The Mechanisms, Effects, and Outcomes of Manual Therapy in the Treatment of Adhesive Capsulitis: A Literature Review
Authors: C* Cleve 
Published: April 2024

Purpose of the Study: Adhesive capsulitis, commonly called frozen shoulder, is frequently treated with manual therapy. This pathology cycles through three stages and usually resolves itself; however, many patients will use traditional treatments to expedite their recovery. The researchers theorize that a variety of manual therapy techniques improve the adverse effects of this condition, greater than that of traditional treatments. This literature review aimed to explore various manual therapy techniques that are beneficial in preventing and minimizing lifelong symptoms associated with adhesive capsulitis and analyze which ones are most effective in treating this pathology. Methods: The mechanisms of orthopedic manual therapy for adhesive capsulitis are vast. This literature review examined the following techniques. The first technique reviewed was Mulligan’s mobilization with movement techniques applied to the GH joint in elevation, internal rotation, and flexion compared with passive stretching. Proprioceptive neuromuscular facilitation (PNF) techniques were reviewed, where specific techniques were picked based on the patient’s dysfunctions and compared to traditional manual therapies. In addition, Maitland’s mobilization techniques were reviewed, and patients were given mobilizations to treat pain or restrictions in the tissue. These were compared to Kaltenborn’s mobilization techniques. Next, Maitland’s mobilization techniques were compared with a myofascial release arm-pull technique. Finally, scapular mobilization was compared to posterior capsular stretching in treating adhesive capsulitis. Discussion: The outcomes of this literature review evaluated various manual therapy techniques for treating adhesive capsulitis, aiming to improve shoulder movement and alleviate pain. Researchers expected manual therapy to outperform traditional treatments like medications and surgery by enhancing ROM and reducing pain. Mulligan’s manual therapy demonstrated significant pain reduction and ROM improvement, particularly in flexion, abduction, and rotation. Combining Mulligan’s technique with other modalities yielded superior outcomes compared to passive stretching. Proprioceptive Neuromuscular Facilitation (PNF) techniques showed better pain reduction, ROM enhancement, and coracohumeral thickness reduction than traditional manual therapy. Maitland and Kaltenborn’s techniques significantly improved shoulder rotation and functional movement, especially with soft tissue mobilization. Scapular mobilization techniques increased joint motions, but ROM improvements varied. Manual therapy techniques like Mulligan’s, PNF, Maitland, and scapular mobilization offer promising results in improving the quality of life for adhesive capsulitis patients by enhancing ROM and reducing pain. As more research is done with this pathology, it was found that Mulligan’s, Maitland’s, PNF’s, and soft tissue mobilizations were effective in increasing ROM and decreasing stiffness in patients with this diagnosis. These are all effective forms of manual therapy, specifically when performed by a skilled clinician, further advocating for education on these techniques. Additionally, understanding the mechanisms, effects, and outcomes of different manual therapies for treating adhesive capsulitis can reduce the risk of life-long symptoms and improve quality of life. Results: Various manual therapy methods, such as Mulligan’s mobilization with movement (MWM), Maitland’s mobilization, and PNF have been used to treat adhesive capsulitis. These manual therapy techniques increased joint range of motion (ROM) and reduced the patients’ perceived pain.