THE ROLE OF MOBILIZATION TECHNIQUES IN THE PHYSICAL THERAPY OF PATIENTS WITH ADHESIVE CAPSULITIS OF THE SHOULDER JOINT
Authors: Rusanov A. P. , Vitomskyi V. ‌V. , Vitomska M. V. 
Published: January 2023

The purpose of the study: to analyze the results of studies devoted to the study of the effectiveness of the use of mobilization techniques in patients with adhesive capsulitis of the shoulder joint.

Materials and methods. This work is the result of an analysis of studies devoted to the study of the effect of mobilization techniques as monotherapy and as part of a complex physical therapy on the range of motion in the shoulder joint, pain on the visual analog scale, and the shoulder pain and disability index.

Results. Stretching exercises, pendulum exercises, various manual therapies, proprioceptive neuromuscular facilitation techniques, and muscle energy techniques are used in physical therapy for adhesive capsulitis. Analysis of the literature confirmed that mobilization is widely used in the therapy of patients with adhesive capsulitis of the shoulder joint. At the same time, the number of mobilization techniques, which are used in the form of monotherapy or part of complex treatment, is significant. There are quite a few types of mobilization techniques for adhesive capsulitis of the shoulder joint: angular mobilization; progressive mobilization; mobilization of the spine in combination with scapular stretching, angular and translational mobilization; high-intensity techniques based on the pain threshold; the Cyriax approach; Mulligan technique; Maitland technique. There are research results that indicate an immediate effect of intensive mobilization on the amplitude of passive abduction. A number of studies have established the advantages of end-range and intensive mobilization compared to mid-range mobilization. At the same time, studies were found that did not establish the advantages of mobilization over therapeutic exercises, and also established the advantages of therapeutic exercises without pain compared to a complex intervention that included exercises and mobilization with exceeding the pain threshold. Thus, the question of the intensity of mobilization, the level of pain during mobilization remains relevant. Results of literature reviews noted that the Kaltenborn technique shows better results after 2-6 weeks of therapy in reducing pain, improving range of motion and functional activity; that there is moderate evidence of effectiveness of mobilization methods in the short and long term; that the Maitland technique and combined mobilization are recommended for use. In the aspect of mobilization with adhesive capsulitis, there is a question of its direction (anterior or posterior) to improve the amplitude of external rotation. At the same time, the conclusions of the last systematic review of the effectiveness of conservative methods of treatment of adhesive capsulitis indicate that there is no reliable evidence that would convincingly testify to the superiority of one method of treatment of adhesive capsulitis over another.

Conclusions. The results of scientific studies indicate different conclusions regarding the effectiveness of mobilization techniques. There are works that indicate both the advantages of mobilization in adhesive capsulitis of the shoulder joint and their absence. Undisputed strong evidence in favor of one of the mobilization techniques is also lacking. Mobilization techniques can be used in physical therapy for patients with adhesive capsulitis, but more research is needed to determine the most effective intervention.