Get Relieved From The Pain With The Best Therapies As the hours of work are getting concentrated on more of computer work and less of any manual work, humans hardly put exercise or physical work in their schedule, and that's the reason, in the present generation many people are found suffering from different kind of pains. Once your body gets affected by depression in an internal part, then it makes you suffer for your entire life. If you are looking for a remedy for your long term pains, then Maitland mobilization will surely help you in getting out of your problematic situation. Many people are still not aware of this method; well, it is one technique which cures joint pain with the help of physical labor. If you are facing any problem in moving a particular joint of your body, then mobilization makes it moving.

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To study the effectiveness of Maitland techniques in the treatment of idiopathic shoulder adhesive capsulitis. In Group A subjects were treated with Maitland mobilization technique and common supervised exercises, whereas subjects in Group B only received common supervised exercises. These were recorded before and after the session of the training.

Total duration of the study was four weeks. Statistical analysis of the data revealed that within-group comparison both groups showed significant improvement for all the parameters, whereas between-group comparison revealed higher improvement in Group A compared to the Group B. The study confirmed that addition of the Maitland mobilization technique with the combination of exercises have proved their efficacy in relieving pain and improving R.

The capsular pattern in the shoulder is characterized by most limitation of passive lateral rotation and abduction [ 1 ]. The presence of capsular pattern is necessary to give a diagnosis of shoulder Capsulitis [ 2 ]. Although the ROM varies depending upon which stage the patient presents, yet he or she still has limitations of passive ROM in a capsular pattern.

Neviaser [ 5 ] called it adhesive capsulitis, as he, under arthroscopy, observed that the capsule looked thickened and adhered to underlying bone and could be peeled off from the bone. In an idiopathic capsulitis there is no apparent cause. The shoulder gradually becomes painful and stiff. Some authors have divided frozen shoulder in primary frozen shoulder, which corresponds to idiopathic.

The secondary corresponds to traumatic capsulitis or if some other medical condition is present alongside [ 6 ]. The natural course of the condition is longer than generally stated and not always complete, that is, not all get full recovery.

The traditional principles of treatment of adhesive capsulitis are to relieve pain, maintain range of motion, and ultimately to restore function. The treatment of adhesive capsulitis by means of physiotherapy all along consists of different modalities e. Relief of pain may be achieved by massage, deep heat, ice, ultrasound, TENS transcutaneous electrical nerve stimulation , and LASER light amplification by stimulated emission of radiations as described in our standard text books and other literature concerning the treatment of adhesive capsulitis.

However, they probably offer little benefit [ 6 — 10 ]. Mostly these applications are adjunct to other treatment modalities like mobilization techniques or home exercise program [ 6 — 13 ]. Although adhesive capsulitis is generally considered to be a self-limiting condition that can be treated with physical therapy [ 14 , 15 ], to regain the normal extensibility of the shoulder capsule, passive stretching of the shoulder capsule in all planes of motion by means of mobilization techniques has been recommended [ 7 , 8 , 11 , 12 ].

The international Maitland Teachers Association IMTA defines the Maitland concept as a process of examination, assessment, and treatment of neuromusculoskeletal disorder by manipulative physiotherapy [ 12 ].

Grades I and II of Maitland mobilization techniques are primarily used for treating joints limited by pain. The oscillations may have an inhibitory effect on the perception of painful stimuli by repetitively stimulating mechanoreceptors that block nociceptive pathways at the spinal cord or brain stem levels.

These nonstretch motions help move synovial fluid to improve nutrition to the cartilage whereas Grades III and IV are primarily used as stretching manoeuvres. Appropriate selection of mobilization technique for treatment can only take place after a thorough assessment and examination. As mentioned above, the capsulitis is challenging for therapeutic as well as rehabilitation purposes. In this present work, the purpose is to evaluate the efficacy of the Maitland mobilization in the rehabilitation of the adhesive capsulitis.

It is hypothesized that the importance of Maitland techniques is more effective than the conventional exercise program in case of adhesive capsulitis. Forty subjects both male and female between age group of 40 and 60 were selected from National Institute for the Orthopaedically Handicapped NIOH Outpatient Department after they were diagnosed of suffering from the idiopathic shoulder adhesive capsulitis.

All subjects were diagnosed by orthopedic doctor and they were checked for the global restriction at shoulder joint, by expert physiotherapist. After the initial assessment, written informed consent forms were obtained from the participants who met the inclusion criteria.

The inclusion criteria of the study were age between 40 to 60 years; shoulder ROM restriction; pain more than 2 months. All the patients were having global restriction of shoulder joint range of motion, that is, movements of shoulder were restricted in shoulder in all direction.

Figure 1 shows the methodology adopted in the study. Since the symptoms of patients were more than two months old, therefore they were not given any medical intervention in form of steroidal injection, or NSAID nonsteroidal anti inflammatory drugs.

The selected candidates were randomly allocated to two different groups: experimental Group A and control Group B each having 20 participants. The randomization was done using a chit pick box method. Whenever patient was selected for study, a chit was picked from the box, and whatever chit was picked, the patient was assigned to that group.

Abduction range and external rotation range were measured by goniometer. After the assessment and the data collection, participants were given the therapeutic intervention according to their groups. Two groups pretreatment-posttreatment test design was done, and study period of this study was 4 weeks. The glides given included glenohumeral caudal glide, glenohumeral caudal glide progression; glenohumeral postero-anterior glide.

Passive oscillatory movements were performed at the rate of glides per second for 30 seconds for each glide and every glide was given for 5 sets. The technique was applied thrice a week for four weeks 12 sessions. This intervention was given to the experimental as well as the control group. Supervised exercise program was explained and patients were required to repeat all these exercises at center under supervision of the therapist Figure 3. Intervention consisted of the Codman exercise [ 4 ], shoulder wheel exercises [ 6 ], self-stretching exercises [ 6 ], wall-ladder exercises [ 6 , 16 ], and self-stretching exercises for improving abduction, flexion, external rotation, internal rotation, and horizontal adduction.

For improving the abduction, patient was sitting with the side next to a table, the forearm resting with palm up and patient was asked to slide his or her arm across the table, remaining in this position for 10 seconds, relax in starting position, and repeat it for 10 times. Similarly for improving the flexion the client was asked to slide the forearm forward along the table, remain in this position for 10 seconds, relax in starting position, and repeat it for 10 times.

For improving the lateral rotation, the client stood standing and facing a doorframe with the palm of the hand against the edge of the frame and elbow flexed While keeping the arm against the side or in slight abduction, the subjects were asked to turn away from the fixed hand, remain in this position for 10 seconds, relax in starting position, and repeat it for 10 times.

For improving the medial rotation, the client remained in standing or in high sitting with holding the towel from back by using his or her both hand. Subjects hold the towel from back of the neck through affected side hand and tried to pull the towel from sound arm hand through lower back, hold it for 10 seconds, and relax, and Repeat it for 10 times. To improve the shoulder extension, the client stood with the back to the table. Both hands were grasping the edge with the fingers facing forward.

The subjects were asked to begin to squat while letting the elbows flex, hold it for 10 seconds, and relax, repeat it for 10 times. To increase the horizontal adduction clients performed cross stretch where they were asked to adduct the tight shoulder horizontally by placing the arm across the chest.

Apply sustained overpressure to the adducted arm by pulling the arm toward the chest. SPSS version 15 software was used for analysis of the gathered data. External rotation and abduction range were analyzed by Wilcoxon Signed Ranks test for within-group and Mann-Whitney test for between-group variables.

Their variables had insignificant difference between the two groups at preintervention levels Table 1. Both groups have shown statistically significant improvement in pain scores.

During between-group comparison, it was observed that the baseline characteristics of the data for both groups, that is, VAS0 is statistically insignificant. The posttreatment reading at the end of 4th week VAS4 was found to be statistically significant between the two groups Table 2 and Figure 4 , and Group A has shown more improvement than Group B.

During between-group comparison, it was observed that the baseline characteristics of the data for both groups, that is, SPADI0, was statistically insignificant. Both groups improved significantly in external range of motion. For both groups, the baseline characteristics of the data, that is, EXRT0, is statistically insignificant.

The posttreatment reading at the end of 4th week EXRT4 was found to be statistically significant between two groups Table 4. Group A has shown better improvement in comparison to Group B Figure 4. Both groups improved significantly in abduction range of motion. For both groups, the baseline characteristics of the data, that is, ABD0, is statistically insignificant.

The posttreatment reading at the end of 4th week ABD4 was found to be statistically significant between two groups Table 5. The present study was designed to know the efficacy of Maitland mobilization techniques adjunct with exercises in the treatment of idiopathic shoulder adhesive capsulitis by comparing with exercises alone. While analyzing the outcome measures of this study, it was observed that both the groups have shown significant improvement over time.

Statistical analysis of the data in pre- and postintervention VAS values illustrated difference shown by decreasing trends in Table 2 and Figure 4 a for both groups. Though both groups have significantly reduced pain scores, the difference was found in favor of Group A in between-group comparison Table 2 and Figure 4.

Both the groups shown reduction in pain scores, and this is in agreement with previous study suggesting that mobilization reduces pain [ 15 ] due to neurophysiologic effects on the stimulation of peripheral mechanoreceptors and the inhibition of nociceptors [ 17 , 18 ]. The activation of apical spinal neurons as a result of peripheral mechanoreceptor by the joint mobilization produces presynaptic inhibition of nociceptive afferent activity [ 19 ].

Mechanical force during mobilization may include breaking up of adhesions, realigning collagen, or increasing fibre glide when specific movements stress the specific parts of the capsule [ 20 ].

Furthermore mobilization techniques are supposed to increase or maintain joint mobility by inducing biological changes in synovial fluid, enhanced exchange. The ongoing circulatory stasis may lead to ischemia and the potential for intraneural oedema, inflammation, and fibrosis. Mobilization has an effect on fluid flow as blood flow in the vessels supplying the nerve fibres and synovial fluid flow surrounding the avascular articular cartilage. This, by a pressure gradient, is generated which helps in facilitating exchange of fluid, that is, increased venous drainage and dispersing the chemical irritants.

This causes a reversal of the ischemia, edema, and inflammation cycle and reduces joint effusion and relieves pain by reducing the pressure over the nerve endings. The neurophysiologic effect is based on the stimulation of peripheral mechanoreceptors and inhibition of nociceptors [ 12 ]. In Group B, noticeable improvement may be due to beneficial effect of supervised exercise protocol.

Many studies have claimed that exercise programme is the most effective treatment for shoulder adhesive capsulitis [ 21 ]. Exercises within the pain free range of motion stimulates mechanoreceptors and decreases pain. Exercises within pain free range also move the synovial fluid, thus decrease inflammation and decreased pain [ 22 , 23 ].

Weight was not used if pain was severe. This techniques uses the effects of gravity to distract the humerus from the glenoid fossa.

They help to relieve pain through gentle traction and oscillation and provide movement of the synovial fluid. It also relives pain through the neurophysiological and mechanical effect [ 6 ]. The predominant adhesive capsule and associated soft tissue tightness of frozen shoulder have been commonly addressed in clinical treatment approaches by mobilization techniques [ 24 ]. Mobilization techniques improve the normal extensibility of the shoulder capsule and stretch the tightened soft tissues to induce beneficial effects.

It may be attributed to the fact that the intent of end-range mobilizations is not only to restore joint play but also to stretch contracted periarticular structures [ 24 ]. Whereas Group A received mobilization, gliding for mobilization selected to increase external range of motion was postero-anterior glide and to increase abduction, caudal glide was selected. It may be the reason that postero-anterior glide and caudal glide of the glenohumeral joint increased the capsular extensibility and lengthen the soft tissues which were inhibiting joint play movement at the joint.


Maitland physical therapy courses

Therapeutic exercise only was applied to the cervical and upper thoracic spine for Group I, while both therapeutic exercise and joint mobilization were applied to Group II. The visual analog scale, neck disability index, active cervical range of motion, static balance capacity, and muscle tone were assessed with a pre-test. The intervention was carried out for 60 minutes a day, three times a week, for two weeks for each group, followed by a post-test using the same protocol as the pre-test. Group II improved significantly more on right lateral flexion and rightward rotation. Muscle tone improved significantly in the upper trapezius in both groups. Neck pain is a common musculoskeletal disorder in modern society that can produce severe pain. The pain exacerbates and fades periodically, and many patients do not fully recover from the symptoms 2.


Effectiveness of Maitland Techniques in Idiopathic Shoulder Adhesive Capsulitis

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