Effectiveness of Maitland’s Mobilization Versus Sleepers Stretch and Posterior Capsule Stretch on Pain, Rom and Shoulder Functions in Patients with Adhesive Capsulitis: A Randomized Control Trial


Authors : Simran Sharma; Dr. Smruti Swagatika Dash; Dr. Rajendra Kachhwaha

Volume/Issue : Volume 10 - 2025, Issue 1 - January


Google Scholar : https://tinyurl.com/3bba6s8s

Scribd : https://tinyurl.com/4v6yu9vh

DOI : https://doi.org/10.5281/zenodo.14744542


Abstract :  Background and Objectives: Adhesive capsulitis (AC) is a pathological condition of shoulder joint characterized by excessive scar tissue or adhesion formation all across the glenohumeral joint. It is typically marked by a sudden onset of pain and a progressive loss of glenohumeral joint motion, which causes a severe loss of shoulder function. There is a high prevalence in the age group between 40 to 60 years of age. As Compared to men, women are 4 times more likely to be affected by frozen shoulder. AC results in discomfort, pain, stiffness and dysfunction .The study was done to assess the effectiveness of Maitland mobilization vs sleepers and posterior capsule stretch on pain, ROM and shoulder function in patients with adhesive capsulitis.  Methods: According to the sample size estimation the study included 60 participants. All the subjects included were clinically diagnosed by an orthopedic with adhesive capsulitis were screened after finding their suitability as per the inclusion criteria. Participants were briefed about the study and informed consent was obtained for the same. Total of 60 participants were randomly assigned into 2 treatment groups with 30 participants each. Group 1 (n=30) was given Maitland mobilization along with conventional physiotherapy whereas, group 2 (n=30) was followed by vs sleepers and posterior capsule stretch along with conventional physiotherapy protocol. The total duration of treatment was 4 weeks. Pre and post intervention scores were measured in terms of VAS, ROM, and SPADI.  Outcome Measures: Pre and post intervention scores were measured in terms of VAS, ROM, and shoulder disability. The outcome measure pain was measures using Visual analog scale. The availability of range of motion of shoulder was measured using universal goniometer. To calculate the extent of disability caused by the adhesive capsulitis was measured using shoulder pain and disability index.  Result: While comparing pre-test and post-test scores using paired t-test, both the groups showed a significant difference in each parameter (VAS, shoulder ROM, SPADI= <0.001). Independent sample t-test showed significant improvement in all the parameters (VAS, shoulder ROM in flexion, abduction and external rotation, SPADI= <0.001) of both the groups after 4 weeks of intervention.  Conclusion: On the basis of result obtained from this study, Maitland mobilization is significantly more effective in increasing ROM, reducing pain on VAS and decreasing the shoulder disability compared to sleepers and posterior capsule stretch in patients with adhesive capsulitis.

Keywords : Maitland Mobilization, Adhesive Capsulitis, Visual Analog Scale, Sleepers Stretch, Posterior Capsule, Range of Motion.

References :

  1. Cho CH, Lee YH, Kim DH, Lim YJ, Baek CS, Kim DH. Definition, diagnosis, treatment, and prognosis of frozen shoulder: a consensus survey of shoulder specialists. Clinics in orthopedic surgery. 2020 Mar 1;12(1):60-7.
  2. Binder AI, Bulgen DY, Hazleman BL, Tudor J, Wraight P. Frozen shoulder: an arthrographic and radio nuclear scan assessment. Annals of the rheumatic diseases. 1984 Jun 1;43(3):365-9.
  3. Zuckerman JD, Rokito A. Frozen shoulder: a consensus definition. Journal of Shoulder and Elbow Surgery. 2011 Mar 1;20(2):322-5.
  4. Kingston K, Curry EJ, Galvin JW, Li X. Shoulder adhesive capsulitis: epidemiology and predictors of surgery. Journal of shoulder and elbow surgery. 2018 Aug 1;27(8):1437-43.
  5. Robinson CM, Seah KM, Chee YH, Hindle P, Murray IR. Frozen shoulder. The Journal of bone and joint surgery. British volume. 2012 Jan;94(1):1-9.
  6. Jain TK, Sharma NK. The effectiveness of physiotherapeutic interventions in treatment of frozen shoulder/adhesive capsulitis: a systematic review. Journal of back and musculoskeletal rehabilitation. 2014 Jan 1;27(3):247-73.
  7. Chan HB, Pua PY, How CH. Physical therapy in the management of frozen shoulder. Singapore medical journal. 2017 Dec;58(12):685.
  8. Almureef SS, Ali WM, Shamsi S, Al Zahrani MB. Effectiveness of mobilization with conventional physiotherapy in frozen shoulder: a systematic review. International journal of recent innovations in medicine and clinical research. 2020;2(4):22-9.
  9. Kumar A, Kumar S, Aggarwal A, Kumar R, Das PG. Effectiveness of Maitland Techniques in idiopathic shoulder adhesive capsulitis. International Scholarly Research Notices. 2012;2012.
  10. Neeti Mishra et al.2018, Effect of Capsular Stretch Versus Sleeper Stretch on Pain, Rom and Shoulder Functions in Patients with Adhesive Capsulities –A comparative study. Int J Recent Sci Res. 9(4), pp. 25634-25637. DOI: http://dx.doi.org/10.24327/ijrsr.2018.0904.1897
  11. Duzgun I, Turgut E, Çinar-Medeni Ö, Kafa N, Tuna Z, Elbasan B, Oskay D. The presence and influence of posterior capsule tightness on different shoulder problems. Journal of Back and Musculoskeletal Rehabilitation. 2017 Jan 1;30(2):187-93.
  12. Venturin D, Giannotta G, Pellicciari L, Rossi A, Pennella D, Goffredo M, Poser A. Reliability and validity of the Shoulder Pain and Disability Index in a sample of patients with frozen shoulder. BMC Musculoskeletal Disorders. 2023 Dec;24(1):1-9.
  13. Boonstra AM, Preuper HR, Reneman MF, Posthumus JB, Stewart RE. Reliability and validity of the visual analogue scale for disability in patients with chronic musculoskeletal pain. International journal of rehabilitation research. 2008 Jun 1;31(2):165-9.
  14. Do Moon G, Lim JY, Da YK, Kim TH. Comparison of Maitland and Kaltenborn mobilization techniques for improving shoulder pain and range of motion in frozen shoulders. Journal of physical therapy science. 2015;27(5):1391-5.
  15. Manske RC, Prohaska D. Diagnosis and management of adhesive capsulitis. Current reviews in musculoskeletal medicine. 2008 Dec;1:180-9.
  16. Zreik NH, Malik RA, Charalambous CP. Adhesive capsulitis of the shoulder and diabetes: a meta-analysis of prevalence. Muscles, ligaments and tendons journal. 2016 Jan;6(1):26.
  17. Luke TA, Rovner AD, Karas SG, Hawkins RJ, Plancher KD. Volumetric change in the shoulder capsule after open inferior capsular shift versus arthroscopic thermal capsular shrinkage: a cadaveric model. Journal of shoulder and elbow surgery. 2004 Mar 1;13(2):146-9.
  18. Itoi E, Arce G, Bain GI, Diercks RL, Guttmann D, Imhoff AB, Mazzocca AD, Sugaya H, Yoo YS. Shoulder stiffness: current concepts and concerns. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2016 Jul 1;32(7):1402-14.
  19. CHARLES S NEER II, SATTERLEE CC, DALSEY RM, FLATOW EL. The anatomy and potential effects of contracture of the coracohumeral ligament. Clinical Orthopaedics and Related Research®. 1992 Jul 1;280:182-5.
  20. Ozaki JI, Nakagawa Y, Sakurai G, Tamai S. Recalcitrant chronic adhesive capsulitis of the shoulder. Role of contracture of the coracohumeral ligament and rotator interval in pathogenesis and treatment. JBJS. 1989 Dec 1;71(10):1511-5.
  21. Sun Y, Liu S, Chen S, Chen J. The effect of corticosteroid injection into rotator interval for early frozen shoulder: a randomized controlled trial. The American Journal of Sports Medicine. 2018 Mar;46(3):663-70.
  22. Hagiwara Y, Ando A, Kanazawa K, Koide M, Sekiguchi T, Hamada J, Itoi E. Arthroscopic coracohumeral ligament release for patients with frozen shoulder. Arthroscopy Techniques. 2018 Jan 1;7(1):e1-5.
  23. Kim DH, Sung DH, Ga HY, Choi JY. Metabolic patterns of the shoulder joint on 18 F-fluorodeoxyglucose positron emission tomography/computed tomography in adhesive capsulitis. Annals of nuclear medicine. 2014 Feb;28:136-44.
  24. Okuno Y, Oguro S, Iwamoto W, Miyamoto T, Ikegami H, Matsumura N. Short-term results of transcatheter arterial embolization for abnormal neovessels in patients with adhesive capsulitis: a pilot study. Journal of Shoulder and Elbow Surgery. 2014 Sep 1;23(9):e199-206.
  25. Hannafin JA, DiCarlo EF, Wickiewicz TL, Warren RF. Adhesive capsulitis: capsular fibroplasia of the glenohumeral joint. J Shoulder Elbow Surg. 1994;3(5):435.
  26. Ryan V, Brown H, Minns Lowe CJ, Lewis JS. The pathophysiology associated with primary (idiopathic) frozen shoulder: A systematic review. BMC musculoskeletal disorders. 2016 Dec;17:1-21.
  27. Bunker TD, Anthony PP. The pathology of frozen shoulder. A Dupuytren-like disease. The Journal of Bone & Joint Surgery British Volume. 1995 Sep 1;77(5):677-83.
  28. Hettrich CM, DiCarlo EF, Faryniarz D, Vadasdi KB, Williams R, Hannafin JA. The effect of myofibroblasts and corticosteroid injections in adhesive capsulitis. Journal of shoulder and elbow surgery. 2016 Aug 1;25(8):1274-9.
  29. Kilian O, Pfeil U, Wenisch S, Heiss C, Kraus R, Schnettler R. Enhanced alpha1 (I) mRNA expression in frozen shoulder and dupuytren tissue. European journal of medical research. 2007 Dec 14;12(12):585.
  30. Hutchinson JW, Tierney GM, Parsons SL, Davis TR. Dupuytren’s disease and frozen shoulder induced by treatment with a matrix metalloproteinase inhibitor. The Journal of Bone & Joint Surgery British Volume. 1998 Sep 1;80(5):907-8.
  31. Lubis AM, Lubis VK. Matrix metalloproteinase, tissue inhibitor of metalloproteinase and transforming growth factor-beta 1 in frozen shoulder, and their changes as response to intensive stretching and supervised neglect exercise. Journal of Orthopaedic Science. 2013 Jul;18:519-27.
  32. Kraal T, Lübbers J, van den Bekerom MP, Alessie J, van Kooyk Y, Eygendaal D, Koorevaar RC. The puzzling pathophysiology of frozen shoulders–a scoping review. Journal of Experimental Orthopaedics. 2020 Dec;7(1):1-5.
  33. Bunker TD. Frozen shoulder: unravelling the enigma. Annals of the Royal College of Surgeons of England. 1997 May;79(3):210.
  34. Biernacka A, Dobaczewski M, Frangogiannis NG. TGF-β signaling in fibrosis. Growth factors. 2011 Oct 1;29(5):196-202.
  35. Piersma B, Bank RA, Boersema M. Signaling in fibrosis: TGF-β, WNT, and YAP/TAZ converge. Frontiers in medicine. 2015 Sep 3;2:59.
  36. Hong-yun LI, Shi-yi CH, Wei-tao ZH. Expression of transforming growth factor-beta and metalloproteinases in joint capsule of frozen shoulder. Journal of Shanghai Jiaotong University (Medical Science). 2009 Nov 25;29(11):1363.
  37. Arora PD, Narani N, McCulloch CA. The compliance of collagen gels regulates transforming growth factor-β induction of α-smooth muscle actin in fibroblasts. The American journal of pathology. 1999 Mar 1;154(3):871-82.
  38. Cho CH, Song KS, Kim BS, Kim DH, Lho YM. Biological aspect of pathophysiology for frozen shoulder. BioMed Research International. 2018 May 24;2018.
  39. Rodeo SA, Hannafin JA, Tom J, Warren RF, Wickiewicz TL. Immunolocalization of cytokines and their receptors in adhesive capsulitis of the shoulder. Journal of Orthopaedic Research. 1997 May;15(3):427-36.
  40. Cher JZ, Akbar M, Kitson S, Crowe LA, Garcia-Melchor E, Hannah SC, McLean M, Fazzi UG, Kerr SC, Murrell GA, Millar NL. Alarmins in frozen shoulder: a molecular association between inflammation and pain. The American journal of sports medicine. 2018 Mar;46(3):671-8.
  41. Taniguchi N, Kawakami Y, Maruyama I, Lotz M. HMGB proteins and arthritis. Human cell. 2018 Jan;31:1-9.
  42. Lee WJ, Song SY, Roh H, Ahn HM, Na Y, Kim J, Lee JH, Yun CO. Profibrogenic effect of high-mobility group box protein-1 in human dermal fibroblasts and its excess in keloid tissues. Scientific reports. 2018 May 30;8(1):8434.
  43. Pandey V, Aier S, Agarwal S, Sandhu AS, Murali SD. Prevalence of prediabetes in patients with idiopathic frozen shoulder: a prospective study. JSES international. 2024 Jan 1;8(1):85-9.
  44. Maini S, Bansal A, Arora R, Bansal S. Prevalence of diabetes in patients with frozen shoulder. J Evolution Med Dent Sci. 2019 Mar 18;8(11):804-6.
  45. Duzgun I, Turgut E, Eraslan L, Elbasan B, Oskay D, Atay OA. Which method for frozen shoulder mobilization: manual posterior capsule stretching or scapular mobilization?. Journal of musculoskeletal & neuronal interactions. 2019;19(3):311.
  46. Meena M. Comparative Effectiveness Of Sleeper Stretch And Cross-Body Stretch For Improving Posterior Shoulder Tightness, Pain And Function In Patients With Adhesive Capsulitis–A Randomized Controlled Trial.
  47. Zahoor M, Ali B, Khan A, Zeb GS, Sumayyah E, Qamar G. Effectiveness of Maitland manual therapy technique in management of idiopathic adhesive capsulitis. Annals of Allied Health Sciences. 2021 Jun 30;7(1):3-7.
  48. Sharma SK. Comparative Evaluation of Muscle Energy Technique and Maitland Mobilization Technique on Functional Activity, Motion Range, and Pain in Subjects with Adhesive Capsulitis. Tobacco Regulatory Science (TRS). 2022 May 25:848-53.
  49. Al Shehri A, Almureef SS, Khan S, Shamsi S. Efficacy of maitland mobilization in frozen shoulder. Europ J Biomed Pharma Sci. 2018;5(12):22-7.
  50. Chester R, Jerosch-Herold C, Lewis J, Shepstone L. The SPADI and QuickDASH are similarly responsive in patients undergoing physical therapy for shoulder pain. journal of orthopaedic & sports physical therapy. 2017 Aug;47(8):538-47.
  51. Tveitå EK, Ekeberg OM, Juel NG, Bautz-Holter E. Responsiveness of the shoulder pain and disability index in patients with adhesive capsulitis. BMC musculoskeletal disorders. 2008 Dec;9:1-8
  52. Manske RC, Prohaska D. Diagnosis and management of adhesive capsulitis. Current reviews in musculoskeletal medicine. 2008 Dec;1:180-9.
  53. Hand C, Clipsham K, Rees JL, Carr AJ. Long-term outcome of frozen shoulder. Journal of shoulder and elbow surgery. 2008 Mar 1;17(2):231-6.
  54. Le HV, Lee SJ, Nazarian A, Rodriguez EK. Adhesive capsulitis of the shoulder: review of pathophysiology and current clinical treatments. Shoulder & Elbow. 2017;9(2):75-84. doi:10.1177/1758573216676786
  55. Allen GM. The diagnosis and management of shoulder pain. J Ultrason. 2018;18(74):234-239. doi: 10.15557/JoU.2018.0034. PMID: 30451406; PMCID: PMC6442215.
  56. McKean D, Yoong P, Brooks R, Papanikitas J, Hughes R, Pendse A, McElroy BJ. Shoulder manipulation under targeted ultrasound-guided rotator interval block for adhesive capsulitis. Skeletal Radiol. 2019 Aug;48(8):1269-1274. doi: 10.1007/s00256-018-3105-3. Epub 2018 Nov 16. PMID: 30446788.
  57. Sheridan MA, Hannafin JA. Upper extremity: emphasis on frozen shoulder. Orthop Clin North Am. 2006 Oct;37(4):531-9. doi: 10.1016/j.ocl.2006.09.009. PMID: 17141009.
  58. Ewald A. Adhesive capsulitis: a review. Am Fam Physician. 2011 Feb 15;83(4):417-22. PMID: 21322517.
  59. Rundquist PJ, Anderson DD, Guanche CA, Ludewig PM. Shoulder kinematics in subjects with frozen shoulder. Arch Phys Med Rehabil. 2003 Oct;84(10):1473-9. doi: 10.1016/s0003-9993(03)00359-9. PMID: 14586914.
  60. Dias R, Cutts S, Massoud S. Frozen shoulder. BMJ. 2005 Dec 17;331(7530):1453-6. doi: 10.1136/bmj.331.7530.1453. PMID: 16356983; PMCID: PMC1315655.
  61. Patel R, Urits I, Wolf J, Murthy A, Cornett EM, Jones MR, Ngo AL, Manchikanti L, Kaye AD, Viswanath O. A Comprehensive Update of Adhesive Capsulitis and Minimally Invasive Treatment Options. Psychopharmacol Bull. 2020 Oct 15;50(4 Suppl 1):91-107. PMID: 33633420; PMCID: PMC7901130.
  62. Tao MA, Karas V, Riboh JC, Laver L, Garrigues GE. Management of the Stiff Shoulder With Arthroscopic Circumferential Capsulotomy and Axillary Nerve Release. Arthrosc Tech. 2017 Mar 13;6(2):e319-e324. doi: 10.1016/j.eats.2016.10.005. PMID: 28580248; PMCID: PMC5442417.
  63. Sathe S, Khurana SK, Damke U, Agrawal PV. To compare the effects of maitland mobilization with conventional physiotherapy in adhesive capsulitis. International Journal of Current Research and Review. 2020 Jul.
  64. Cavalleri E, Servadio A, Berardi A, Tofani M, Galeoto G. The effectiveness of physiotherapy in idiopathic or primary frozen shoulder. A systematic review and meta-analysis. MLTJ MUSCLES, LIGAMENTS AND TENDONS JOURNAL. 2020;10(1):24-39.
  65. Nakandala P, Nanayakkara I, Wadugodapitiya S, Gawarammana I. The efficacy of physiotherapy interventions in the treatment of adhesive capsulitis: A systematic review. Journal of back and musculoskeletal rehabilitation. 2021 Jan 1;34(2):195-205.
  66. Noten S, Meeus M, Stassijns G, Van Glabbeek F, Verborgt O, Struyf F. Efficacy of different types of mobilization techniques in patients with primary adhesive capsulitis of the shoulder: a systematic review. Archives of physical medicine and rehabilitation. 2016 May 1;97(5):815-25
  67. Hussain MA, Premkumar M, Kumar RM, Sundar RS. Effectiveness of Sleeper and Cross Body Stretches and Muscle Energy Techniques for Periarthritis Shoulder: Comparative Study. Indian Journal of Physiotherapy & Occupational Therapy. 2022 Oct 1;16(4).
  68. Mouleeswari B, Ramana K, Suganthirababu P, Alagesan J. Comparison of Effectiveness of Maitland Mobilization and Muscle Energy Technique in Patients with Periarthritis Shoulder Using SPADI and NPRS. Indian Journal of Physiotherapy & Occupational Therapy. 2024 Jan 2;18.
  69. Sule K, Rathi M, Palekar TJ, Anwer S. Comparison of conventional therapy versus sleeper stretch with conventional therapy in adhesive capsulitis. Int J Health Sci Res. 2015;5(11):186-92.
  70. Anwer Z, Kumar S. To study the effectiveness of gd maitland Mobilization versus laser therapy in adhesive capsulities. Int J Physiother Res. 2017;5(5):2371-78.

 Background and Objectives: Adhesive capsulitis (AC) is a pathological condition of shoulder joint characterized by excessive scar tissue or adhesion formation all across the glenohumeral joint. It is typically marked by a sudden onset of pain and a progressive loss of glenohumeral joint motion, which causes a severe loss of shoulder function. There is a high prevalence in the age group between 40 to 60 years of age. As Compared to men, women are 4 times more likely to be affected by frozen shoulder. AC results in discomfort, pain, stiffness and dysfunction .The study was done to assess the effectiveness of Maitland mobilization vs sleepers and posterior capsule stretch on pain, ROM and shoulder function in patients with adhesive capsulitis.  Methods: According to the sample size estimation the study included 60 participants. All the subjects included were clinically diagnosed by an orthopedic with adhesive capsulitis were screened after finding their suitability as per the inclusion criteria. Participants were briefed about the study and informed consent was obtained for the same. Total of 60 participants were randomly assigned into 2 treatment groups with 30 participants each. Group 1 (n=30) was given Maitland mobilization along with conventional physiotherapy whereas, group 2 (n=30) was followed by vs sleepers and posterior capsule stretch along with conventional physiotherapy protocol. The total duration of treatment was 4 weeks. Pre and post intervention scores were measured in terms of VAS, ROM, and SPADI.  Outcome Measures: Pre and post intervention scores were measured in terms of VAS, ROM, and shoulder disability. The outcome measure pain was measures using Visual analog scale. The availability of range of motion of shoulder was measured using universal goniometer. To calculate the extent of disability caused by the adhesive capsulitis was measured using shoulder pain and disability index.  Result: While comparing pre-test and post-test scores using paired t-test, both the groups showed a significant difference in each parameter (VAS, shoulder ROM, SPADI= <0.001). Independent sample t-test showed significant improvement in all the parameters (VAS, shoulder ROM in flexion, abduction and external rotation, SPADI= <0.001) of both the groups after 4 weeks of intervention.  Conclusion: On the basis of result obtained from this study, Maitland mobilization is significantly more effective in increasing ROM, reducing pain on VAS and decreasing the shoulder disability compared to sleepers and posterior capsule stretch in patients with adhesive capsulitis.

Keywords : Maitland Mobilization, Adhesive Capsulitis, Visual Analog Scale, Sleepers Stretch, Posterior Capsule, Range of Motion.

Never miss an update from Papermashup

Get notified about the latest tutorials and downloads.

Subscribe by Email

Get alerts directly into your inbox after each post and stay updated.
Subscribe
OR

Subscribe by RSS

Add our RSS to your feedreader to get regular updates from us.
Subscribe