Additional Effects of Thoracic Spine Mobilization Combined With Glenohumeral Joint Mobilization on Pain, Range of Motion, and Functional Disability in Adhesive Capsulitis

Adhesive capsulitis, widely known as frozen shoulder, is a progressive musculoskeletal condition characterized by shoulder pain, restricted range of motion (ROM), and marked functional limitations. Traditional treatment approaches have largely focused on mobilization techniques directed at the glenohumeral joint, aiming to reduce capsular tightness and restore movement. While this is effective to some degree, it does not fully address the concept of regional interdependence, where dysfunction in adjacent regions, particularly the thoracic spine, may influence shoulder function. The thoracic spine plays a vital role in maintaining optimal shoulder kinematics by supporting scapular positioning, facilitating overhead motion, and reducing compensatory stress on the glenohumeral joint. Stiffness or hypomobility in this region may therefore perpetuate pain and mechanical restriction in adhesive capsulitis. Treatment strategies that combine glenohumeral joint mobilization with thoracic spine mobilization have the potential to provide superior outcomes compared to conventional therapy alone. Thoracic mobilization techniques, including central and unilateral posterior-anterior glides, enhance spinal extension and rotation, indirectly improving scapular mobility and shoulder elevation. When paired with targeted glenohumeral mobilizations such as anterior, posterior, and inferior glides, patients may experience greater improvements in pain relief, ROM, and functional ability. These three variables-pain, ROM, and functional disability-are critical in determining treatment effectiveness. By incorporating thoracic mobilization into standard rehabilitation, clinicians may adopt a more holistic approach that enhances recovery, promotes long-term function, and improves the quality of life for individuals with adhesive capsulitis.

Inclusion criteria

• • Both male and female patients with a primary complaint of unilateral or bilateral shoulder pain

• Pain has persisted for at least 3 to 4 months
• Decreased shoulder ROM observed, including external shoulder rotation, abduction, internal rotation, and flexion
• Age range between 40 to 65 years
• Diagnosed with stage 2nd or 3rd of the disease.

Exclusion criteria

• • Patients if they had any shoulder pain resulting from systematic disease such as Rheumatoid Arthritis (morning stiffness > 1 hour, multiple small joints pain/swelling) Infection, Tumors, and conditions like myelopathy (Hoffman's sign).

• Recent shoulder joint fracture/ trauma.
• Thoracic Outlet Syndrome (Roos test).
• The presence of Cervical radiculopathy (Spurling's test)