The primer aim of this study is to demonstrate the effect of instrument assisted soft
tissue mobılızatıon on paın ,functıonality, joint range of motion patients with adhesive
capsulitis

The Effect of Instrument Assisted Soft Tissue Mobilization in Adhesive Capsulıtıs Treatment

Adhesive Capsulitis

ınstrument assısted Soft tıssue molılızatıon

Adhesive capsulitis is also called arthrofibrosis, which involves excessive adhesion
formation along the glenohumeral joint. It is a disease of unknown etiology and is
classified as primary and secondary. Primary adhesive capsulitis includes cases of
idiopathic origin resulting from chronic inflammation with fibroblast proliferation.
Secondary adhesive capsulitis, central nervous system involvement, arm immobilized for a
long time, trauma or fracture, infectious diseases, etc. Includes post-mortem situations.

It is characterized by shoulder pain, decreased range of motion, and limitation of
function. This affects the function of the entire upper extremity. Idiopathic adhesive
capsulitis usually involves the non-dominant upper extremity, with bilateral involvement
in 40-50% of cases. It is more common in women between the ages of 40 and 60. The
incidence of adhesive capsulitis among the population is between 3% and 5%. It has been
reported with up to 20% higher incidence in the diabetic population. It is also
associated with other pathological disorders such as thyroid dysfunction, coronary artery
disease and cerebrovascular disease. Although the pathology is self-limiting, long-term
symptoms develop in approximately 20% to 50% of cases.

Adhesive capsulitis progression is characterized by four stages, each stage presenting a
distinctive clinical picture.

  1. The painful phase lasts less than three months and presents with shoulder pain at
     night when glenohumeral movement is preserved.

  2. The freezing process lasts three to nine months and is manifested by severe pain and
     stiffness in the glenohumeral joint.

  3. The frozen shoulder process lasts nine to fourteen months and is eventually
     characterized by loss of motion and pain in all directions.

  4. The resolution phase lasts for fifteen to twenty-four months and is characterized by
     persistent stiffness, minimal pain, and delayed improvement in shoulder motion.

Abnormal shoulder kinematics develops in response to the lack of extensibility of the
capsule with the change in motor patterns in the central nervous system. Increased
thoracic kyphosis can be seen as postural deviations. However, fibrotic changes are also
seen in the periarticular connective tissue and trigger points. This presents as a higher
level of disability with painful shoulder. Physiotherapy is the mainstay of treatment for
patients with adhesive capsulitis. Joint mobilization has a proven role in conjunction
with Codman's exercises. Transcutaneous Electrical Nerve Stimulation (TENS), Diathermy is
used in the treatment to reduce pain. Instrument Assisted Soft Tissue Mobilization
(IASTM) is a soft tissue mobilization method that works by generating localized
inflammation and facilitates collagen synthesis and realignment. In fact, when IASTM is
given to soft tissues with appropriate pressure, localized inflammation occurs with
microvascular bleeding. This will increase blood flow to the injured area along with the
recruitment of more fibroblasts. With the removal of scar tissues and adhesions, healing
will be supported by the organization of collagen of fibroblasts. The fibronectin induced
by IASTM is required for tissue repair. A localized force will be transmitted through an
instrument to the affected tissues to leave a scar.

IASTM has become increasingly popular as a tool for the rehabilitation of sports
injuries. It has been proven to be successful in a short time in reducing pain and
increasing mobility after sports injuries. There are studies showing an increase in ROM
after a single application of this technique.

It is known that it takes a long time to relieve pain and achieve a good improvement in
ROM in adhesive capsulitis. This affects their quality of life and creates the need for
treatment options that provide a shorter recovery time. Various conservative protocols
are followed with physical therapy as the main treatment in adhesive capsulitis. Few
studies have used IASTM as a treatment to evaluate its effect on adhesive capsulitis.

soft tissue mobilization

conventional physical therapy

Visual Analogue Scale (VAS) for pain assesment .In tgis scale ,evaluaments paın with 10-
point Likert scale , 0 is scored as no pain,5 as modarete pain , and 10 as excrucıatıng
pain.

SPADI is a pain and functional disability questionnaire specifically for the shoulder. It
is divided into two parts: the pain scale (5 questions) and the disability scale (8
questions). Each question is rated on a scale from 0 to 10. The final score is calculated
as a percentage.

Assistant professor

measured using a protractor. Shoulder flexion, extension, abduction, internal rotation
and external rotation intervals are measured in the supine position.

Hot-pack to warm the superficial tissue, TENS for pain relief, ultrasound (US) to warm
the joint structures before mobilization techniques, ROM, stretching, and isometric
strengthening exercises to restore joint mobility and function of the shoulder area soft
tissue mobilization; For the shoulder area, the application will take between 3-5
minutes. Instrumental Soft tissue mobilization will be performed while the participant is
sitting in a supported chair, parallel to the shoulder and scapular muscle fibers and at
an angle of 45 degrees to the vertical. Patients will be told that there may be small red
spots called petechiae in the treated area. The application will be made using Graston
iron rods.

Hot-pack to warm the superficial tissue, TENS for pain relief, ultrasound to warm the
joint structures before mobilization techniques, ROM, stretching, and isometric
strengthening exercises to restore joint mobility and function of the shoulder area.

The Effect of Instrument Assisted Soft Tissue Mobilization in Adhesive Capsulıtıs Treatment

About this trial

Study ID

Status

Type

Phase

Placebo

Accepting

Not accepting

Trial Timing

What is this trial about?

What are the participation requirements?

Locations

Location

Status