Highlights
- •Exercise therapy is effective in improving range of motion, function and pain
- •The effect of adding stretches to a program with exercises is uncertain
- •Adding physical modalities is to a program with exercises not beneficial
- •The effect of exercise therapy in the long term is unknown
- •There is large heterogeneity in exercise therapy and physical therapy programs
Abstract
Objective(s)
To determine (1) the effect of exercise therapy alone or in combination with other
interventions compared with solely exercises and programs with or without exercises
and (2) what kind of exercise therapy or combination with other interventions is most
effective.
Data Sources
PubMed, Web of Science and Cochrane Central Register of Controlled Trials.
Study Selection
Studies were screened in a 2-phase approach by 2 independent reviewers (M.M. and L.M.).
Reference lists of included studies and interesting systematic reviews were hand searched.
Data Extraction
Two independent reviewers (M.M. and L.M.) extracted information about origin, characteristics
of study participants, eligibility criteria, characteristics of interventions, outcome
measures and main results in a pre-defined template.
Data Synthesis
Thirty-three studies were included in the qualitative and 19 in the meta-analysis.
Preliminary evidence was found for supervised exercises to be more beneficial than
home exercises for ROM and function. Multimodal programs comprising exercises may
result in little to no difference in ROM compared to solely exercises. Programs comprising
muscle energy techniques show little to no difference in ROM when compared with programs
with other exercises. Adding stretches to a multimodal program with exercises may
increase ROM. There is uncertain evidence that there is a difference between those
programs regarding function and pain. Preliminary evidence was found for several treatment
programs including exercises to be beneficial for improvement in both passive and
active ROM, function, pain, and muscle strength. No studies used patient satisfaction
as an outcome measure.
Conclusions
ROM, function, and pain improve with both solely exercises and programs with exercises,
but for ROM and pain there was little to no difference between programs and for function
the evidence was uncertain. Adding exercises improve active ROM compared with a program
without exercises, whereas adding physical modalities has no beneficial effect. Muscle
energy techniques are a beneficial type of exercise therapy for improving function
compared with other types of exercise. Unfortunately, no conclusion can be drawn about
the results in the long-term and most effective dose of exercise therapy.
Keywords
List of abbreviations:
AROM (active range of motion), CPM (continuous passive motion), CMS (Constant Murley Score), FS (frozen shoulder), GRADE (Grading of Recommendations Assessment, Development and Evaluation), MD (mean difference), PROM (passive range of motion), ROM (range of motion), SMD (standardized mean difference), SPADI (Shoulder Pain and Disability Index), RC (rotator cuff)To read this article in full you will need to make a payment
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References
- Frozen shoulder: unravelling the enigma.Ann R Coll Surg Engl. 1997; 79: 210-213
- The pathology of frozen shoulder.J Bone Joint Surg Br. 2007; 89: 928-932
- The frozen shoulder: myths and realities.Open Orthop J. 2013; 7: 352-355
- Primary frozen shoulder: brief review of pathology and imaging abnormalities.J Orthop Sci. 2014; 19: 1-5
- Frozen shoulder: a consensus definition.J Shoulder Elbow Surg. 2011; 20: 322-325
- Frozen shoulder. A long-term follow-up.J Bone Joint Surg Am. 1992; 74: 738-746
- Idiopathic adhesive capsulitis. A prospective functional outcome study of nonoperative treatment.J Bone Joint Surg Am. 2000; 82: 1398-1407
- Long-term outcome of frozen shoulder.J Shoulder Elbow Surg. 2008; 17: 231-236
- Immunological studies in frozen shoulder.J Rheumatol. 1982; 9: 893-898
- Frozen shoulder.Semin Arthritis Rheum. 1982; 11: 440-452
- Adhesive capsulitis. A treatment approach.Clin Orthop Relat Res. 2000; : 95-109
- Secular trend of adhesive capsulitis.Arthritis Care Res (Hoboken). 2011; 63: 1571-1575
- Idiopathic adhesive capsulitis of the shoulder: a review.Knee Surg Sports Traumatol Arthrosc. 2007; 15: 1048-1054
- Shoulder pain and mobility deficits: adhesive capsulitis.J Orthop Sports Phys Ther. 2013; 43: A1-31
- The effect of myofibroblasts and corticosteroid injections in adhesive capsulitis.J Shoulder Elbow Surg. 2016; 25: 1274-1279
- Is there a genetic predisposition to frozen shoulder?: a systematic review and meta-analysis.JBJS Rev. 2016; 4: e4
- Upper extremity: emphasis on frozen shoulder.Orthop Clin North Am. 2006; 37: 531-539
- Risk factors for idiopathic frozen shoulder.Isr Med Assoc J. 2008; 10: 361-364
- Which musculoskeletal complications are most frequently seen in type 2 diabetes mellitus?.J Int Med Res. 2008; 36: 505-511
- Adhesive capsulitis of the shoulder and diabetes: a meta-analysis of prevalence.Muscles Ligaments Tendons J. 2016; 6: 26-34
- Adhesive capsulitis: a review of current treatment.Am J Sports Med. 2010; 38: 2346-2356
- A questionnaire survey of UK physiotherapists on the diagnosis and management of contracted (frozen) shoulder.Physiotherapy. 2011; 97: 115-125
- Management of frozen shoulder: a systematic review and cost-effectiveness analysis.Health Technol Assess. 2012; 16: 1-264
- Adhesive capsulitis of the shoulder. Is there consensus regarding the treatment? A comprehensive review.Open Orthop J. 2017; 11: 65-76
- Physiotherapy interventions for shoulder pain.Cochrane Database Syst Rev. 2003; CD004258
- Manual therapy and exercise for adhesive capsulitis (frozen shoulder).Cochrane Database Syst Rev. 2014; CD011275
- Exercise therapy for bone and muscle health: an overview of systematic reviews.BMC Med. 2012; 10: 167
- Subacromial impingement syndrome—effectiveness of physiotherapy and manual therapy.Br J Sports Med. 2014; 48: 1202-1208
- Exercise as medicine—evidence for prescribing exercise as therapy in 26 different chronic diseases.Scand J Med Sci Sports. 2015; 25: 1-72
- Are group-based and individual physiotherapy exercise programmes equally effective for musculoskeletal conditions? A systematic review and meta-analysis.Br J Sports Med. 2017; 51: 126-132
- Systematic review of nondrug, nonsurgical treatment of shoulder conditions.J Manipulative Physiol Ther. 2017; 40: 293-319
- Effectiveness of occupational therapy interventions for musculoskeletal shoulder conditions: a systematic review.Am J Occup Ther. 2017; 71 (7101180020p1-p11)
- Evidence-based clinical guidelines for the diagnosis, assessment and physiotherapy management of contracted (frozen) shoulder.Physiotherapy. 2012; 98: 117-120
- Effectiveness of nonsurgical interventions for managing adhesive capsulitis in patients with diabetes: a systematic review.Arch Phys Med Rehabil. 2019; 100: 350-365
- Adhesive capsulitis: a review.Am Fam Physician. 2011; 83: 417-422
- Frozen shoulder syndrome: a review of literature.J Orthop Sports Phys Ther. 1993; 18: 479-487
- Current review of adhesive capsulitis.J Shoulder Elbow Surg. 2011; 20: 502-514
- The effectiveness of physiotherapeutic interventions in treatment of frozen shoulder/adhesive capsulitis: a systematic review.J Back Musculoskelet Rehabil. 2014; 27: 247-273
- Adhesive capsulitis: use the evidence to integrate your interventions.N Am J Sports Phys Ther. 2010; 5: 266-273
- The effectiveness of joint mobilization techniques for range of motion in adult patients with primary adhesive capsulitis of the shoulder: a systematic review and meta-analysis.Medwave. 2018; 18: e7265
- Frozen shoulder: methods for bringing about early mobilization.Calif Med. 1958; 89: 333-334
- What can we expect from nonoperative treatment options for shoulder pain?.J Fam Pract. 2005; 54: 216-223
- Adhesive capsulitis: diagnosis and management.Am Fam Physician. 2019; 99: 297-300
- How CH. Physical therapy in the management of frozen shoulder.Singapore Med J. 2017; 58: 685-689
- Frozen shoulder.Can Fam Physician. 1993; 39: 1773-1778
- Idiopathic frozen shoulder.Aust J Gen. 2019; 48: 757-761
- Treatment of adhesive capsulitis of the shoulder.J Am Acad Orthop Surg. 2019; 27: e544-ee54
- Comparison of treatments for frozen shoulder: a systematic review and meta-analysis.JAMA Netw Open. 2020; 3e2029581
- Comparative efficacy and patient- specific moderating factors of nonsurgical treatment strategies for frozen shoulder: an updated systematic review and network meta-analysis.Am J Sports Med. 2021; 49: 1669-1679
- The efficacy of physiotherapy interventions in the treatment of adhesive capsulitis: a systematic review.J Back Musculoskelet Rehabil. 2021; 34: 195-205
- Rayyan-a web and mobile app for systematic reviews.Syst Rev. 2016; 5: 210
- A revised tool for assessing risk of bias in . randomized trial.Cochrane Database Syst Rev. 2016; 10: 29-31
- GRADE Handbook for Grading Quality of Evidence and Strength of Recommendations. Updated October 2013.The GRADE Working Group, 2013 (Available at guidelinedevelopment.org/handbook. Accessed June 3, 2021)
- Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range.BMC Med Res Methodol. 2014; 14: 135
- Higgins JPT Thomas J Chandler J Cumpston M Li T Page MJ Cochrane Handbook for Systematic Reviews of Interventions version 6.2 (updated February 2021). Cochrane, 2021 (Available from www.training.cochrane.org/handbook. Accessed April 13, 2021)
- Glenohumeral posterior mobilization versus conventional physiotherapy for primary adhesive capsulitis: a randomized clinical trial.Medwave. 2015; 15: e6267
- Activity- vs. structural-oriented treatment approach for frozen shoulder: a randomized controlled trial.Clin Rehabil. 2017; 31: 686-695
- Dynamic scapular recognition exercise improves scapular upward rotation and shoulder pain and disability in patients with adhesive capsulitis: a randomized controlled trial.J Man Manip Ther. 2020; 28: 146-158
- Efficacy of high-intensity laser therapy in patients with adhesive capsulitis: a sham-controlled randomized controlled trial.Lasers Med Sci. 2021; 36: 207-217
Leclaire R, Bourgouin J. Electromagnetic treatment of shoulder periarthritis: a randomized controlled trial of the efficiency and tolerance of magnetotherapy. Arch Phys Med Rehabil 991; 72:284-7.
- Effect of rotator cuff strengthening as an adjunct to standard care in subjects with adhesive capsulitis: a randomized controlled trial.J Hand Ther. 2017; 30: 235-241
- Adhesive capsulitis (frozen shoulder): a new approach to its management.Arch Phys Med Rehabil. 1983; 64: 29-33
- Effect of strengthening lower trapezius muscle on scapular tipping in patients with diabetic frozen shoulder: a randomized controlled study.Biomedical Research India. 2018; 29: 442-447
- The effects of additional proprioceptive neuromuscular facilitation over conventional therapy in patients with adhesive capsulitis.Turk J Physiother Rehabil. 2015; 26: 78-85
- Comparison for efficacy of general exercises with and without mobilization therapy for the management of adhesive capsulitis of shoulder—an interventional study.Pak J Med Sci. 2015; 31: 1372-1376
- Acute effect of scapular proprioceptive neuromuscular facilitation (PNF) techniques and classic exercises in adhesive capsulitis: a randomized controlled trial.J Phys Ther Sci. 2016; 28: 1219-1227
- The efficacy of mirror therapy in patients with adhesive capsulitis: a randomized, prospective, controlled study.J Back Musculoskelet Rehabil. 2018; 31: 1177-1182
- A controlled study of oral prednisolone in frozen shoulder.Br J Rheumatol. 1986; 25: 288-292
- Comparison of the outcomes of two different exercise programs on frozen shoulder.Acta Orthop Traumatol Turc. 2010; 44: 285-292
- Continuous passive motion provides good pain control in patients with adhesive capsulitis.Int J Rehabil Res. 2009; 32: 193-198
- Continuous passive motion in adhesive capsulitis patients with diabetes mellitus: a randomized controlled trial.J Back Musculoskelet Rehabil. 2016; 29: 779-786
- Axillary ultrasound and laser combined with postisometric facilitation in treatment of shoulder adhesive capsulitis: a randomized clinical trial.J Manipulative Physiol Ther. 2016; 39: 330-338
- Static progressive stretch is effective in treating shoulder adhesive capsulitis: prospective, randomized, controlled study with a two-year follow-up.Eur J Physiother. 2015; 17: 138-147
- A comparative study to determine the efficacy of routine physical therapy treatment with and without Kaltenborn mobilization on pain and shoulder mobility in frozen shoulder patients.Int J Physiother. 2016; 3: 316-319
- The combined effectiveness of glenohumeral end-range mobilization and contract-relax technique for glenohumeral internal rotators in subjects with adhesive capsulitis.Int J Physiother. 2015; 2: 691-697
- Subscapularis muscle spray and stretch technique with conventional physical therapy for the management of adhesive capsulitis.Biomed India. 2017; 37: 511-517
- Comparison of effectiveness of the combination of muscle energy techniques and conventional physiotherapy alone in periarthritis of shoulder: a randomized study.J Evol Med Dent Sci. 2015; 4: 545-554
- Is position induced movement re-education helpful on early functional recovery in acute adhesive capsulitis? A randomised controlled trial.J Clin Diagnostic Res. 2018; 12: YC08-YC13
- Effectiveness of physical therapy for patients with adhesive capsulitis: a randomized controlled trial.J Med Assoc Thai. 2004; 87: 473-480
- Comparison of conventional therapy versus sleeper stretch with conventional therapy in Adhesive Capsulitis.Int J Health Sci Res. 2015; 5: 7
- Effectiveness of the end-range mobilization and scapular mobilization approach in a subgroup of subjects with frozen shoulder syndrome: a randomized control trial.Man Ther. 2012; 17: 47-52
- A blinded, randomized, controlled trial assessing conservative management strategies for frozen shoulder.J Shoulder Elbow Surg. 2014; 23: 500-507
- Instrument assisted soft tissue mobilization in adhesive capsulitis:a randomized clinical trial.J Bodyw Mov Ther. 2021; 26: 435-442
- Effect of Spencer Muscle Energy Technique on pain and functional disability in cases of adhesive capsulitis of shoulder joint.Int Arch Integr Med. 2016; 3: 6
- Gentle thawing of the frozen shoulder: a prospective study of supervised neglect versus intensive physical therapy in seventy-seven patients with frozen shoulder syndrome followed up for two years.J Shoulder Elbow Surg. 2004; 13: 499-502
- Short term effect of yoga asana—an adjunct therapy to conventional treatment in frozen shoulder.J Ayurveda Integr Med. 2020; 11: 101-105
- Comparative study between efficacy of pnf movement patterns versus conventional free exercises on functional activities among patiens with chronic peri-arthritis of shoulder.Indian J Physiother Occup Ther. 2011; 5: 62-67
- Effect of Yi Jin Jing (sinew-transforming Qigong Exercises) plus tuina on scapulohumeral periarthritis.J Acupuncture and Tuina Sci. 2017; 15: 285-289
- Evaluating the outcome of two different regimes in adhesive capsulitis: a prospective clinical study.Med Princ Pract. 2020; 29: 225-230
- Challenges and recommendations for placebo controls in randomized trials in physical and rehabilitation medicine: a report of the international placebo symposium working group.Am J Phys Med Rehabil. 2010; 89: 160-172
- Natural history of frozen shoulder: fact or fiction? A systematic review.Physiotherapy. 2017; 103: 40-47
- Range of motion of diabetic frozen shoulder recovers to the contralateral level.J Int Med Res. 2016; 44: 1191-1199
- Comparison of high-grade and low-grade mobilization techniques in the management of adhesive capsulitis of the shoulder: randomized controlled trial.Phys Ther. 2006; 86: 355-368
- Identification of prognostic factors for the nonoperative treatment of stiff shoulder.Int Orthop. 2013; 37: 859-864
- Predictors of outcome after nonoperative and operative treatment of adhesive capsulitis.Am J Sports Med. 2011; 39: 567-574
- Constant-Murley Score: systematic review and standardized evaluation in different shoulder pathologies.Qual Life Res. 2018; 27: 2217-2226
- A systematic review of the psychometric properties of the Constant-Murley score.J Shoulder Elbow Surg. 2010; 19: 157-164
- Reliability of shoulder abduction strength measure for the Constant-Murley score.Clin Orthop Relat Res. 2010; 468: 1565-1571
- Is the constant score reliable in assessing patients with frozen shoulder? 60 shoulders scored 3 years after manipulation under anaesthesia.Acta Orthop Scand. 2004; 75: 114-116
- Passive range of motion in patients with adhesive shoulder capsulitis, an intertester reliability study over eight weeks.BMC Musculoskelet Disord. 2015; 16: 37
- Measuring shoulder function: a systematic review of four questionnaires.Arthritis Rheum. 2009; 61: 623-632
- The minimum clinically significant difference in visual analogue scale pain score does not differ with severity of pain.Emerg Med J. 2001; 18: 205-207
Article info
Publication history
Published online: August 20, 2021
Accepted:
July 9,
2021
Received in revised form:
July 7,
2021
Received:
January 19,
2021
Footnotes
Disclosures: Lotte Meert is a PhD research fellow funded by the Research Foundation—Flanders (FWO) (no. 11E5720N). The other authors have nothing to disclose.
Identification
Copyright
© 2021 by the American Congress of Rehabilitation Medicine.
