PT Critically Appraised Topics

Document Type

Critically Appraised Topic

Publication Date


Clinical Scenario

A large percentage of my current caseload is comprised of patients recovering from adhesive capsulitis; the majority of these patients are over 40 years of age, there is no overwhelming disparity between the number of women versus men, and in each case the principle impairment is decreased glenohumeral (GH) range of motion (ROM). Physical therapy intervention to date has consisted of passive stretching into flexion, internal rotation, and external rotation, and active stretching into abduction, given as a home exercise program (HEP).

Clinical Question

Do patients diagnosed with adhesive capsulitis regain full passive glenohumeral range of motion more quickly with a combination of accessory glide mobilizations, exercise, and stretching, than from exercise and stretching alone?

Clinical Bottom Line

Based on the results of outcomes by Johnson AJ et al. and Vermeulen HM et al., posterior mobilizations resulted in a significant increase in GH external rotation (ER) when compared to anterior mobilizations (Johnson 2007), and high-grade mobilizations resulted in a significant increase in passive abduction when compared to low-grade mobilizations (Vermeulen 2006). It is interesting to note that Johnson et al. focused on ER, the reason being that ER is often the most restricted physiological motion in adhesive capsulitis (Mao 1997); this corresponds with limitations I have seen in clinic, and the influence of restricted ER can be seen on abduction through the anterior translation of the humerus in the glenoid fossa during abduction beyond 90 degrees. Both studies had an acceptable level of evidence, with PEDro scores of 6/10 (Johnson 2007) and 8/10 (Vermeulen 2006), and both were randomized clinical trials. Neither study incorporated a control group that did not receive mobilizations, however, and this makes it impossible to claim that mobilizations and stretching together are more beneficial than stretching alone. There is a clear need for such a study, and these two articles offer excellent support for an experimental intervention of high-grade, posterior mobilizations combined with stretching, versus stretching alone.