The Combined Effect of Mulligan Mobilization, Pain Neuroscience-Based Training, and Core Stabilization Exercises in Frozen Shoulder Patients

Adhesive capsulitis, commonly known as frozen shoulder, is a musculoskeletal disorder characterized by shoulder pain, progressive restriction of active and passive range of motion, and functional disability. The condition negatively affects activities of daily living and quality of life and is most frequently observed in individuals between 40 and 65 years of age. Despite the widespread use of conventional physiotherapy interventions, optimal treatment strategies remain under investigation.

Mulligan Mobilization with Movement (MWM) is a manual therapy technique that combines sustained accessory joint glides with active pain-free movement. Previous studies have demonstrated beneficial effects of Mulligan mobilization on pain reduction and functional improvement in individuals with adhesive capsulitis. Pain Neuroscience Education (PNE) is an educational approach designed to improve patients' understanding of pain mechanisms and reduce maladaptive beliefs related to pain. Core stabilization exercises, particularly those based on Dynamic Neuromuscular Stabilization (DNS) principles, aim to improve postural control, neuromuscular coordination, and movement efficiency.

Although the effectiveness of Mulligan mobilization has been investigated in patients with adhesive capsulitis, there is limited evidence regarding the use of Pain Neuroscience Education in this population, and the effects of DNS-based core stabilization exercises have not been adequately studied. Furthermore, no previous study has examined the combined effects of Mulligan mobilization, Pain Neuroscience Education, and core stabilization exercises in individuals with adhesive capsulitis.

This randomized controlled trial aims to evaluate the short-term effects of a combined intervention consisting of Mulligan mobilization, Pain Neuroscience Education, and core stabilization exercises on pain intensity, shoulder range of motion, shoulder function, pain catastrophizing, scapular dyskinesis, core stability, and health-related quality of life in individuals with adhesive capsulitis.

Participants diagnosed with adhesive capsulitis will be randomly allocated to one of two groups. The experimental group will receive Mulligan mobilization, Pain Neuroscience Education, and DNS-based core stabilization exercises. The control group will receive conventional physical therapy consisting of transcutaneous electrical nerve stimulation (TENS), hot-pack application, passive joint mobilization, and stretching exercises. Both groups will participate in treatment sessions three times per week for six weeks. Assessments will be conducted at baseline and after completion of the intervention period.