Effectiveness of SCS Technique Verses ART in Adhesive Capsulitis
Condition: Adhesive Capsulitis
MeSH terms: Bursitis
Study type: Interventional

Summary: 
      To find out the effectiveness of Strain Counter strain Technique verses Active Release
      Technique on upper trapezius, subscapularis, anterior fiber of deltoid and supraspinatus
      muscles trigger points in adhesive capsulitis in term of pain intensity, range of motion and
      muscle strength.
    

Detailed description: 
      Frozen shoulder, also known as adhesive capsulitis, is defined as "a condition of uncertain
      aetiology, characterized by significant restriction of both active and passive shoulder
      motion that occurs in the absence of a known intrinsic shoulder disorder". Prevalence ranges
      from 2% to 5% in general population. It is relatively more common in women than men, often in
      non-dominant arm and age between 40 and 60 years. Frozen shoulder was also termed as adhesive
      capsulitis (AC) due to its chronic inflammatory process. Painful stiffness of the shoulder
      can adversely affect activities of daily living and consequently impair quality of life.
      Adhesive capsulitis can be primary or secondary. Primary (or idiopathic) adhesive capsulitis
      can occur spontaneously without any specific trauma or inciting event. Secondary adhesive
      capsulitis is often observed after periarticular fracture dislocation of the glenohumeral
      joint or other severe articular trauma.

      Dr. Lawrence Jones, an osteopathic physician, is credited with the discovery of the therapy;
      he initially called it Positional release technique (PRT) and later coined the term strain
      counterstrain. Originally termed strain-counterstrain, is a therapeutic technique that uses
      trigger points (TrPs) and a position of comfort (POC) to resolve the associated dysfunction.
      A gentle and passive technique, SCS has been advocated for the treatment of acute, subacute
      and chronic dysfunction in people of all ages.A number of studies have reported the use of
      strain/counterstrain in combination with other interventions for treating a variety of
      disorders, including chondromalacia patellae, low back pain, and cervicothoracic pain.

      Active Release Techniques (ART) is a soft tissue method that focuses on relieving tissue
      tension via the removal of fibrosis/adhesions which can develop in tissues as a result of
      overload due to repetitive use. The goals of ART are to restore optimal tissue texture,
      tension and movement, restore the strength, flexibility, function, and relative translation
      between soft tissue layers, release any soft tissue restrictions, entrapped nerve, restricted
      circulatory structures, or lymphatic restrictions. ART is used to find the specific tissues
      that are restricted, physically work on the soft tissues back to their normal texture,
      tension, and length by using various hand positions and soft tissue manipulation methods.

      Active release technique and capsular stretch with conventional therapy is more effective in
      increasing ROM and decreasing pain of frozen shoulder rather alone capsular stretch with
      conventional therapy. These changes are clinically significant. Both positional release and
      muscle energy techniques were shown to be effective in improving functional ability of
      shoulder in Adhesive Capsulitis, but muscle energy technique was better than positional
      release technique..Both ART and SCS technique play important role in decreasing hamstring
      tightness but Active Release Technique is more effective physiotherapeutic intervention than
      strain counterstrain technique in reducing hamstrings tightness instantly.

      Active Release Techniqueand Strain Counterstrain have been proved to be effective in many
      conditions like low back pain, chronic neck pain, tennis elbow, CTS and shoulder pain. ART
      and SCS has also been proved effective in treating upper trapezius, subscapularis SCM,
      hamstring muscle trigger point in comparison with other treatment protocol. But there is
      limited studies done on comparing these two techniques i.e ART and SCS for the adhesive
      capsulitis and specifically the use of ART and SCS for AC induced trigger points in different
      muscles of shoulder. Hence, the aim of present study is to compare the effectiveness of
      Active release technique and Strain counterstrain technique in adhesive capsulitis induce
      trigger points in different shoulder muscle in term of pain, ROM and muscle strength.
    

Intervention name(s): STRAIN COUNTER STRAIN GROUP; ACTIVE RELESAE TECHNIQUE GROUP
Intervention type(s): Other; Other
Intervention description(s): Strain Counterstrain Technique in combination with conventional physiotherapy (Hot pack, Codman"s exercises, active assisted exercises, Pendulum exercises, Finger Ladder Exercise, Maitland mobilization of shoulder joint.
Therapist palpate surrounding and opposing tissues to locate trigger point by using one or two finger pads to monitor fasciculation and MTrP.
Hold the POC (position of comfort) until fasciculation decreases significantly or ceases. Average positions hold time while pressure is 90 s to 3 min.
Release tissue or joint slowly and reassess. Each patient will receive total 6 sessions (3sessions/week) over a period of 2 weeks.
Assessment would be done on baseline and after every three sessions.; Active Release Technique in combination with conventional physiotherapy (Hot pack, Codman"s exercises, active assisted exercises, Pendulum exercises, Finger Ladder Exercise, Maitland mobilization of shoulder joint.
The targeted muscle will be palpated while the therapist will looks for localized tenderness or trigger points with referred pain elicitation.
With the thumb therapist will relieve the trigger point. In ART the particular muscle is taken from shortened to lengthened position or from lengthened to shortened position.
Duration of treatment will be 8-15 minutes. Each patient will receive total 6 sessions (3sessions/week) over a period of 2 weeks.
Assessment would be done on baseline and after every three sessions.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment
Keywords: ADHESIVE CAPSULITIS; SHOULDER PAIN; Range of Motion; Shoulder Muscle Strength