A prospective clinical trial comparing chiropractic manipulation and exercise therapy vs. chiropractic mobilization and exercise therapy for treatment of patients suffering from adhesive capsulitis/frozen shoulder

Abstract

Objectives: To compare the effect of shoulder, cervical, and thoracic spine highvelocity, low-amplitude (HVLA) chiropractic manipulative therapy (CMT) and exercise vs. shoulder mobilization (Mob) and exercise in the treatment of frozen shoulder. Design: A prospective, systematically allocated clinical trial. Setting: The University of Surrey Chiropractic Clinic, Guildford, Surrey. Sample: Eight subjects diagnosed with primary stage 2 to 3 adhesive capsulitis/frozen shoulder. Method: The experimental intervention consisted of the comparison of treatment Group 1, receiving HVLA CMT for 6 weeks to the glenohumeral joint, cervical, and thoracic spines, along with home exercise, vs. treatment Group 2, receiving grade-4 glenohumeral joint Mob for 6 weeks along with home exercise therapy. The primary outcome measure used to determine change in shoulder pain and disability was the Shoulder Pain and Disability Index (SPADI). A >/=10-point decrease in SPADI score is considered clinically significant and meaningful. Results: Descriptive statistics revealed baseline mean values for the SPADI scores of 68.3 in the CMT group and 65.2 in the Mob group. After 6 weeks of treatment, the CMT and Mob group mean SPADI scores reduced to 14.1 and 35.0 respectively. Both groups appeared to demonstrate clinically meaningful changes in reduced pain and disability; CMT decreased 54.2 points overall -- 24 points more than Mob. Conclusion: While both treatment strategies demonstrated clinical improvement in subject SPADI scores, in this study, CMT with exercise had a superior effect in the short-term treatment of stage 2 and stage 3 frozen shoulder. Considering methodological limitations (such as the small sample size), the authors hesitate to extrapolate beyond the current cohort data. However, these findings do appear to correlate with similar and previously published studies, suggesting the possibility of an important mechanical and/or neurophysiological component (vertebral and shoulder joint dysfunction) underlying frozen shoulder. Additional research is warranted.