The Combined Effect of Mulligan Technique and Scapular Mobilization in Shoulder Adhesive Capsulitis

NCT07356947 | Not Yet Recruiting

• 1 other identifier: Shoulder Adhesive Capsulitis
• Study Type: interventional
• Target: 38
• Locations: 1 country
• Sites: 1

Brief Summary

The shoulder joint capsule is a fibrous sheath that encloses and stabilizes the structures of the shoulder joint, extending from the anatomical neck of the humerus to the rim of the glenoid fossa. It is normally lax, allowing a wide range of motion. Shoulder adhesive capsulitis, or frozen shoulder, is a common musculoskeletal condition characterized by pain and restricted movement due to thickening and contraction of this capsule. Proper coordination between the scapula and humerus-known as the scapulohumeral rhythm-is essential for normal shoulder motion. Disruption of this rhythm contributes to movement limitation and pain in adhesive capsulitis. This randomized, single-blind clinical trial aims to investigate the combined effect of the Mulligan technique and scapular mobilization on improving shoulder range of motion, pain, disability, and scapulohumeral rhythm in patients with adhesive capsulitis. Thirty-eight participants aged 30 to 60 years, diagnosed with unilateral adhesive capsulitis, will be randomly assigned to two groups. Group A will receive Mulligan mobilization techniques for shoulder elevation, internal and external rotation, along with scapular mobilization. Group B will receive conventional physical therapy consisting of hot packs, ultrasound, stretching, and range-of-motion exercises. Both groups will undergo treatment three times per week for four weeks. Primary outcomes include changes in shoulder range of motion (measured using a digital goniometer), pain and disability (measured by the Shoulder Pain and Disability Index \[SPADI\]), and scapulohumeral rhythm (assessed using tape measurement). The study is expected to provide clinical evidence on whether combining Mulligan and scapular mobilization techniques yields superior functional recovery compared with conventional physiotherapy alone in patients with shoulder adhesive capsulitis.

Conditions

Shoulder Pain and Stiffness; Adhesive Capsulitis of Shoulder; Frozen Shoulder

Keywords

Adhesive Capsulitis; Frozen Shoulder; Shoulder Joint; Shoulder Pain; Scapulohumeral Rhythm; Mulligan Technique; Mobilization with Movement; Scapular Mobilization

Outcome Measures

Primary Outcomes (3)

• Change in Shoulder Range of Motion (Flexion, Internal Rotation, External Rotation, and Abduction)

  Shoulder joint range of motion (flexion, internal rotation, external rotation, and abduction) will be assessed using a digital goniometer. Each movement will be measured three times, and the mean value will be used for analysis.

  Baseline and at 4 weeks post-intervention

• Change in Shoulder Pain and Disability (SPADI Score)

  Pain and functional disability will be assessed using the Shoulder Pain and Disability Index (SPADI). The SPADI includes 13 items: a 5-item pain subscale and an 8-item disability subscale. Each item is scored on a 0-10 scale, with higher scores indicating greater pain and disability.

  Baseline and at 4 weeks post-intervention

• Change in Scapulohumeral Rhythm

  Scapulohumeral rhythm will be evaluated using a tape measurement method during shoulder elevation to assess the coordination between scapular and humeral motion.

  Baseline and at 4 weeks post-intervention

Study Arms (2)

Conventional Physiotherapy

ACTIVE COMPARATOR

Participants in this group will receive conventional physiotherapy consisting of: Hot pack application for 10 minutes Ultrasound therapy in pulsed mode (1 MHz frequency, 0.8 W/cm²) for 5 minutes Posterior capsule stretching (2 sets × 3 repetitions, 30-second holds) Active and active-assisted range of motion exercises for elevation, internal rotation, external rotation, and pendulum exercises. Treatment will be administered three times per week for four weeks. This intervention represents standard physiotherapy care for adhesive capsulitis.

Other: Conventional Physiotherapy

Mulligan Technique with Scapular Mobilization

EXPERIMENTAL

Participants in this group will receive the Mulligan mobilization technique for shoulder elevation, internal and external rotation, combined with scapular mobilization. Each session will include three sets of ten repetitions with a two-minute rest between sets. Treatment sessions will occur three times per week for four weeks.

Other: Mulligan Technique with Scapular Mobilization

Interventions

Mulligan Technique with Scapular Mobilization OTHER

Participants in this group will receive the Mulligan mobilization technique for shoulder elevation, internal rotation, and external rotation combined with scapular mobilization. Each session will include three sets of ten repetitions with a two-minute rest between sets. Treatment sessions will be conducted three times per week for four weeks. The intervention aims to improve shoulder joint mobility, reduce pain, and enhance scapulohumeral rhythm.

Mulligan Technique with Scapular Mobilization

Conventional Physiotherapy OTHER

Standard physiotherapy including hot packs, ultrasound, posterior capsule stretching, and active/assisted range-of-motion exercises. Three sessions per week for four weeks.

Conventional Physiotherapy

Eligibility Criteria

• Age: 30 Years - 60 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64)

You may qualify if:

• Medically stable and willing to provide informed consent to participate in the study.
• Age between 30 and 60 years.
• Both male and female participants.
• Unilateral shoulder involvement with pain and limited active and passive range of motion in lateral rotation, abduction, and internal rotation for more than three months compared with the unaffected side.
• Clinically diagnosed with adhesive capsulitis (frozen shoulder).

You may not qualify if:

• History of shoulder surgery.
• History of radiotherapy or chemotherapy.
• Presence of acute infection in the area to be treated.
• History of skin disease.
• History of cervical radiculopathy within the past six months.
• Secondary adhesive capsulitis, rotator cuff tears, shoulder fractures, or dislocations.

Sponsors & Collaborators

• Deraya University: lead

Study Sites (1)

faculty of physical therapy, Deraya University

Minya, Menia Governorate, Egypt

Location

Related Publications (10)

• Norkin C. C., White D. J. Measurement of Joint Motion: A Guide to Goniometry. 5th Edition. F.A. Davis Company; 2016.

  BACKGROUND

• Kisner C., Colby L. A. Therapeutic Exercise: Foundations and Techniques. 7th Edition. F.A. Davis Company; 2022.

  BACKGROUND

• Rahbar M, Ranjbar Kiyakalayeh S, Mirzajani R, Eftekharsadat B, Dolatkhah N. Effectiveness of acromioclavicular joint mobilization and physical therapy vs physical therapy alone in patients with frozen shoulder: A randomized clinical trial. Clin Rehabil. 2022 May;36(5):669-682. doi: 10.1177/02692155211070451. Epub 2021 Dec 29.

  PMID: 34964679 BACKGROUND

• Brumitt J. Scapula stabilization and rehabilitation exercise prescription. Strength and Conditioning Journal. 2006; 28(3):62-65.

  BACKGROUND

• McQuade KJ, Smidt GL. Dynamic scapulohumeral rhythm: the effects of external resistance during elevation of the arm in the scapular plane. J Orthop Sports Phys Ther. 1998 Feb;27(2):125-33. doi: 10.2519/jospt.1998.27.2.125.

  PMID: 9475136 BACKGROUND

• Mathieu Vanderroost, Venus Pagare, Kai A. Sigel, Naomi O'Reilly, Claire Knott. Scapulohumeral rhythm. Physiopedia. Available online at: https://www.physio-pedia.com/Scapulohumeral_rhythm

  BACKGROUND

• Ludewig PM, Reynolds JF. The association of scapular kinematics and glenohumeral joint pathologies. J Orthop Sports Phys Ther. 2009 Feb;39(2):90-104. doi: 10.2519/jospt.2009.2808.

  PMID: 19194022 BACKGROUND

• Scibek JS, Carcia CR. Assessment of scapulohumeral rhythm for scapular plane shoulder elevation using a modified digital inclinometer. World J Orthop. 2012 Jun 18;3(6):87-94. doi: 10.5312/wjo.v3.i6.87.

  PMID: 22720268 BACKGROUND

• Kibler WB. The role of the scapula in athletic shoulder function. Am J Sports Med. 1998 Mar-Apr;26(2):325-37. doi: 10.1177/03635465980260022801.

  PMID: 9548131 BACKGROUND

• Sami S. Almureef, et al. Effectiveness of mobilization with conventional physiotherapy in frozen shoulder patients: a systematic review. Journal of Musculoskeletal Research. 2020.

  BACKGROUND

MeSH Terms

Conditions

Bursitis; Shoulder Pain

Condition Hierarchy (Ancestors)

Joint Diseases; Musculoskeletal Diseases; Arthralgia; Pain; Neurologic Manifestations; Signs and Symptoms; Pathological Conditions, Signs and Symptoms

Central Study Contacts

Wafaa Mahney

CONTACT

+201067348583; wafaa.mahney@deraya.edu.eg

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: PARTICIPANT
• Masking Details: The study is single-blind; participants will not be informed about the treatment group assignment. Groups will be treated and evaluated in separate sessions to maintain blinding.
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Model Details: Participants will be randomly assigned into two groups receiving different therapeutic interventions (Mulligan technique with scapular mobilization versus conventional physiotherapy).

Study Record Dates

• First Submitted: January 13, 2026
• First Posted: January 21, 2026
• Study Start: February 1, 2026
• Primary Completion (Estimated): July 1, 2027
• Study Completion (Estimated): August 1, 2027
• Last Updated: January 28, 2026

Record last verified: 2026-01

Data Sharing

• IPD Sharing: Will not share

Locations

EG (1)