Effects of Scapular Proprioceptive Neuromuscular Facilitation on Pain and Range of Motion in Patients with Adhesive Capsulitis: A Randomized Controlled Trial
Abstract
Background: Adhesive capsulitis is a common musculoskeletal condition exhibiting pain and a gradual loss of range of motion in the glenohumeral joint. This affects the activities of daily life and most commonly results in functional limitations.
Objective: To assess the effects of proprioceptive neuromuscular facilitation (PNF) technique on scapula along with conventional physical therapy on pain reduction and improvement in the range of motion of shoulder joints in patients with adhesive capsulitis.
Methodology: At the department of Physical medicine and rehabilitation of Fauji Foundation Hospital, Rawalpindi and District Head Quarter Hospital, Jhelum a single-blind randomized controlled trial was carried out, dated from October 2022 to September 2023. A total of 32 patients with diabetes, aged 40 years and above, both males and females who were diagnosed with pain in one shoulder and whose range of motion was limited were included in this study. Patients with prior shoulder surgery, manipulation under anesthesia, corticosteroid injections within the last three months, or any musculoskeletal, neurological, or cardiovascular disorders were not included in this study. Conventional physiotherapy was given to the control group, and scapular proprioceptive neuromuscular facilitation with conventional treatment was given to the experimental group for two weeks. Pain (visual analogue scale), shoulder ROM (goniometer), and scapular dyskinesia (LSST), were the outcome measures which were assessed at baseline and after two weeks as well. (Clinical Trial Registry Number: NCT05889065)
Results: A total of 32 participants were randomized (n=16 per group). VAS differences between groups were non-significant at baseline (p=0.052) and at 2 weeks (p=0.277), although both groups improved significantly over time (p<0.001). Significant between-group effects were observed for shoulder flexion (168.12 ± 11.08 vs. 146.80 ± 18.51; p=0.001) and abduction (165.62 ± 10.93 vs. 142.80 ± 22.94; p=0.001), but not external rotation (p=0.145). LSST values were comparable at neutral and 45°, with a significant difference at 90° (p=0.031). Within-group improvements were significant at 45° and 90° positions in both groups (p<0.05). The experimental group demonstrated clinically greater improvement across most outcomes.
Conclusion: Scapular PNF combined with conventional physiotherapy produced greater improvements in pain, shoulder range of motion, and selected measures of scapular stability than conventional therapy alone. These findings support the added benefit of incorporating scapular PNF techniques in the rehabilitation of patients with diabetic shoulder dysfunction.
Keywords: Adhesive Capsulitis, Pain, Physical Therapy Modalities, Proprioceptive Neuromuscular Facilitation, Range of Motion, Articular.
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