When this phase is achieved, two home exercise program self- stretches become effective and tolerable (Figures 4 & 5). These stretches are held for at least one minute per repetition and are performed two or more times daily. As the patient progresses to pain-free and improved mobility, internal rotation stretches and posterior glide joint mobilizations are added to the program. This progression requires an important clinical adjustment. At this point, it is advisable to alternate clinical days between treatment of the anterior capsule and posterior capsule. This rotation of mobilizations and stretches protects against common pain flare-ups and allows for overall improved capsular mobility. Figure 3
Figure 4: External Rotation
Figure 5: Internal Rotation
Evidence-based practice: Early applications of stretching and joint mobilization in the frozen phase should concentrate on improving elevation mobility first, which is produced with inferior glides. Using inferior glides will also allow for improvement to adjacent capsular restrictions and benefit mobility of external rotation and abduction. This treatment plan is confirmed by the Rundquist and Ludewig (2004) seminal study.
Case study Idiopathic Adhesive Capsulitis - Left Shoulder Dysfunction This case demonstrates the process of range of motion acquisition and exemplifies an optimal level of sustained weekly ROM improvement. Figure 6 shows the patient’s active external rotation at neutral on the discharge date. All active ROM measurements were taken prior to treatment, directly from the chart (Figure 7). Figure 6
Figure 7 Flexion Abduction External Rotation
October 15th
54°
46°
14°
November 1st
101°
74°
24°
November 15th
104°
76°
35°
December 1st
110°
78°
48°
December 15th
121°
84°
52°
December 30th
124°
88°
54°
Average Change/ Week
8.75°
5.25°
5°
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