MDNews - Greater Kansas

+++++++++++++++++++++++++ +++ +++ +++++++++++++++++++++++++ PHYSICAL THERAPY + + Frozen Shoulder and PhysicalTherapy By Cody Barnett of motion of the glenohumeral joint and primarily affects individuals between 40 and 60 years of age. Women are typically affected more frequently than men. Other risk factors include diabetes, autoimmune diseases, and shoulder trauma or prolonged immobilization of the shoulder or upper extremity. If left untreated, adhesive capsulitis can go on to become an extremely debilitating condition, causing diffi culty with daily activities such as dressing, reaching overhead and reaching behind the back. The economic impact of frozen shoulder has been estimated at $7,000 to $8,000 per episode. To better understand the effects of A physical therapy interventions on this condition, a large randomized controlled trial (RCT) was conducted. Results showed joint mobilization and exercise to be effective treatment options in reducing pain and improving mobility for the patient with adhesive capsulitis. In this study, a sample of 2,370 patients with adhesive capsulitis underwent physical therapy for treatment. After each patient completed his or her physical therapy sessions, the therapist recorded the specific interventions used for each subject. Patients were also issued questionnaires to assess various aspects of their rehabilitation. A clinically signifi cant improvement was defi ned as a 50% or higher increase in scores based on physical function and bodily pain, a number admitted to be high by the study group but used nonetheless. DH E S IV E CAP SU L I T I S , OR "frozen shoulder," is a disorder that causes pain, stiffness and loss of range Joint Mobilization and Exercise Proven Effective Analysis of the physical therapy inter- ventions provided during treatment revealed that the use of interventions in the "joint mobilization/mobility" category improved pain scores by an average of 34% over those who did not receive this intervention. Improvements in function were 50% greater in patients who received interventions in the "exer- cise" category, compared with those who did not receive this intervention. These proven, effective interventions are commonly used by physical therapists when treating adhesive capsulitis, either exclusively or in conjunction with other treatment techniques. In addition, the study also indicated that exercise interventions improved the likelihood of meaningful improvements in the physical health of the patient. Though future RCTs are needed, this powerful cohort study clearly defines joint mobilization and exercise as effec- tive treatments for adhesive capsulitis and recommends that passive modalities be limited, as they were found less effective as treatment for this condition. Orthopedic physical therapists spe- cialize in the use of joint-mobilization treatment techniques and the prescrip- tion of appropriate therapeutic exercise for the improvement and treatment of frozen shoulder. Clinically, we fi nd that specifi c exercise and mobilization techniques that emphasize the anterior and inferior joint capsule tend to produce the greatest improvement. In addition, patient education about this painful condition is the key to seeing the fastest results and improvement, so patients can get better faster and return to the activities they enjoy without pain. Cody Barnett, P.T., is in private practice in Wichita, KS. He specializes in the treatment of orthopedic and musculoskeletal injuries with a special emphasis in lower-body biomechan- ics, pediatric and adult sports injuries, and neck and back pain. He may be reached at www.BodyworxPhysicalTherapy.net or (316) 558-8808. n References: Jewell DV, et al. Interventions associated with an increased or decreased likelihood of pain reduction and improved function in patients with adhesive capsulitis: a retrospec- tive cohort study. Phys Ther. 2009 May; 89(5):419-29 MDNEWS.COM n MD NEWS Greater Kansas | 5

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