The Combined Effect of Mulligan Mobilization, Pain Neuroscience-Based Training, and Core Stabilization Exercises in Frozen Shoulder Patients

NCT07667556 | Recruiting

• 1 other identifier: Dilay Döner
• Study Type: interventional
• Target: 36
• Locations: 1 country
• Sites: 1

Brief Summary

The purpose of this randomized controlled study is to investigate the effects of a combined rehabilitation program consisting of Mulligan Mobilization with Movement (MWM), Pain Neuroscience Education (PNE), and core stabilization exercises in individuals with adhesive capsulitis (frozen shoulder). The main questions this study aims to answer are: Does the combination of Mulligan mobilization, Pain Neuroscience Education, and core stabilization exercises reduce pain in individuals with adhesive capsulitis? Does this combined intervention improve shoulder range of motion, shoulder function, quality of life, scapular dyskinesis, and pain catastrophizing compared with conventional physical therapy? Participants diagnosed with adhesive capsulitis will be randomly assigned to one of two groups. The intervention group will receive Mulligan mobilization, Pain Neuroscience Education, and core stabilization exercises, while the control group will receive conventional physical therapy, including TENS, hot-pack application, passive joint mobilization, and stretching exercises. Both groups will participate in treatment sessions three times per week for six weeks. Outcome measures will be assessed at baseline and after completion of the 6-week intervention period.

Conditions

Frozen Shoulder

Outcome Measures

Primary Outcomes (3)

• Pain Intensity

  Pain intensity during movement will be assessed using the Visual Analog Scale (VAS). Higher scores indicate greater pain intensity.

  Baseline and week 6

• Shoulder Function

  Shoulder pain, function, and patient satisfaction will be evaluated using the Penn Shoulder Score (PSS). Higher scores indicate better shoulder function.

  Baseline and week 6

• Shoulder Range of Motion

  Active shoulder flexion, abduction, internal rotation, and external rotation range of motion will be measured using a goniometer.

  Baseline and week 6

Secondary Outcomes (4)

• Pain Catastrophizing

  Baseline and week 6

• Core Stability

  Baseline and week 6

• Change in Scapular Dyskinesis

  Baseline and week 6

• Change in Health-Related Quality of Life

  Baseline and week 6

Study Arms (2)

Experimental - Combined Treatment Group

EXPERIMENTAL

Mulligan Mobilization + Pain Neuroscience Education + Core Stabilization Exercises

Behavioral: Pain Neuroscience Education (PNE); Procedure: Mulligan Mobilization With Movement (MWM); Behavioral: Core Stabilization Exercises

Active Comparator - Conventional Physical Therapy Group

ACTIVE COMPARATOR

Conventional Physical Therapy (TENS + hot-pack + ROM Exercises + Stretching Exercises)

Other: Conventional Physical Therapy

Interventions

Pain Neuroscience Education (PNE) BEHAVIORAL

Participants will receive Pain Neuroscience Education focused on the biopsychosocial nature of pain, central sensitization, the distinction between pain and tissue damage, and strategies to reduce fear of movement. The initial educational session will last approximately 15-20 minutes, followed by 5-10 minute reinforcement sessions throughout the intervention period. Education will be delivered through verbal explanations and interactive discussion.

Experimental - Combined Treatment Group

Mulligan Mobilization With Movement (MWM) PROCEDURE

Participants will receive Mulligan Mobilization with Movement techniques applied to the glenohumeral joint, including posterolateral glide with active abduction, inferior glide with shoulder flexion, and posterior glide with internal rotation. Mobilizations will be performed within a pain-free range of motion. Each technique will be administered in 3 sets of 10 repetitions with 30 seconds of rest between sets. Treatment will be provided three times per week for six weeks

Experimental - Combined Treatment Group

Conventional Physical Therapy OTHER

Participants in the control group will receive conventional physical therapy consisting of transcutaneous electrical nerve stimulation (TENS) applied at a sensory level for 20 minutes, hot-pack application for 20 minutes, passive shoulder joint mobilization exercises, pendulum exercises, and wand exercises. Treatment sessions will be conducted three times per week for six weeks.

Active Comparator - Conventional Physical Therapy Group

Core Stabilization Exercises BEHAVIORAL

Participants will perform Dynamic Neuromuscular Stabilization (DNS)-based core stabilization exercises. The program will include diaphragmatic breathing, supine 90/90 positioning, abdominal bracing, and progression to dead bug, bird-dog, and modified plank exercises as tolerated. Exercises will be performed in 2-3 sets of 8-12 repetitions with 10-20 second isometric holds. Progression will occur from stable to unstable surfaces and from static to dynamic activities

Experimental - Combined Treatment Group

Eligibility Criteria

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

You may qualify if:

• Adults aged 18 to 65 years
• Diagnosis of adhesive capsulitis confirmed by an orthopedic surgeon or a physical medicine and rehabilitation physician
• Presence of shoulder pain and limitation of shoulder range of motion
• Ability to communicate verbally
• Ability to understand study procedures and educational content
• Willingness to participate and provide written informed consent
• Mini-Mental State Examination (MMSE) score of 24 or higher
• Ability to attend treatment and assessment sessions regularly

You may not qualify if:

• MMSE score below 24
• Severe cognitive impairment
• Severe psychiatric disorders
• Active infectious disease
• Active malignancy
• Uncontrolled cardiovascular disease
• Presence of a cardiac pacemaker
• Contraindications to transcutaneous electrical nerve stimulation (TENS)
• Neurological disorders that may affect participation or outcomes
• Systemic diseases that may interfere with the safe implementation of the intervention
• Inability to comply with the study protocol or attend scheduled sessions

Sponsors & Collaborators

• Yeditepe University: lead

Study Sites (1)

Life Med Tıp Merkezi

Istanbul, Turkey (Türkiye)

RECRUITING

Related Publications (4)

• Sullivan MJL, Bishop SR, Pivik J. The Pain Catastrophizing Scale: Development and validation. Psychological Assessment. 1995;7(4):524-532.

  BACKGROUND

• Leggin BG, Michener LA, Shaffer MA, Brenneman SK, Iannotti JP, Williams GR Jr. The Penn shoulder score: reliability and validity. J Orthop Sports Phys Ther. 2006 Mar;36(3):138-51. doi: 10.2519/jospt.2006.36.3.138.

  PMID: 16596890 BACKGROUND

• Razzaq A, Nadeem RD, Akhtar M, Ghazanfar M, Aslam N, Nawaz S. Comparing the effects of muscle energy technique and mulligan mobilization with movements on pain, range of motion, and disability in adhesive capsulitis. J Pak Med Assoc. 2022 Jan;72(1):13-16. doi: 10.47391/JPMA.1360.

  PMID: 35099430 BACKGROUND

• Doner G, Guven Z, Atalay A, Celiker R. Evalution of Mulligan's technique for adhesive capsulitis of the shoulder. J Rehabil Med. 2013 Jan;45(1):87-91. doi: 10.2340/16501977-1064.

  PMID: 23037929 BACKGROUND

MeSH Terms

Conditions

Bursitis

Interventions

Movement

Condition Hierarchy (Ancestors)

Joint Diseases; Musculoskeletal Diseases

Intervention Hierarchy (Ancestors)

Physiological Phenomena; Musculoskeletal Physiological Phenomena; Musculoskeletal and Neural Physiological Phenomena

Central Study Contacts

Dilay Döner

CONTACT

+90 0535 019 58 83; dilay.doner@std.yeditepe.edu.tr

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: June 19, 2026
• First Posted: June 25, 2026
• Study Start: April 21, 2026
• Primary Completion: June 1, 2026
• Study Completion: June 1, 2026
• Last Updated: June 25, 2026

Record last verified: 2026-06

Data Sharing

• IPD Sharing: Will not share

Locations

TU (1)