Comparison of Spencer Technique and Gongs Mobilization on Pain, Range of Motion, Disability and Scapular Symmetry in Patients With Phase ii Adhesive Capsulitis

Adhesive capsulitis is characterized by a painful, gradual loss of both active and passive glenohumeral motion resulting from progressive fibrosis and ultimate contracture of the glenohumeral joint capsule. The term "frozen shoulder" was first introduced by Codman in 1934. He described frozen shoulder as a painful shoulder condition of insidious onset that was associated with stiffness and difficulty in sleeping on the affected side. In the general population, the incidence of adhesive capsulitis is 2-5%, more in females, those aged 40-65 years and those suffering from diabetes mellitus. In Pakistan, its precise prevalence is unknown, but, in general, it ranges 2-5%.

An increased incidence of frozen shoulder has been noticed in patients with hyperthyroidism and hypertriglyceridemia. Frozen shoulder progressive through three clinical phases painful phase- severe pain usually worst at night and when lying on the affected side (2-9 months) are stiffening or frozen phase- difficulty with simple activities of daily living. Stiffness progresses and leads to disused atrophy (4-12 months) Thawing phase - gradual increase in range of motion and improvement in pain, although it may reappear as stiffness ceases (5-12 months). In pathological condition like adhesive capsulitis where there is presence of capsular pattern of glenohumeral joint, in such a condition it is not possible to achieve full abduction through elevation because of marked limitation of external rotation.

Adhesive capsulitis is primarily categorized into two types: primary and secondary. Primary or idiopathic adhesive capsulitis is characterized by a gradual onset of pain and stiffness at the gleno-humeral joint without a specific cause. Secondary adhesive capsulitis is known to be caused by several predisposing factors. Women are affected more than men with a ratio of 58:423. The spencer technique is developed by spencer D. O. in 1916. This approach is a well-known osteopathic manipulative technique that focuses on mobilization of the glenohumeral and scapulothoracic joints. It helps the restricted joints to improve their functions, as well as positively affects other emotional, social, and cognitive areas. Spencer technique is an articulatory technique with 6 different procedures used to treat shoulder restriction caused by adhesive capsulitis. In this technique passive, smooth, rhythmic motion is designed to stretch contracted muscles, ligaments and capsules.

Physiotherapy methods such as active and active assisted exercises, pendular exercises, wand exercises, wall and ladder exercises, capsular stretching exercises and shoulder joint mobilization are often standard exercises in treating frozen shoulder. Electrotherapy modalities such as application of ultrasound, short-wave diathermy and LASER are used to relieve pain and promote hyperthermic effect to tissues.

Joint Mobilization is a manual therapy that applies passive traction and gliding motion to the articular surface to maintain free mobility of joints or to restore the normal condition of joints . Gong's mobilization technique helps to heal physical pain as well as distract the mind from stress. It is a corrective antero-posterior glide applied for shoulder distraction and their restricted movements to decrease pain and to improve range of motion. According to Wontae gong, gong's mobilization is more effective for anterior to posterior glide to improve shoulder abduction, external and internal rotation. Joint mobilization technique is effective to reduce pain and improves range of motion.