Joint Mobilization

Skilled passive movement of the articular surfaces performed by a physical therapist to decrease pain or increase joint mobility

Grade I:	Small amplitude at the beginning of the range of motion (ROM)
Grade II:	Large amplitude not reaching the end of the ROM
Grade III:	Large amplitude reaching the limited ROM
Grade IV:	Small amplitude at the end of the limited ROM
Grade V:	Small amplitude and high velocity at the end of limited ROM (manipulation or thrust)

Joint mobilization is an often-used intervention by physical therapists to treat patients with adhesive capsulitis. Yang et al conducted a study that compared the use of three mobilization techniques – end-range mobilization, mid-range mobilization, and mobilization with movement in the management of 28 subjects with adhesive capsulitis. Their study concluded that there was an improvement in mobility and functional ability at 12 weeks in subjects treated with the three mobilization techniques. When comparing the effectiveness of the three treatment strategies in subjects with unilateral adhesive capsulitis, they found that end-range mobilization and mobilization with movement were more effective than mid-range mobilization in increasing mobility and functional ability.

In a preliminary study by Vermeulen et al published in 2000, they conducted a study on four men and three women with adhesive capsulitis who were treated with end-range mobilization techniques, twice a week for 3 months. Their study found that after 3 months of treatment, there were increases in both active range of motion and passive range of motion. However, their study didn’t include a control group and they recommended that further investigation in the form of controlled studies is warranted to compare the therapeutic effect of these mobilizations with the natural course of the disease or other treatment regimes.

In a later study by Vermeulen et al published in 2006, they conducted a study on 100 subjects with unilateral adhesive capsulitis who were randomly divided into two groups and were treated with either high-grade mobilization techniques or low-grade mobilization techniques. Their study found that high-grade mobilization techniques proved to be more effective than low-grade mobilization techniques with improving glenohumeral joint mobility and reducing disability, with the overall differences between the two interventions being small.

Despite the positive findings with the above-mentioned studies, the inclusion of a control group where no treatment is received by patients with adhesive capsulitis was not included in any of the studies. Because the natural course of this condition remains a matter of dispute future studies involving a control group and a larger sample population are recommended.