Adhesive Capsulitis JOSPT Article

[Kyle Feldman]

Hello Residents,
I am a graduate of the residency a few years ago. I hope you are enjoying the year!

I reviewed this article today and was very impressed by the detail and clinical reasoning for the progression of manual therapy and stretching.

I feel that articles like these can help a therapist with a plan for treatment. It does not just give a forced “do this, next that” but a thought process of progression.

What do you think about these techniques?
What are your thoughts on the quality of the research?
Will this article effect your treatment of patients with frozen shoulder?

Kyle

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[Erik Kreil]

Hey Kyle,

My immediate takeaway is the obvious outcome trend: while the pathology typically dictates a pain >> stiffness >> recovery progression, patients’ pain recovered last (6-9mos) whereas their mobility, strength, and DASH scores improved by the end of the treatment duration (3mos).

I really appreciated the thought progression that was obviously patient centered and very simply founded on perceived patient sx irritability. I mean, the techniques ranged from Gr1-4 in neutral, at midrange, and at endrange. Be as specific as possible, as tolerably as possible. It’s a good exhibition of maintaining a logical clinical decision tree that is based on the person in front of you. The pathology is going to take its course, and it’s my job to choose the techniques that make sense.

I appreciate the post, Kyle

[jeffpeckins]

I liked the articles as well. I appreciated that the treatment was similar to how we would all treat a patient, which is with consistent reassessment of their symptoms and appropriately progressing or regressing from there. Most articles are very specific and rigid in their treatment protocols, so I liked the flexibility and it was more applicable to the clinic. I think it is a good reminder to be as specific as possible in addressing the impairments in front of you. Each patient had specific impairments and therefore the PT used different MT and exercises techniques to treat. They did not treat every frozen shoulder patient the exact same.

I found it interesting that they kind-of categorized the patients in different stages of frozen shoulder, but their stage didn’t dictate their treatment. In addition, the case series showed that improvements can be made in any of the different stages, so it should not be necessarily expected for outcomes to regress depending on their stage. However, there were some patients who had declines throughout their treatment in different outcomes.

Lastly, I really like how they included so many different MT techniques used in their treatment. I found the MWM especially useful, and definitely want to take time and see how I can possibly incorporate these into my treatment.

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