Effectiveness of SCS Technique Verses ART in Adhesive Capsulitis

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.

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.

Eligibility Criteria:
Inclusion Criteria:

* Idiopathic Adhesive Capsulitis (AC)
* Stage 2 AC
* Both genders
* ROM limitation in capsular pattern
* AC having myofascial trigger points in upper trapezius, subscapularis, anterior fibers of deltoid and supraspinatus muscle

Exclusion Criteria:

* Cervical Radiculopathies
* Thoracic outlet syndrome
* Rotator cuff tear
* Diabetes mellitus.
* Patients with any neurological disorder like hemiplegia.
* Fracture in and around shoulder