PNF Technique in Adhesive Capsulitis

Effects of Scapular Proprioceptive Neuromuscular Facilitation Techniques in Addition to Routine Physical Therapy on Clinical Outcomes in Patients With Adhesive Capsulitis:a Randomized Controlled Trial

Adhesive capsulitis is painful movement restricted condition linked with pain, restricted range of motion and difficulty in performing daily life activities. Multiple treatment options are there for its treatment. However, role of peripheral neuromuscular facilitation in this regimen is still under consideration.

Adhesive Capsulitis or peri-arthritis or Frozen Shoulder is self-limiting condition of unknown etiology that usually affects middle aged population of 40-70 years and rarely it occur secondary to rheumatoid arthritis, osteoarthritis, trauma or immobilization of shoulder joint. It is characterized by development of dense adhesions, capsular thickening and restrictions which limits active and passive shoulder range of motion (ROM) with scapular dyskinesia.The aim of the of the study is to investigate the effects of scapular proprioceptive neuromuscular techniques with routine physical therapy on pain, scapular dyskinesia, shoulder ranges of motion and functionality in patients with adhesive capsulitis. Proper functioning of upper extremities requires both motion and stability of scapula on thorax. Prolonged immobilization of shoulder joint leads to ankylosis of joint and scapular dyskinesia. This study will help with a positive effect by using a non-invasive, less painful, cost effective and time saving approach of scapular proprioceptive neuromuscular facilitation techniques among joint mobilization and other therapeutic approaches like intra articular injections and manipulation under anesthesia on alleviating pain, muscle strength, shoulder ranges of motion and early restoration of normal functioning of shoulder joint.

Control group receivewill routine physical therapy including modalities like ultrasound (3 MHz continuous type; duration 10 minutes), heat modalities (apply to the involved region of shoulder joint shoulder for 10 minutes), shoulder ROM exercises, capsular stretching, and joint mobilization 5 times per week for four weeks. Duration of session will be 40 minutes. All Maitland mobilization will be given in supine position. After giving glenohumeral (GH) joint distraction, GH caudal glide, GH dorsal glide, and GH ventral glide were given at a rate of 2-3/second oscillations for 1-2 minutes to patients. Grade I or II rhythmic oscillations will be applied in pain free movement.

Group will receive scapular PNF techniques with routine physical therapy explained above For PNF techniques, patients will be lying on unaffected shoulder. In this group, 20 repetitions of diagonal scapular Pattern (Anterior Elevation and Posterior Depression and Posterior Elevation and Anterior Depression) with 20 sec rest period will be given to patients. Preparatory instructions for the desired movement will be given to patients at the start of procedure. PNF facilitation techniques of RI (Rhythmic initiation) & repeated contractions will be used in all patterns

Inclusion Criteria: Diagnosed cases of stage II & III adhesive capsulitis Referred by orthopedic physician Duration of stage approximately 1 month Both male and female Age: 40-70 years Exclusion Criteria: Recent history of trauma Dislocation or fractures of shoulder History of diabetes and hypertension Congenital shoulder deformity Previous surgery patients Patients with diagnosed cardiovascular disease Patients with malignancy

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