Both passive joint mobilization and capsular stretching significantly improved pain, range of motion, and disability in stage-II frozen shoulder over four weeks, though mobilization produced larger gains in certain directions (flexion, extension, abduction) while stretching excelled at internal rotation .
Frozen shoulder, or adhesive capsulitis, is a progressive condition characterized by inflammation and stiffening of the shoulder joint capsule. It typically unfolds in stages: initial pain, progressive stiffness, and eventual recovery. Stage II, the middle phase, is when the joint becomes notably restricted and patients experience significant functional loss. This randomized controlled trial compared two manual therapy approaches in 38 patients aged 30-50 with confirmed stage-II adhesive capsulitis.
The trial split participants into two groups. Group A (control) received Maitland mobilization, a passive technique where a therapist applies controlled oscillating movements to the joint itself. Group B (experimental) received capsular stretching, where the therapist applies sustained force to lengthen the tightened joint capsule. Both groups completed 12 sessions delivered three times weekly over four weeks. Researchers measured outcomes using three tools: a goniometer to quantify shoulder range of motion in multiple directions, a numeric pain rating scale (0-10), and the Shoulder Pain and Disability Index (SPADI) to assess functional limitations.
The results reveal a nuanced picture. Both interventions produced substantial within-group improvements across all measured movements and pain, with gains large enough to be clinically meaningful. When compared head-to-head, however, the mobilization group showed significantly greater improvements in shoulder flexion (forward raising), extension (backward raising), abduction (side raising), and the overall SPADI disability score. The effect size for SPADI improvement was particularly large in the mobilization group (eta-squared = 0.605), meaning approximately 61% of the variance in disability reduction could be attributed to the intervention type. By contrast, the stretching group achieved notably better gains in internal rotation (inward turning), while external rotation (outward turning) showed no significant difference between groups. Pain severity shifted in both groups from predominantly severe baseline pain to mainly mild and moderate pain post-intervention, with no statistically significant intergroup difference in pain reduction.
The study suggests the two techniques address the frozen shoulder problem through different biomechanical pathways. Mobilization appears more effective at restoring the gross movement patterns most impaired in frozen shoulder, while sustained capsular stretching may more directly target the internal rotational restriction that often persists longest.
If you have been diagnosed with stage-II frozen shoulder, this evidence suggests both mobilization and stretching-based physical therapy are evidence-supported options. The choice between them may hinge on your specific movement limitation pattern. If your primary functional loss is in forward reaching, overhead activity, or side raising, mobilization showed an advantage. If internal rotation is your most limiting restriction, or if your therapist recommends a stretching-focused approach, the data supports meaningful improvement.
Neither technique eliminated pain or restored full motion in four weeks, which aligns with the natural history of adhesive capsulitis. Continued therapy or home-based stretching beyond the four-week study window would likely be necessary. The study also used relatively short treatment duration (12 sessions), so longer intervention periods might yield different comparative results.
This research applies specifically to stage-II disease in adults aged 30-50. Outcomes may differ in earlier or later stages, or in different age groups. The study was conducted in Pakistan and reflects clinical practice patterns there, which may or may not exactly match protocols available in your region.
One practical consideration: mobilization requires a skilled therapist and cannot be self-administered, while stretching-based protocols may include home components. Ask your physical therapist whether the treatment plan incorporates elements you can perform independently to extend benefit between sessions.
| Characteristic | Details |
|---|---|
| Study type | Randomized controlled trial |
| Participants | 38 adults, ages 30-50 (mean 45.5 years) |
| Condition | Stage-II idiopathic adhesive capsulitis of shoulder |
| Intervention A | Maitland passive joint mobilization, 12 sessions over 4 weeks |
| Intervention B | Capsular stretching, 12 sessions over 4 weeks |
| Primary outcomes | Shoulder range of motion (goniometer), pain (numeric rating scale), disability (SPADI) |
| Duration | 4 weeks of treatment; measured pre- and post-intervention |
| Location | Lady Reading Hospital and Khyber Teaching Hospital, Peshawar, Pakistan |
| Publication | JPMA. The Journal of the Pakistan Medical Association |
| Registration | NCT05903768 |
| Outcome magnitude | Large effect size for SPADI in mobilization group (eta-squared = 0.605) |
Ansari, A., et al. "Comparison of capsular stretching and passive joint mobilisation in idiopathic adhesive capsulitis of the shoulder: A randomised controlled trial." *JPMA. The Journal of the Pakistan Medical Association*, vol. 74, no. 3, 2024.
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