Kinesiotaping With Kaltenborn Mobilization Effects on Adhesive Capsulitis Recovery.

The purpose of the study is to determine the Effects of Kinesiotaping with Kaltenborn Mobilization on Rate of Recovery in Freezing Stage of Adhesive Capsulitis. A randomized control trial was conducted at Habib physiotherapy complex Peshawar and Pak physio rehabilitation Peshawar. The sample size was 34 calculated through open-epi tool. The participants were divided into two groups each having 17 participants. The study duration was six months. Consecutive sampling technique was used for the selection of subjects for the study that fulfills the eligibility criteria was included in the study. Block randomization was used to allocate subjects into interventional and control arms of the trial. The first two patients who fulfill the criteria were allocated to interventional arm and the next two patients were allocated in control arm till completion of the sample size for both the arms. Tools used in this study are Goniometer, SPADI, NPRS. Data was collected before and immediately after the application of interventions. Data analyzed through SPSS version 20

Human kinematics is always in spotlight and considered as a unique feature in which shoulder joint kinematics have grabbed the attention of researchers. The complexity of the shoulder joint is evident from the literature. It is having high functional demands and wide range of motion than any other joint in the human body. It is balanced by stability and mobility provided by number of ligaments, capsule, labrum and active muscles. However sometimes this balance is disturbed that results in different musculoskeletal complaints and pathologies in which one of them is adhesive capsulitis (1).The exact cause of adhesive capsulitis remains controversial.

However calcific tendinitis, glenohumeral arthritis, acromioclavicular arthritis, dupuytrens, contractures, breast cancer, cardiac issues, autonomic neuropathy, stroke, cervical disc disorders, humeral fractures, hypoadrenalism, Parkinson's disease are some of the known causes (7). It can also occur as a sequalae of osteoarthritis, rheumatoid arthritis or joint dislocation and fracture (8). The evaluation of adhesive capsulitis starts from a thorough history and proceeding towards physical examination, clinical tests and radiographic techniques. The patient usually recalls a mild trauma or accident that has caused damage to the shoulder joint, as well as limited range of motion especially external rotation, sleep disturbance and pain on insertion of deltoid and unable to perform overhead activities (9). Physical examination exposes loss of natural swing of arm. Scapular dyskinesis is also noted in some cases. shoulder joint may be painful to touch and muscle atrophy can be present. Loss of ROM is seen (9). Fasting blood sugar is performed in patients having diabetes mellitus. Since inflammation is its feature so erythrocyte sedimentation rate is suggested. Some special tests are also positive in this condition that are Neer impingement sign and Hawkin's-Kneddy. These tests are positive due to capsular stretch and internal impingement that occurs in this condition simultaneously but due to adhesive capsulitis (10). Adhesive capsulitis can be diagnosed using imaging studies like radiographs, magnetic resonance imaging, arthrography, ultrasound, and nuclear medicine. Magnetic resonance imaging is considered the gold standard due to its soft tissue visualization and scanning capabilities. However, some studies suggest that it may not accurately diagnose the condition due to the similar thickness of the Page 3 of 11 (Draft) coracohumeral ligament (10 11). Rahee Mulmulay and Himanshu Pathak et al describes kinesiotaping along with Kaltenborn mobilization and Kaltenborn mobilization alone on pain, range of motion and functional disability in patients with adhesive capsulitis is effective treatment to significant improvement in terms of pain, range of motion and functional disability (12). Literature review: A systematic and evidence based search of relevant literature was performed by utilizing PubMed and Google Scholar as search engines and the key words used were Kinesiotaping, mobilization, Kaltenborn mobilization, adhesive capsulitis, frozen shoulder conventional physical therapy, freezing stage. The purpose of the literature review is to find out the pre-existing literature regarding the Kinesiotaping with Kaltenborn mobalization effects on adhesive capsulitis recovery. In 2017 a randomized controlled trial conducted by Rahee Mulmulay and Himanshu Pathak et al on effectiveness of kinesiotaping along with kaltenborn mobilization and kaltenborn mobilization alone on pain, range of motion and functional disability in patients with adhesive capsulitis stated that there is significance improvement in terms of pain, range of motion and functional disability (12). In 2019 a randomized controlled trial conducted by Sumit Raghav et in India on effectiveness of Mulligan versus Kaltenborn mobilization in the management of adhesive capsulitis. The results of the study showed significant improvement in terms of pain, range of motion and functional disability (13).

Eligibility Criteria:
Inclusion Criteria:

* Both genders male and female.
* Age 35-60 years.
* Acute shoulder pain (10 to 36 weeks).
* Patients with diabetes mellitus.
* Referred and diagnose patients

Exclusion Criteria:

* Any fracture related to the shoulder joint.
* Post operative case and osteoporotic.
* Shoulder with manipulation under anesthesia.
* Steroid injection therapy
* Diagnosed rheumatoid arthritis
* Neurological deficits / Hemiplegics