The Effect of Cross Training on Clinical and Functional Outcomes in Frozen Shoulder Rehabilitation

NCT07510737 | Recruiting

• 1 other identifier: 1004
• Study Type: observational
• Target: 38
• Locations: 1 country
• Sites: 1

Brief Summary

This randomized controlled, single-blind, quasi-experimental study primarily aims to investigate the effects of unilateral resistance exercise applied without directly loading the affected shoulder on muscle strength and upper extremity function in individuals with frozen shoulder. Additionally, the study seeks to examine the effects on joint range of motion, quality of life, and activities of daily living. The study will be conducted among individuals diagnosed with frozen shoulder at the Physiotherapy and Rehabilitation Outpatient Clinic of Malatya Battalgazi State Hospital. The data collection process is planned to be completed between February 2026 and December 2026. Participants will be selected from the relevant population using a non-probability convenience sampling method. Individuals meeting the inclusion criteria will be enrolled after providing written informed consent. The study will be carried out in accordance with the principles of the Declaration of Helsinki. Participants will be randomly assigned to either the control or intervention group. The study will include individuals aged 18-65 years with a diagnosis of unilateral primary or secondary frozen shoulder, presenting with more than 50% restriction in at least one of the following shoulder movements compared to the unaffected side: external rotation, abduction, or flexion, and with more than 30% limitation in joint range of motion in at least two movement planes. Individuals with concomitant shoulder trauma (e.g., rotator cuff injury), bilateral shoulder involvement, acromioclavicular joint osteoarthritis, prior treatment for frozen shoulder, psychiatric disorders that may affect compliance with medical or physical therapy interventions, concomitant neurological conditions, or a Mini-Mental State Examination (MMSE) score below 24 will be excluded from the study.

Conditions

Frozen Shoulder

Keywords

Frozen shoulder; Cross training; Muscle strength; Function

Outcome Measures

Primary Outcomes (1)

• Shoulder Pain and Functional Disability

  Participants' shoulder pain and functional disability will be assessed using the Shoulder Pain and Disability Index (SPADI). The SPADI is a 13-item self-reported questionnaire designed to evaluate pain and functional impairment associated with shoulder dysfunction. Each item is rated on a numeric scale ranging from 0 ('no pain/no difficulty') to 10 ('worst imaginable pain/extreme difficulty requiring assistance'). The total SPADI score ranges from 0 to 100, with higher scores indicating greater pain and functional disability. The SPADI has been demonstrated to be a valid and reliable outcome measure for the assessment of individuals with frozen shoulder.

  Baseline and post-intervention (8 weeks later )

Secondary Outcomes (7)

• Numeric Pain Rating Scale (NPRS)

  Baseline and post-intervention (8 weeks later )

• Muscle Strength

  Baseline and post-intervention (8 weeks later )

• Joint Range of Motion Assessment

  Baseline and post-intervention (8 weeks later )

• Upper Extremity Function

  Baseline and post-intervention (8 weeks later )

• Quality of Life (QoL)

  Baseline and post-intervention (8 weeks later )

Study Arms (2)

cross training group

Participants diagnosed with frozen shoulder will receive 20 minutes of standard physiotherapy followed by 20 minutes of cross-education intervention.

Other: Cross-Education Group

standard physical therapy group

A 40-minute standard physiotherapy program will be administered to participants diagnosed with frozen shoulder

Other: Standard Physical Therapy Group

Interventions

Cross-Education Group OTHER

In the experimental group, each session will last 40 minutes, comprising 20 minutes of standard physical therapy and 20 minutes of cross-education. The standard physical therapy content will be identical to that of the control group. The cross-education program will aim to increase the internal rotation, external rotation, flexion, and abduction strength of the unaffected shoulder during immobilization. Resistance exercises will be performed at 70-80% of the one-repetition maximum (1RM) of the unaffected extremity, with loads progressively adjusted according to individual tolerance. Strengthening exercises targeting the internal rotators, external rotators, flexors, and abductors will be performed using dumbbells and therabands. Each contraction will last 3 seconds, with repetitions performed at 10-second intervals.

cross training group

Standard Physical Therapy Group OTHER

The program will be applied to both groups twice weekly for eight weeks, with the experimental group additionally receiving cross-education. The control group will undergo a 40-minute standard physical therapy protocol per session, progressively structured to reduce pain and improve shoulder range of motion. During weeks 0-3, passive and active-assisted range of motion exercises, scapular mobilization, stretching, and joint mobilizations with distraction will be performed within pain limits. Between weeks 3-5, active-assisted and active exercises, stretching, joint mobilizations, and scapulothoracic strengthening will continue. During weeks 6-8, active range of motion and strengthening exercises targeting the rotator cuff and scapulothoracic muscles will be implemented within pain limits.

standard physical therapy group

Eligibility Criteria

• Age: 18 Years - 65 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)
• Sampling Method: Non-Probability Sample

Study Population

The study will include patients aged 18-65 years with a diagnosis of unilateral primary or secondary frozen shoulder. Participants will be randomly assigned to either the control or intervention group.

You may qualify if:

• Having a diagnosis of unilateral primary or secondary frozen shoulder.
• Range of motion in external rotation, abduction, or flexion reduced by less than 50% in at least one of these directions compared to the unaffected shoulder.
• Loss of joint range of motion exceeding 30% in at least two movement planes compared to the unaffected shoulder.
• Aged between 18 and 65 years.

You may not qualify if:

• Presence of a concomitant shoulder injury (e.g., rotator cuff tear).
• Osteoarthritis in both shoulders or in the acromioclavicular joint.
• Previous treatment for frozen shoulder.
• Psychiatric disorders that may interfere with adherence to medical or physical therapy.
• Presence of other neurological disorders.
• A score below 24 on the Mini-Mental State Examination (MMSE).

Sponsors & Collaborators

• Inonu University: lead

Study Sites (1)

Battalgazi Devlet Hastanesi

Malatya, Turkey (Türkiye)

RECRUITING

Related Publications (20)

• Saldiran TC, Tanhan A, Celikel R, Dincer E. Reliability of a Visual-Cognitive Technology in Measuring Reaction Times: Associations with Age, Activity Level, and Grip Strength. J Manipulative Physiol Ther. 2025 Jul-Dec;48(6-9):789-799. doi: 10.1016/j.jmpt.2025.10.054. Epub 2025 Nov 13.

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• Loubani K, Kizony R, Milman U, Schreuer N. Hybrid Tele and In-Clinic Occupation Based Intervention to Improve Women's Daily Participation after Breast Cancer: A Pilot Randomized Controlled Trial. Int J Environ Res Public Health. 2021 Jun 2;18(11):5966. doi: 10.3390/ijerph18115966.

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• Mena-Del Horno S, Balasch-Bernat M, Louw A, Luque-Suarez A, Rodriguez-Brazzarola P, Navarro-Ledesma S, Murillo C, Duenas L, Lluch E. Is there any benefit of adding a central nervous system-focused intervention to a manual therapy and home stretching program for people with frozen shoulder? A randomized controlled trial. J Shoulder Elbow Surg. 2023 Jul;32(7):1401-1411. doi: 10.1016/j.jse.2023.02.134. Epub 2023 Mar 29.

  PMID: 37001795 BACKGROUND

• Duzgun I, Turgut E, Eraslan L, Elbasan B, Oskay D, Atay OA. Which method for frozen shoulder mobilization: manual posterior capsule stretching or scapular mobilization? J Musculoskelet Neuronal Interact. 2019 Sep 1;19(3):311-316.

  PMID: 31475938 BACKGROUND

• Yasaci Z, Celik D. Does Integration of Graded Motor Imagery Training Augment the Efficacy of a Multimodal Physiotherapy Program for Patients With Frozen Shoulder? A Randomized Controlled Trial. Clin Orthop Relat Res. 2025 Apr 1;483(4):707-716. doi: 10.1097/CORR.0000000000003252. Epub 2024 Sep 17.

  PMID: 39436270 BACKGROUND

• Lluch-Girbes E, Duenas L, Mena-Del Horno S, Luque-Suarez A, Navarro-Ledesma S, Louw A. A central nervous system-focused treatment approach for people with frozen shoulder: protocol for a randomized clinical trial. Trials. 2019 Aug 13;20(1):498. doi: 10.1186/s13063-019-3585-z.

  PMID: 31409380 BACKGROUND

• Hendy AM, Lamon S. The Cross-Education Phenomenon: Brain and Beyond. Front Physiol. 2017 May 10;8:297. doi: 10.3389/fphys.2017.00297. eCollection 2017.

  PMID: 28539892 BACKGROUND

• Lee M, Carroll TJ. Cross education: possible mechanisms for the contralateral effects of unilateral resistance training. Sports Med. 2007;37(1):1-14. doi: 10.2165/00007256-200737010-00001.

  PMID: 17190532 BACKGROUND

• Paillard T. Cross-Education Related to the Ipsilateral Limb Activity on Monopedal Postural Control of the Contralateral Limb: A Review. Front Physiol. 2020 May 21;11:496. doi: 10.3389/fphys.2020.00496. eCollection 2020.

  PMID: 32528312 BACKGROUND

• Mortezanejad M, Roostayi MM, Daryabor A, Salemi P. The Effect of Contraction Type and Training Volume in Unilateral Exercises on Cross-Education: A Narrative Review Study. Muscle Ligaments and Tendons Journal. 2023.

  BACKGROUND

• Mirto M, Esposito F, Iaia FM, Codella R. Cross-Education of Strength: From Theory to Practice in Contemporary Sports Rehabilitation-A Narrative Review and Clinical Implications. Sports Med Open. 2025 Nov 21;11(1):129. doi: 10.1186/s40798-025-00931-9.

  PMID: 41269443 BACKGROUND

• Frazer AK, Pearce AJ, Howatson G, Thomas K, Goodall S, Kidgell DJ. Determining the potential sites of neural adaptation to cross-education: implications for the cross-education of muscle strength. Eur J Appl Physiol. 2018 Sep;118(9):1751-1772. doi: 10.1007/s00421-018-3937-5. Epub 2018 Jul 11.

  PMID: 29995227 BACKGROUND

• Sokk J, Gapeyeva H, Ereline J, Merila M, Paasuke M. Shoulder muscle function in frozen shoulder syndrome patients following manipulation under anesthesia: a 6-month follow-up study. Orthop Traumatol Surg Res. 2013 Oct;99(6):699-705. doi: 10.1016/j.otsr.2013.04.008. Epub 2013 Aug 28.

  PMID: 23993770 BACKGROUND

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  PMID: 34046418 BACKGROUND

• Vita F, Pederiva D, Tedeschi R, Spinnato P, Origlio F, Faldini C, Miceli M, Stella SM, Galletti S, Cavallo M, Pilla F, Donati D. Adhesive capsulitis: the importance of early diagnosis and treatment. J Ultrasound. 2024 Sep;27(3):579-587. doi: 10.1007/s40477-024-00891-y. Epub 2024 Jun 6.

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• Mertens MG, Meeus M, Lluch Girbes E, Duenas L, Twickler MT, Verborgt O, Struyf F. Differences in biomechanical and metabolic factors between patients with frozen shoulder and asymptomatic individuals. A cross-sectional study. Musculoskelet Sci Pract. 2024 Aug;72:102980. doi: 10.1016/j.msksp.2024.102980. Epub 2024 May 28.

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• Kim WM, Seo YG, Park YJ, Cho HS, Lee SA, Jeon SJ, Ji SM. Effects of Different Types of Contraction Exercises on Shoulder Function and Muscle Strength in Patients with Adhesive Capsulitis. Int J Environ Res Public Health. 2021 Dec 11;18(24):13078. doi: 10.3390/ijerph182413078.

  PMID: 34948688 BACKGROUND

• Millar NL, Meakins A, Struyf F, Willmore E, Campbell AL, Kirwan PD, Akbar M, Moore L, Ronquillo JC, Murrell GAC, Rodeo SA. Frozen shoulder. Nat Rev Dis Primers. 2022 Sep 8;8(1):59. doi: 10.1038/s41572-022-00386-2.

  PMID: 36075904 BACKGROUND

MeSH Terms

Conditions

Bursitis

Condition Hierarchy (Ancestors)

Joint Diseases; Musculoskeletal Diseases

Study Officials

• Zeynal YASACI

  Inonu University

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Melisa İlhan

CONTACT

+905539712295; melisailhan09@gmail.com

Zeynal YASACI

CONTACT

+905075409791; zeynal.yasaci@inonu.edu.tr

Study Design

• Study Type: observational
• Observational Model: OTHER
• Time Perspective: CROSS SECTIONAL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Doctor Lecturer

Study Record Dates

• First Submitted: March 2, 2026
• First Posted: April 3, 2026
• Study Start: March 15, 2026
• Primary Completion (Estimated): December 25, 2026
• Study Completion (Estimated): December 25, 2026
• Last Updated: September 10, 2026

Record last verified: 2026-09

Data Sharing

• IPD Sharing: Will not share

Locations

TU (1)