
Conclusion: Position induced movement therapy along with LLLT is effective in reducing pain, improving range of motion and disability in stage I AC.