Effects of Sleeper Stretch and Mobilizations With Movement in Patients With Adhesive Capsulitis

Adhesive capsulitis is a condition characterized by progressive declination range of motion at the glenohumeral joint due to tightness of capsule. The joint capsule and its surrounding connective tissue becomes stiffed, inflamed and shortened which in return causes decrease in range of motion that progress to chronic pain and stiffness. Adhesive capsulitis is a self-limiting disorder that resolves within 1-3 years.

Idiopathic (primary) adhesive capsulitis occurs spontaneously without a specific precipitating event. Primary adhesive capsulitis results from a chronic inflammatory response with fibro elastic proliferation, which may actually be an abnormal response from the immune system. Secondary adhesive capsulitis occurs after a shoulder injury or surgery or may be associated with another condition such as diabetes, rotator cuff injury, cerebrovascular accident or cardiovascular disease, which may prolong recovery and limit outcomes The prevalence of adhesive capsulitis is estimated at 2% to 5% of the general population. Frozen shoulder mainly affects individuals of 40-65 years of age with a female predominance. Adhesive Capsulitis follows a capsular pattern where external rotation is greatly restricted followed by abduction and internal rotation. Adhesive capsulitis is classically characterized by three stages. The length of each stage is variable, but typically the first stage (freezing) lasts for 3 to 6 months, the second stage (frozen) from 3 to 18 months and the final stage (thawing) from 3 to 6 months Currently various techniques are used, such as the application of moist heat, strengthening exercises, stretching and manual exercises for the treatment of Adhesive Capsulitis .Manual therapy techniques such as high and low grade glenohumeral mobilizations ,Proprioceptive neuromuscular facilitation techniques, Muscle energy Techniques, Mobilization with movement, and Sleeper stretch all have been proved effective for the treatment of adhesive capsulitis through different researches. Conservative treatment includes various exercises method and physical therapy modalities such as a heat therapy, transcutaneous electrical nerve stimulation (TENS), Ultrasound (US), Acupuncture and (Light Amplification by Stimulated Emission of Radiation) LASER

Eligibility Criteria:
Inclusion Criteria:

* Patients with Adhesive Capsulitis of stage 1 and 2.
* Patients with idiopathic adhesive capsulitis.
* Patients with unilateral involvement having painful stiff shoulder for 3 or more months without any shoulder trauma.
* Marked loss in active and passive Range of Motion (Abduction, external and internal rotation) minimum 50% compared to the unaffected side.
* 1.5cm asymmetry on bilateral comparison during lateral scapular slide test.

Exclusion Criteria:

* Patients with shoulder pain due to neurological abnormalities e.g. Hemiplegia.
* Patients with Rotator cuff injury or tear.
* Recent trauma to upper limb.
* Disorders of bones such as fractures, osteoporosis, glenohumeral arthritis.
* Cervical spondylosis or cervical radiculopathy.
* Any malignancy or tumor.
* Patients having any intra articular injection in the gleno-humeral joint during last three months.
* Patients with cardiovascular impairments