Mulligan Mobilization Technique and Muscle Energy Technique on Pain and ROM

Frozen shoulder, also known as adhesive capsulitis, is a condition characterized by stiffness and pain in your shoulder joint. A condition in which a person has severe limitation of the range of motion of the shoulder due to scarring around the shoulder joint. Adhesive capsulitis is an unwanted consequence of rotator cuff disease that involves damage to the rotator cuff. Muscle energy technique involves careful positioning of an area of the body by the physical therapist. After positioning, you will be asked to contract the muscle or resist a movement done by the physical therapist. This will be followed by a stretch to lengthen the same or opposite muscle group.

This will be followed by a stretch to lengthen the same or opposite muscle group. Mulligan's technique "combines the sustained application of manual gliding force to a joint, with the aim of repositioning bone positional faults while enabling concurrent physiological (osteo-kinematic) motion of the joint. Essentially, this means repositioning a joint to enable proper motion while taking that joint through pain-free passive and active range of motion (ROM).

Mulligan Manual Therapy can be used to help treat a variety of injuries and pain including neck pain, back pain and upper and lower extremity injuries. Designed to reduce pain and improve the patient's range of motion the Mulligan technique involves Natural Apophyseal Glides (NAGS), Sustained Natural Apophyseal Glides (SNAGS) and Mobilization with Movement (MWM) for the treatment of musculoskeletal injuries.

The American Academy of Orthopedic Surgeons describe three stages: Freezing, or painful stage: Pain increases gradually, making shoulder motion harder and harder. Pain tends to be worse at night. Frozen: Pain does not worsen, and it may decrease at this stage. The shoulder remains stiff. Thawing: Movement gets easier and may eventually return to normal. Signs and symptoms typically begin gradually, worsen over time and then resolve, usually within one to three years.

Inclusion criteria

• Pain in shoulder for at least 3 months
• Unilateral frozen shoulder of stage 3 and 4
• Capsular pattern i.e. (lateral rotation, Abduction, Medial rotation)

Exclusion criteria

• Secondary capsulitis
• Shoulder injury such as proximal humerus fracture.
• History of Neurological deficit i.e. cervical stenosis, myelopathy.
• Prolong immobilization due to cardiothoracic surgery, neurosurgery.
• Shoulder surgical history such as shoulder arthroplasty.
• History of other pathological condition of shoulders i.e. Impingement syndrome, rotator cuff tear or any shoulder injury