EFFECTIVENESS OF END RANGE MOBILIZATION AND REVERSE DISTRACTION TECHNIQUE IN ADHESIVE CAPSULITIS - A COMPARATIVE STUDY

Adhesive capsulitis is an insidious onset of painful stiffness of the glenohumeral joint. Despite the last centurial research the etiopathology of adhesive capsulitis remain enigmatic. The prevalence of adhesive capsulitis in the normal population is 2 to 5 percent and increases in patients with type 1 and type 2 diabetes. It is commonly seen between the age groups of 40 and 65 years with more occurrence in women. Most of the authors agree that the cause for adhesive capsulitis is due to the inflammatory changes in the capsule and synovium of the glenohumeral joint and therefore responsible for the contracture of the capsule.The term adhesive does not imply that the capsule is adhered to the humerus, but the humeral head is tightly held by the contracted capsule against the glenoid fossa.  There is reduction in the overall active and passive range of motion of the shoulder joint in the capsular pattern with changes observed in ROM, in ascending order, flexion, internal rotation, abduction and external rotation. The capsular extensibility is reduced and there is adherence of axillary recess. The tightness in thecapsule of the joint allows the restriction of motion in  predictable capsular pattern, capsular pattern for shoulder is one in which there is more limited external rotation than abduction. The most common functional limitations / disabilities in adhesive capsulitis often interferes with recreational activities, overhead activities, inability to reach behind head and back hence difficulty in dressing, to retrieve wallet from back pocket and sleep disturbance. Many patients complain inability to lie on the affected shoulder. Mobilization techniques are important part of intervention in many physical therapy programs. Mobilization techniques can be executed as physiological movements or accessory movements. In cardinal planes the movements of the humerus with respect to the glenohumeral joint are the physiological movements (flexion, extension, abduction, adduction, external rotation and internal rotation). The movements that occur along with the physiological movements or induced by the therapist are the accessory movements which consist of rolling, gliding, spinning and distraction within the joint. The five grade classification system of Maitland categorizes the intensity of mobilization techniques with rhythmic oscillatory movements. There are varied studies which interpret the effects of various manual therapy techniques on range of motion and functional capabilities of shoulder joint in adhesive capsulitis. Few studies conclude that the end range mobilization to be better effective than midrange mobilization,low grade mobilization technique,37 and contract relax in the intervention of adhesive capsulitis. There are also case report studies that showed improvement in glenohumeral range of motion in subjects with adhesive capsulitis. There are very limited studies which interpret the effectiveness of reverse distraction technique in subjects with  adhesive capsulitis. But there is scarcity of the literature which compared the effectiveness of end range mobilization versus the reverse distraction technique in adhesive capsulitis. Hence the study aims to know the better mobilization technique to treat the patients with adhesive capsulitis.