The Combined Effect of Mulligan Mobilization, Pain Neuroscience-Based Training, and Core Stabilization Exercises in Frozen Shoulder Patients

Обзор

The purpose of this randomized controlled study is to investigate the effects of a combined rehabilitation program consisting of Mulligan Mobilization with Movement (MWM), Pain Neuroscience Education (PNE), and core stabilization exercises in individuals with adhesive capsulitis (frozen shoulder). The main questions this study aims to answer are: Does the combination of Mulligan mobilization, Pain Neuroscience Education, and core stabilization exercises reduce pain in individuals with adhesive capsulitis? Does this combined intervention improve shoulder range of motion, shoulder function, quality of life, scapular dyskinesis, and pain catastrophizing compared with conventional physical therapy? Participants diagnosed with adhesive capsulitis will be randomly assigned to one of two groups. The intervention group will receive Mulligan mobilization, Pain Neuroscience Education, and core stabilization exercises, while the control group will receive conventional physical therapy, including TENS, hot-pack application, passive joint mobilization, and stretching exercises. Both groups will participate in treatment sessions three times per week for six weeks. Outcome measures will be assessed at baseline and after completion of the 6-week intervention period.

Подробное описание

Adhesive capsulitis, commonly known as frozen shoulder, is a musculoskeletal disorder characterized by shoulder pain, progressive restriction of active and passive range of motion, and functional disability. The condition negatively affects activities of daily living and quality of life and is most frequently observed in individuals between 40 and 65 years of age. Despite the widespread use of conventional physiotherapy interventions, optimal treatment strategies remain under investigation.

Mulligan Mobilization with Movement (MWM) is a manual therapy technique that combines sustained accessory joint glides with active pain-free movement. Previous studies have demonstrated beneficial effects of Mulligan mobilization on pain reduction and functional improvement in individuals with adhesive capsulitis. Pain Neuroscience Education (PNE) is an educational approach designed to improve patients' understanding of pain mechanisms and reduce maladaptive beliefs related to pain. Core stabilization exercises, particularly those based on Dynamic Neuromuscular Stabilization (DNS) principles, aim to improve postural control, neuromuscular coordination, and movement efficiency.

Although the effectiveness of Mulligan mobilization has been investigated in patients with adhesive capsulitis, there is limited evidence regarding the use of Pain Neuroscience Education in this population, and the effects of DNS-based core stabilization exercises have not been adequately studied. Furthermore, no previous study has examined the combined effects of Mulligan mobilization, Pain Neuroscience Education, and core stabilization exercises in individuals with adhesive capsulitis.

This randomized controlled trial aims to evaluate the short-term effects of a combined intervention consisting of Mulligan mobilization, Pain Neuroscience Education, and core stabilization exercises on pain intensity, shoulder range of motion, shoulder function, pain catastrophizing, scapular dyskinesis, core stability, and health-related quality of life in individuals with adhesive capsulitis.

Participants diagnosed with adhesive capsulitis will be randomly allocated to one of two groups. The experimental group will receive Mulligan mobilization, Pain Neuroscience Education, and DNS-based core stabilization exercises. The control group will receive conventional physical therapy consisting of transcutaneous electrical nerve stimulation (TENS), hot-pack application, passive joint mobilization, and stretching exercises. Both groups will participate in treatment sessions three times per week for six weeks. Assessments will be conducted at baseline and after completion of the intervention period.

The findings of this study may contribute to the development of a more comprehensive rehabilitation approach for individuals with adhesive capsulitis and provide evidence regarding the effectiveness of combining manual therapy, pain education, and core stabilization strategies in clinical practice.

Вмешательства

• Поведенческое Pain Neuroscience Education (PNE)
  Participants will receive Pain Neuroscience Education focused on the biopsychosocial nature of pain, central sensitization, the distinction between pain and tissue damage, and strategies to reduce fear of movement. The initial educational session will last approximately 15-20 minutes, followed by 5-10 minute reinforcement sessions throughout the intervention period. Education will be delivered through verbal explanations and interactive discussion.
• Процедура Mulligan Mobilization With Movement (MWM)
  Participants will receive Mulligan Mobilization with Movement techniques applied to the glenohumeral joint, including posterolateral glide with active abduction, inferior glide with shoulder flexion, and posterior glide with internal rotation. Mobilizations will be performed within a pain-free range of motion. Each technique will be administered in 3 sets of 10 repetitions with 30 seconds of rest between sets. Treatment will be provided three times per week for six weeks
• Поведенческое Core Stabilization Exercises
  Participants will perform Dynamic Neuromuscular Stabilization (DNS)-based core stabilization exercises. The program will include diaphragmatic breathing, supine 90/90 positioning, abdominal bracing, and progression to dead bug, bird-dog, and modified plank exercises as tolerated. Exercises will be performed in 2-3 sets of 8-12 repetitions with 10-20 second isometric holds. Progression will occur from stable to unstable surfaces and from static to dynamic activities
• Другое Conventional Physical Therapy
  Participants in the control group will receive conventional physical therapy consisting of transcutaneous electrical nerve stimulation (TENS) applied at a sensory level for 20 minutes, hot-pack application for 20 minutes, passive shoulder joint mobilization exercises, pendulum exercises, and wand exercises. Treatment sessions will be conducted three times per week for six weeks.

Первичные конечные точки

• Pain Intensity [Срок оценки: Baseline and week 6]
• Shoulder Function [Срок оценки: Baseline and week 6]
• Shoulder Range of Motion [Срок оценки: Baseline and week 6]

Вторичные конечные точки (4)

• Pain Catastrophizing [Срок оценки: Baseline and week 6]
• Core Stability [Срок оценки: Baseline and week 6]
• Change in Scapular Dyskinesis [Срок оценки: Baseline and week 6]
• Change in Health-Related Quality of Life [Срок оценки: Baseline and week 6]

Критерии участия

Критерии включения

• Adults aged 18 to 65 years
• Diagnosis of adhesive capsulitis confirmed by an orthopedic surgeon or a physical medicine and rehabilitation physician
• Presence of shoulder pain and limitation of shoulder range of motion
• Ability to communicate verbally
• Ability to understand study procedures and educational content
• Willingness to participate and provide written informed consent
• Mini-Mental State Examination (MMSE) score of 24 or higher
• Ability to attend treatment and assessment sessions regularly

Критерии исключения

• MMSE score below 24
• Severe cognitive impairment
• Severe psychiatric disorders
• Active infectious disease
• Active malignancy
• Uncontrolled cardiovascular disease
• Presence of a cardiac pacemaker
• Contraindications to transcutaneous electrical nerve stimulation (TENS)
• Neurological disorders that may affect participation or outcomes
• Systemic diseases that may interfere with the safe implementation of the intervention
• Inability to comply with the study protocol or attend scheduled sessions

Критерии приведены из реестра в оригинале (на английском). Окончательную оценку соответствия проводит исследовательский центр.

Здоровые добровольцы: Нет

Дизайн исследования

Распределение

Рандомизированное

Модель

Параллельные группы

Маскирование

Простое слепое

Основная цель

Лечение

Центры проведения

Turkey (Türkiye) · 1 центр

• Life Med Tıp Merkezi — Istanbul

Публикации

• Sullivan MJL, Bishop SR, Pivik J. The Pain Catastrophizing Scale: Development and validation. Psychological Assessment. 1995;7(4):524-532.
• Leggin BG, Michener LA, Shaffer MA, Brenneman SK, Iannotti JP, Williams GR Jr. The Penn shoulder score: reliability and validity. J Orthop Sports Phys Ther. 2006 Mar;36(3):138-51. doi: 10.2519/jospt.2006.36.3.138. PMID 16596890
• Razzaq A, Nadeem RD, Akhtar M, Ghazanfar M, Aslam N, Nawaz S. Comparing the effects of muscle energy technique and mulligan mobilization with movements on pain, range of motion, and disability in adhesive capsulitis. J Pak Med Assoc. 2022 Jan;72(1):13-16. doi: 10.47391/JPMA.1360. PMID 35099430
• Doner G, Guven Z, Atalay A, Celiker R. Evalution of Mulligan's technique for adhesive capsulitis of the shoulder. J Rehabil Med. 2013 Jan;45(1):87-91. doi: 10.2340/16501977-1064. PMID 23037929

Идентификаторы

NCT: NCT07667556 · Dilay Döner

Первоисточники (государственные реестры)

• ClinicalTrials.gov (NIH, США)

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