Effect of Maitland mobilization and exercises for the treatment of shoulder adhesive capsulitis: A single-case design

Abstract

The purpose of this single-case design (ABCBC) was to investigate the response of shoulder motions, pain, and function to two commonly used physiotherapy management approaches. An individual with stage three shoulder adhesive capsulitis was treated with exercise (phase B) and exercise plus mobilization (phase C). Initially, a “baseline” phase (phase A) when treatment had not started was established for comparison. Two types of Maitland “accessory” glenohumeral mobilization techniques, anteroposterior mobilization in shoulder flexion and longitudinal caudad in shoulder abduction, were evaluated during phase C. The Shoulder Pain and Disability Index (SPADI) was used to monitor pain and functional disability, and four shoulder movements (flexion, abduction, internal, and external rotations) were measured. The results were evaluated by using single-case design analysis method of Split Middle Technique and visual observation. The SPADI scores deteriorated in phase A but improved in phase B1, C1, and B2. All four shoulder movements improved under both management approaches, although more gain in motion was observed when mobilizations were added to an exercise program. The exercise plus mobilization intervention shows promise as a cost-effective management. The deterioration in shoulder motion, pain, and function observed in phase A may suggest benefit of an earlier physiotherapy intervention.