A Comparative study of proprioceptive neuromuscular facilitation stretching and capsular stretching on range of motion and functional activities in frozen shoulder

TITLE OF THETOPIC :COMPARITIVE EFFECT OF PROPRIOCEPTIVE NEUROMUSCULAR FACILITATION STRETCHING ANDCAPSULAR STRETCHING ON RANGE OF MOTION AND FUNCTIONAL ACTIVITES IN FROZENSHOULDER

                    Frozen shoulder, oradhesive capsulitis, describes the common shoulder condition characterized bypainful and limited active and passive range of motion (ROM). Frozen shoulderis reported to affect 2% to 5% of the general population increasing to 10% to38% in patients with diabetes and thyroid disease. Individuals with primaryfrozen shoulder are commonly between 40 and 65 years old, and the incidenceappears higher in females than males.The occurrence of frozen shoulder in 1shoulder increases the risk of contralateral shoulder involvement by 5% to 34%,and simultaneous bilateral shoulder involvement occurs as often as 14% of thetime. Based on the etiology adhesive capsulitis can be classifiedas primary or secondary. Primary adhesive capsulitis is an idiopathiccondition, where the exact underlying cause is unknown. Adhesive capsulitisassociated with a known underlying disorder is considered to be secondary.adhesive capsulitis is described  in fourstages, Stage I: Preadhesive stage in which lining of the joint (synovium) isinflamed depicts little or no restriction of glenohumeral motion, Stage II (Freezingstage): Acute adhesive synovitis with proliferative synovitis and scarformation of the underlying capsule, Stage III (Frozen stage): Marked stiffnessdue to scar formation in the capsule with loss of axillary fold, Stage IV(Thawing stage): Chronic stage presenting with fully mature adhesions withnotable restriction of ROM. In Stages II and III of frozen shoulder, ROM issignificantly restricted. Restriction of movement is in the capsular pattern, that is,external rotation is most limited, followed by limitation in abduction andinternal rotation respectively.

Research question:

Is there a significantdifference in the effectiveness between proprioceptive neuromuscularfacilitation stretching and capsular stretching in improving the Range ofmotion and functional activities in individulas with frozen shoulder?

 Hypothesis:

Nullhypothesis:

Thereis no significant difference in the effectiveness between proprioceptiveneuromuscular facilitation stretching and capsular stretching in improving theRange of motion and functional activities in individuals with frozen shoulder.

             Alternate hypothesis:

Thereis significant difference in the effectiveness between proprioceptiveneuromuscular facilitation stretching and capsular stretching in improving theRange of motion and functional activities in individuals with frozen shoulder.

OBJECTIVE OF THESTUDY**:**To compare the effectivenessbetween proprioceptive neuromuscular facilitation  stretching and capsular stretching inimproving the Range of motion and functional activities in frozen shoulder.

               **PROCEDURE:**Thesubjects falling within the inclusion criteria will be included in the studyand then they will be randomly assigned into two groups. Three outcome measureswill be taken for the individuals that is both pre and post treatment outcomemeasures by using goniometry for range of motion, visual analogue scale forpain and shoulder pain and disability index for functional limitation.

GROUP-A:- The individuals in Group –A will be receiving first moistheat therapy  for  10 to 20 minutess followed by proprioceptiveneuromuscular facilitation stretching in supine lying to improveflexion, abduction and external rotation of the glenohumeral joint in D2proprioceptive neuromuscular facilitation stretching in Flexion and Extensionpattern. The stretch will be given for 8 repetitions per set consisting of 2sets per session with one single session per day for 10 days in two weeks witheach repetition or stretch maintained for a duration of 5–10 seconds. This will be followed by Active assistedrange of motion exercises, Pendulum exercises and Finger ladder exercises.

GROUP-B:-The individuals in Group­-B will also be receivingfirst the moist heat therapy for 10 to 20 minutes followed by capsularstretching in four directions (Passive forward elevation, external rotation,Horizontal adduction and internal rotation) the stretching will be maintainedfor 10 seconds within pain limits, with 10–15 repetitions. The sets ofexercises should be performed twice a day for ten days in two weeks. This willbe followed by Active assisted range of motion exercises, Pendulumexercises and Finger ladder exercises.