The Effects of Additional Proprioceptive Neuromuscular Facilitation Over Conventional Therapy In Patients With Adhesive Capsulitis

Abstract

Purpose: This study is performed to investigate the effectiveness of upper extremity and scapula Proprioceptive Neuromuscular Facilitation (PNF) techniques in adhesive capsulitis (AC).Methods: Thirty-six subjects were randomized into two groups. Control group (n=18) was treated with conventional physiotherapy applications consisting of hot-pack and ultrasound, and wall and wand exercises instructed as a home program; study group (n=18) was treated with upper extremity and scapula PNF patterns besides conventional physiotherapy. Patients were treated five times a week, for a total of 15 sessions. Pain intensity was assessed on a visual analogue scale; postural deformities were evaluated by inspection. Range of shoulder movements (ROM) were measured by a universal goniometer. "Lateral Scapular Slide Test" and assessment of scapular position were used for evaluation of the scapula. Functional performance was assessed by Shoulder Pain and Disability Index (SPADI). Results:Intensity of pain during activity significantly decreased and ROM increased in both groups (p<0.05). While increase amounts of shoulder flexion and abduction ROMs were higher in the PNF group (p<0.05), there was no difference between groups in internal and external rotation movements. Although, night pain significantly decreased in the study group (p<0.05), it remained unchanged in the control group (p>0.05). Scapula position didn't change after therapy in both groups (p>0.05). SPADI scores decreased in both groups (p<0.05).Discussion: This study showed that PNF patterns provide significant contribution to night pain and range of flexion and abduction movements in patients with AC. Including PNF applications in AC treatment program may provide better outcomes. Yöntemler: Çalışmaya katılan 36 olgu, rastgele iki gruba ayrılmıştır. Kontrol grubundaki hastalar (n=18) geleneksel fizik tedavi uygulamalarından sıcak yastık, ultrason ve ev programı olarak gösterilen duvar ve baston egzersizleri ile, çalışma grubundaki hastalar (n=18) ise bunların yanı sıra fizyoterapist tarafından uygulanan üst ekstremite ve skapula PNF paternleri ile tedavi edildi. Hastalar haftada 5 kez olmak üzere toplam 15 seans tedavi aldı. Ağrı değerlendirmesi için Vizüel Analog Skalası kullanıldı. Gözlemsel postür analiz yöntemi ile postüral bozukluklar değerlendirildi. Üniversal gonyometre ile eklem hareket açıklığı ölçümü yapıldı. Skapulanın değerlendirmesinde, "Lateral Skapula Kayma Testi" ve skapula pozisyonu değerlendirmesi kullanıldı. "Omuz Ağrı ve Özürlülük İndeksi" ile hastaların fonksiyonel performansı değerlendirildi. Sonuçlar: Çalışmanın sonucunda, her iki grupta da aktivite sırasındaki ağrının anlamlı olarak azaldığı ve eklem hareket açıklığının arttığı görüldü (p<0.05). Fleksiyon ve abduksiyon hareket açıklığındaki artış, PNF grubunda fazla olurken (p<0.05), internal ve eksternal rotasyon hareket açıklığında gruplar arasında fark görülmedi. PNF grubunda gece ağrısında azalma tespit edilirken (p<0.05), kontrol grubunda anlamlı bir değişiklik olmadı (p>0.05). Teda...

The Effectiveness of Physiotherapy in Idiopathic or Primary Frozen Shoulder: a Systematic Review and Meta-Analysis

“…According to this review physiotherapy seems to be recommended in individuals with primary frozen shoulder. Therapeutic exercise has demonstrated to be an effective option in all outcomes reported, from mobility to function and pain (9,(22)(23)(24)27,29,30).…”

“…However, the analysis between two groups showed significant differences favour to experimental group in all parameters except forward flexion. Akbas et al (30) investigated the role of PNF exercises for scapula and arm in addition to home exercises in thirty-six patient. Both groups also received heat packs and ultrasound before their three weeks treatment (fifteen sessions).…”

“…We also used Jadad scale to assess the quality of included studies. Five articles had a Jadad score of two points (8,23,27,30,31), five had three points (9,22,24,28,29) and two had five points (25,26). The main problems of the articles who received a low score according to Jadad scale were the impossibility of a double blind study due to nature of treatment, inadequate description of dropout and withdraws and inadequate randomization method.…”

“…Another limit of some articles (8,24,(27)(28)(29)(30)(31) was the absence of follow-up, so it was not possible to assess long period effectiveness. Due to the physiotherapy intervention in many studies, double-blinding was not possible; only two studies (25,26) had maximum score according to Jadad scale.…”

The efficacy of physiotherapy interventions in the treatment of adhesive capsulitis: A systematic review

“…Nevertheless, significant group differences were not encountered. Akbaş et al [47] indicated significant effects on night pain and flexion, and abduction ROM values with upper extremity and scapular proprioceptive neuromuscular facilitation (PNF) along with conventional physiotherapy compared to the control group, whereas Balci et al…”