Effect of Eccentric Control Exercises on Patients with Frozen Shoulder and Mild to Moderate Disability: A Single-Group Pre-Post Study

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Eccentric control exercises have demonstrated effectiveness in managing various upper limb disorders, including subacromial impingement, tennis elbow, and rotator cuff tendinopathy. However, there is limited evidence on their efficacy in individuals with frozen shoulder. This study aimed to evaluate the effects of eccentric control exercises on pain, functional disability, range of motion, psychosocial outcomes, and patient satisfaction in individuals with FS and mild to moderate disability. Methods A single-group pre-post design was used. Twenty patients with clinically diagnosed FS and mild to moderate disability participated. All underwent 20 sessions of supervised eccentric control exercises over four weeks. Outcome measures included the Shoulder Pain and Disability Index (SPADI), Numerical Pain Rating Scale (NPRS), shoulder range of motion (flexion, abduction, hand-behind-back, and external rotation), Tampa Scale of Kinesiophobia (TSK), and Pain Self-Efficacy Questionnaire (PSEQ). Assessments were conducted at baseline, post-intervention (4 weeks), and follow-ups at 3 and 6 months. A 6-point Likert scale was used to measure patient satisfaction post-intervention. Data were analyzed using Repeated Measures ANOVA. Results All outcome measures showed statistically significant improvement post-intervention (p < 0.05), with the benefits maintained at the 3- and 6-month follow-ups. Effect size indices at 4 weeks demonstrated a large treatment effect across all variables, suggesting strong clinical relevance. Conclusions Eccentric control exercises significantly improved pain, functional disability, range of motion, kinesiophobia, pain self-efficacy, and patient satisfaction in individuals with frozen shoulder and mild to moderate disability. These findings support the incorporation of eccentric training in rehabilitation programs for frozen shoulder. " } { "@context": "http://schema.org", "@type": "BreadcrumbList", "itemListElement": [ { "@type": "ListItem", "position": "1", "item": { "@id": "https://f1000research.com/", "name": "Home" } }, { "@type": "ListItem", "position": "2", "item": { "@id": "https://f1000research.com/browse/articles", "name": "Browse" } }, { "@type": "ListItem", "position": "3", "item": { "@id": "https://f1000research.com/articles/14-1257/v1", "name": "Effect of Eccentric Control Exercises on Patients with Frozen Shoulder..." } } ] } Home Browse Effect of Eccentric Control Exercises on Patients with Frozen Shoulder... ALL Metrics - Views Downloads Get PDF Get XML Cite How to cite this article Mohan MP J, Sannasi SR, Dsouza GA and Kumar P. Effect of Eccentric Control Exercises on Patients with Frozen Shoulder and Mild to Moderate Disability: A Single-Group Pre-Post Study [version 1; peer review: 1 approved, 2 approved with reservations] . F1000Research 2025, 14 :1257 ( https://doi.org/10.12688/f1000research.167369.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Research Article Effect of Eccentric Control Exercises on Patients with Frozen Shoulder and Mild to Moderate Disability: A Single-Group Pre-Post Study [version 1; peer review: 1 approved, 2 approved with reservations] Jishnu Mohan MP 1 , S.Rajasekar Sannasi 1,2 , Glenisha Ancita Dsouza 1 , Praveen Kumar https://orcid.org/0000-0003-2669-4488 2 Jishnu Mohan MP 1 , S.Rajasekar Sannasi 1,2 , Glenisha Ancita Dsouza 1 , Praveen Kumar https://orcid.org/0000-0003-2669-4488 2 PUBLISHED 14 Nov 2025 Author details Author details 1 Insitute of Physiotherapy, Srinivas University, Mangaluru, Karnataka, India 2 Department of Physiotherapy, College of Health Sciences, Gulf Medical University, Ajman, United Arab Emirates Jishnu Mohan MP Roles: Methodology, Project Administration, Supervision, Writing – Original Draft Preparation S.Rajasekar Sannasi Roles: Conceptualization, Formal Analysis, Methodology, Supervision, Writing – Review & Editing Glenisha Ancita Dsouza Roles: Methodology, Supervision, Validation, Writing – Review & Editing Praveen Kumar Roles: Supervision, Writing – Review & Editing OPEN PEER REVIEW DETAILS REVIEWER STATUS Abstract Background Frozen shoulder (FS) is a common musculoskeletal condition characterized by inflammatory contracture of the glenohumeral joint capsule, leading to restricted active and passive range of motion, particularly in external rotation. Eccentric control exercises have demonstrated effectiveness in managing various upper limb disorders, including subacromial impingement, tennis elbow, and rotator cuff tendinopathy. However, there is limited evidence on their efficacy in individuals with frozen shoulder. This study aimed to evaluate the effects of eccentric control exercises on pain, functional disability, range of motion, psychosocial outcomes, and patient satisfaction in individuals with FS and mild to moderate disability. Methods A single-group pre-post design was used. Twenty patients with clinically diagnosed FS and mild to moderate disability participated. All underwent 20 sessions of supervised eccentric control exercises over four weeks. Outcome measures included the Shoulder Pain and Disability Index (SPADI), Numerical Pain Rating Scale (NPRS), shoulder range of motion (flexion, abduction, hand-behind-back, and external rotation), Tampa Scale of Kinesiophobia (TSK), and Pain Self-Efficacy Questionnaire (PSEQ). Assessments were conducted at baseline, post-intervention (4 weeks), and follow-ups at 3 and 6 months. A 6-point Likert scale was used to measure patient satisfaction post-intervention. Data were analyzed using Repeated Measures ANOVA. Results All outcome measures showed statistically significant improvement post-intervention (p < 0.05), with the benefits maintained at the 3- and 6-month follow-ups. Effect size indices at 4 weeks demonstrated a large treatment effect across all variables, suggesting strong clinical relevance. Conclusions Eccentric control exercises significantly improved pain, functional disability, range of motion, kinesiophobia, pain self-efficacy, and patient satisfaction in individuals with frozen shoulder and mild to moderate disability. These findings support the incorporation of eccentric training in rehabilitation programs for frozen shoulder. READ ALL READ LESS Keywords frozen shoulder, eccentric control exercises, eccentric training, Shoulder condition Corresponding Author(s) Praveen Kumar ( [email protected] ) Close Corresponding author: Praveen Kumar Competing interests: No competing interests were disclosed. Grant information: The author(s) declared that no grants were involved in supporting this work. Copyright: © 2025 Mohan MP J et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Mohan MP J, Sannasi SR, Dsouza GA and Kumar P. Effect of Eccentric Control Exercises on Patients with Frozen Shoulder and Mild to Moderate Disability: A Single-Group Pre-Post Study [version 1; peer review: 1 approved, 2 approved with reservations] . F1000Research 2025, 14 :1257 ( https://doi.org/10.12688/f1000research.167369.1 ) First published: 14 Nov 2025, 14 :1257 ( https://doi.org/10.12688/f1000research.167369.1 ) Latest published: 14 Nov 2025, 14 :1257 ( https://doi.org/10.12688/f1000research.167369.1 ) Introduction Frozen shoulder (FS), also known as adhesive capsulitis, is a common upper extremity condition characterized by an inflammatory contracture of the glenohumeral joint capsule. This leads to progressive restriction of both active and passive shoulder movements, particularly external rotation. 1 The condition affects approximately 2–5% of the general population and is more prevalent in females between 40 and 60 years of age. 2 While pain is typically localized to the anterior shoulder, it can radiate to the anterolateral arm and significantly impair functional activities and quality of life. 2 , 3 Despite substantial research, the pathophysiology of FS remains not fully understood. It is hypothesized to involve a nonspecific, chronic inflammatory response in the synovial tissue, resulting in thickening and fibrosis of the capsule, and subsequent limitation of joint movement. FS is also more frequently observed in individuals with comorbidities such as diabetes mellitus, cardiovascular disease, Parkinson’s disease, stroke, and Dupuytren’s contracture, as well as those with a history of neck or cardiac surgery, smoking, or hyperlipidemia. 4 The clinical presentation of FS varies with disease progression. In early, high-irritability phases, patients often report intense pain with minimal stiffness. As the condition advances, stiffness becomes the predominant symptom with reduced pain levels. 3 , 4 Exercise therapy is widely regarded as an effective conservative management strategy for FS. 5 Early-stage interventions typically include pendulum (Codman’s) exercises, wall walks, pulley-assisted movements, and shoulder wheels. As pain subsides, rehabilitation progresses to stretching, isotonic exercises, rotator cuff and scapular strengthening, and joint mobilization techniques. 6 Eccentric exercises, those that involve muscle lengthening under load, have been found effective in treating various musculoskeletal disorders, including subacromial impingement syndrome, lateral epicondylitis, and rotator cuff tendinopathy. 7 – 10 These exercises generate high mechanical tension, believed to promote remodelling of connective tissues and improve neuromuscular control. 8 Their metabolic efficiency and ability to induce tissue adaptation have made them a subject of growing interest in rehabilitation research. Although eccentric training has demonstrated effectiveness in upper limb disorders, its application in frozen shoulder remains underexplored. Considering the potential for improving joint range, muscular flexibility, and tendon compliance, eccentric training may serve as a valuable therapeutic strategy in FS management. Therefore, we hypothesized that eccentric control exercises targeting the rotator cuff and shoulder musculature would improve pain, range of motion, functional disability, fear of movement (kinesiophobia), and pain self-efficacy in patients with frozen shoulder and mild to moderate disability. The aim of this study was to investigate the effectiveness of an eccentric control exercise protocol on physical and psychosocial outcomes in this population. Methodology The study was conducted at an outpatient department in a medical college Hospital after obtaining approval from the authors affiliated institutions. This is a single group pre-post design which included 20 patients with FS with mild-moderate disability. The clinical trial registration number for the study is CTRI/2023/01/048754. The study was conducted from December 2022 to October 2023. The inclusion criteria were age between 40 and 65 years of both the gender, diagnosed case of frozen shoulder (equal limitation of active range of motion and passive range of motion and normal X ray) with mild to moderate disability <50% reduction of external rotation when comparing opposite side, for mild disability Pain intensity was 3/10 on numerical pain rating scale, No night pain or sleeping pain, both active and passive range of motion are equally limited, but can tolerate passive overpressure at end range of motion. For moderate disability, pain was 4-6/10 on numerical pain rating scale, periodic ache while sleeping or resting, both active and passive range of motion are equally limited, can tolerate basic shoulder loading. The Exclusion criteria include FS patients with calcifying tendinitis, Greater tuberosity fracture, Necrosis of the humeral head, Rotator cuff related shoulder pain, pseudo-frozen shoulder, Neoplasm, Osteonecrosis, Cervicogenic shoulder pain, Locked dislocation, Glenohumeral osteoarthritis. Outcome measures The outcome measures include Shoulder Pain Arm and Disability Index (SPADI). 11 Tampa scale of Kinesiophobia (TSK), 12 Joint ROM using Mobile Inclinometer, 13 Numerical Pain Rating Scale (NPRS), 14 Pain self-efficacy questionnaire 15 and 6-point Likert’s pain satisfaction scale. 16 Procedure A total of 27 patients presenting with shoulder pain were screened for eligibility, of which 20 participants (10 males and 10 females) met the inclusion criteria and were enrolled in the final study. Written informed consent was obtained from all participants in accordance with the Declaration of Helsinki. Prior to the intervention, a blinded outcome assessor measured the following parameters: shoulder joint abduction, internal rotation, external rotation, hand-behind-back (HBB) reach, the Shoulder Pain and Disability Index (SPADI), the Numerical Pain Rating Scale (NPRS), the Tampa Scale of Kinesiophobia (TSK), the Pain Self-Efficacy Questionnaire (PSEQ), and a 6-point Likert scale for pain satisfaction. The intervention consisted of eccentric control exercises, delivered every alternate day over a period of four weeks. Each session included three sets of 8–12 repetitions. Post-treatment outcomes were reassessed at the end of the 4-week intervention. The same eccentric exercise program was advised to be continued at home for follow-up assessments at 3 months and 6 months. The study outline is depicted in the flow diagram ( Figure 1 ). Figure 1. Flow diagram depicts the study outline. Eccentric exercises [ Figures 2 - 7 ] Figure 2. Eccentric exercise for external rotators. Figure 3. Eccentric strengthening for internal rotators (less abducted to more abducted position). Figure 4. Eccentric exercise for flexors. Figure 5. Progressive concentric and eccentric exercise for flexors. Figure 6. Progressive alternate concentric eccentric exercise for shoulder extensors starting position. Figure 7. Progressive concentric and eccentric exercises for shoulder adductors. External rotators: Participants were positioned in crook lying with the shoulder abducted and elbow flexed at 90°. They were instructed to perform active internal rotation using a 1 kg dumbbell, followed by passive external rotation performed by the therapist up to mid-range. During internal rotation, the external rotators undergo eccentric contraction. 17 Internal rotators: In crook lying, with the shoulder abducted and externally rotated, and the elbow flexed at 90°, participants performed controlled external rotation, followed by passive internal rotation by the therapist. The internal rotators contract eccentrically during the external rotation movement. 17 Flexors: Participants lay in a crook-lying position with the shoulder fully flexed. They were instructed to perform a controlled extension with a 1 kg dumbbell, followed by passive full shoulder flexion by the therapist. During the extension phase, the shoulder flexors undergo eccentric contraction. 17 Internal rotators with slight abduction: In crook lying with the shoulder slightly abducted and externally rotated, participants performed a controlled internal rotation using a 1 kg dumbbell. This was followed by passive external rotation by the therapist, maintaining the abducted position. This movement emphasizes eccentric contraction of the internal rotators. 17 Ethical consideration and consent to participate The study was conducted in adherence to the ethical principles outlined in the Declaration of Helsinki for research on human participant. Ethical approval to conduct the study was obtained from Srinivas University, Institutional Ethical Committee in August 20, 2022, with Reference number SUIP/PG22/114/2022. Written informed consent was obtained from each participant, ensuring their understanding and voluntary agreement to partake in the research. Data analysis All statistical analyses were performed using the Statistical Package for the Social Sciences (IBM SPSS Statistics for Windows, Version 28.0). As the demographic data followed a normal distribution, results are presented as mean ± standard deviation (SD) along with the range. The effect size index was calculated for all outcome measures after the 4-week intervention to evaluate the magnitude of change. Apart from the Numerical Pain Rating Scale (NPRS), all outcome measures followed a normal distribution and were therefore analysed using repeated measures ANOVA to determine statistical significance across different time points. Since the NPRS data did not meet the assumption of normality, it was expressed as median with interquartile range (IQR) and analysed using the Friedman test to assess statistical significance over time. Results The demographic characteristics of the recruited sample are presented in Table 1 . Since the demographic variables follow a normal distribution, they are expressed as mean ± SD with range. Table 1. Demographic dimensions of the sample recruited. Demographic dimensions Mean (SD) Range Age (Years) 55.9 ± 6.8 41 to 65 Height (cm) 161.9 ± 7.9 147 to 176 Weight (kg) 65.6 ± 9.9 51 to 83 BMI (kg/m 2 ) 24.9 ± 3.2 19.6 to 30 Table 2 displays the recorded data for outcome measures at baseline, post-intervention, 3-month follow-up, and 6-month follow-up. Table 2. Outcome measures recorded at baseline, post-intervention, 3-month follow-up and 6-month follow-up. Outcomes Baseline Post intervention 3-month follow-up 6-month follow up p-value* SPADI 80.5 ± 18.5 56.2 ± 12.7 28.7 ± 4.6 23.9 ± 2.9 <.001 TSK 36.8 ± 6.1 23.4 ± 4.1 18.4 ± 3.3 15.7 ± 2.8 <.001 PSEQ 42.6 ± 10.8 51.4 ± 4.0 54.9 ± 2.7 56.8 ± 1.5 <.001 NPRS 6.5 (6, 7) 4 (3.3, 5) 3 (2, 3) 1.5 (1, 2) <.001 # SFl 144.1 ± 8.6 158.5 ± 5.0 167.6 ± 3.9 170.9 ± 2.9 <.001 SAb 129.9 ± 11.6 152.9 ± 7.6 165.4 ± 6.8 170.1 ± 4.2 <.001 SHbb 22.6 ± 4.8 35.9 ± 4.1 48.9 ± 5.7 53.1 ± 3.8 <.001 SEr 51.4 ± 9.6 61.9 ± 8.5 74.9 ± 5.7 81.6 ± 3.5 <.001 The effect size indices for the outcome measures SPADI, TSK, PSEQ, NPRS, SFI, Sab, SHb, and SEr were 1.48, 2.49, 0.93, 0.89, 1.93, 2.25, 2.96, and 1.15, respectively, indicating that the treatment was effective. Figure 8 illustrates the timeline changes in patients with frozen shoulder (FS). Figure 8. Timeline changes of SPADI in patients with FS. Figure 9 shows the timeline changes in TSK scores in patients with FS. Figure 9. Timeline changes of TSK in patients with FS. Figure 10 depicts the timeline changes in PSEQ scores in patients with FS. Figure 10. Timeline changes of PSEQ in patients with FS. Discussion This is the first study to evaluate the effects of eccentric control exercises in patients with frozen shoulder (FS) and mild to moderate disability, using a range of outcome measures including psychosocial parameters such as kinesiophobia and pain self-efficacy. Previous research has shown that eccentric exercises outperform concentric exercises in improving pain, muscle strength, and function in various shoulder conditions such as subacromial impingement syndrome and rotator cuff tendinopathy. 18 – 20 In the present study, the observed recovery in shoulder range of motion (ROM) may be attributed to an increase in sarcomere length and alterations in passive tension within the rotator cuff muscles or surrounding connective tissue structures. 21 Eccentric exercises have demonstrated rapid improvements in ROM, often with less energy expenditure than stretching. Unlike concentric contractions, which involve muscle shortening, eccentric contractions occur while the muscle lengthens under tension. This method of training is more metabolically efficient, as it requires less energy to produce the same force. 22 In addition to musculoskeletal benefits, eccentric exercises are known to enhance insulin sensitivity, promote muscle regeneration, improve lipid profiles, increase cortical excitability, and boost cardiorespiratory fitness. 17 Owing to these systemic effects, eccentric exercises have been utilized in managing conditions such as type 2 diabetes, sarcopenia, and cardiorespiratory disorders. 17 The primary goals of FS treatment include increasing both active and passive ROM, reducing pain, and improving shoulder function. 23 In our study, shoulder flexion, abduction, hand-behind-back (HBB) reach, and external rotation all showed notable improvements following the intervention. Importantly, our protocol involved a longer eccentric contraction duration of 10–15 seconds, which contrasts with earlier studies that adopted shorter durations. 16 , 17 A systematic review concluded that eccentric training is more effective than concentric training for enhancing muscle mass in healthy individuals. 18 Additionally, individuals with subacromial pain syndrome demonstrated significant functional gains following eccentric exercise interventions. 16 Another study suggested that eccentric control exercises may be a key component of rehabilitation, particularly in female patients with FS. 6 , 18 Based on these insights, we hypothesized that the improvements observed in our study may be due to mechanical changes such as reorganization of collagen fibers in the joint capsule and remodelling of adhered tissue. 24 Furthermore, increased synovial fluid circulation may have contributed to capsular tissue softening and increased joint mobilit. 25 Strength of the study: The internal validity of this study is strengthened by the standardized protocol, consistent outcome assessment tools, and blinded assessment of outcome measures. The study has several limitations that must be acknowledged. As a single-group pre-post design, it is vulnerable to threats such as history, maturation, and regression to the mean, which may confound the observed effects. The significant improvements seen across various timelines are encouraging, but without a control group, causal inferences should be made cautiously. The external validity, or generalizability, is limited due to the small sample size (n=20), and single-centre design. While the results may be applicable to similar clinical populations in controlled settings, their extrapolation to broader populations (e.g., patients with severe FS, different age groups, or other comorbidities) should be done with caution. Suggestions for future research Future studies should consider using randomized controlled trials with larger and more diverse samples to compare eccentric exercises with other standard or emerging physiotherapy interventions. Inclusion of a placebo or active control group would help establish causal relationships. Additionally, further investigation into the neurophysiological and biomechanical mechanisms underlying the effects of eccentric loading in FS may enhance understanding and inform protocol optimization. It would also be beneficial to explore the long-term adherence to home-based eccentric programs and their impact on sustained functional recovery. Conclusion Eccentric control exercises led to significant improvements in pain, functional disability, range of motion (including flexion, abduction, hand-behind-back, and external rotation), pain self-efficacy, kinesiophobia, and patient satisfaction in individuals with frozen shoulder and mild to moderate disability. Data availability Underlying data Figshare: [data for eccentric exercise] https://doi.org/10.6084/m9.figshare.29491985.v2 . 26 The project contains the following underlying data: • Dataset for eccentric exercise Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0). Extended data Figshare: [data for eccentric exercise] https://doi.org/10.6084/m9.figshare.29491985.v2 . 26 This project contains the following extended data: • Screening form and data collection sheet • Informed consent Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0). References 1. Dyer BP, Rathod-Mistry T, Burton C, et al. : Diabetes as a risk factor for the onset of frozen shoulder: a systematic review and meta-analysis. BMJ Open. 2023; 13 (1): e062377. PubMed Abstract | Publisher Full Text | Free Full Text 2. Rawat P, Eapen C, Seema KP: Effect of rotator cuff strengthening as an adjunct to standard care in subjects with adhesive capsulitis: a randomized controlled trial. J. Hand Ther. 2017; 30 (3): 235–241.e8. PubMed Abstract | Publisher Full Text 3. Lewis J: Frozen shoulder contracture syndrome – aetiology, diagnosis and management. Man. Ther. 2015; 20 (1): 2–9. PubMed Abstract | Publisher Full Text 4. Pandey V, Madi S: Clinical guidelines in the management of frozen shoulder: an update. Indian J. Orthop. 2021; 55 (2): 299–309. PubMed Abstract | Publisher Full Text | Free Full Text 5. Kim WM, Seo YG, Park YJ, et al. : 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; 18 (24): 13078. PubMed Abstract | Publisher Full Text | Free Full Text 6. Macías-Hernández SI, García-Morales JR, Hernández-Díaz C, et al. : Tolerance and effectiveness of eccentric vs concentric muscle strengthening in rotator cuff partial tears and moderate to severe shoulder pain: a randomized pilot study. J. Clin. Orthop. Trauma. 2020; 14 : 106–112. Publisher Full Text 7. Hedt C, Lambert BS, Daum J, et al. : Forearm position matters during eccentric shoulder exercises: an EMG recruitment study with implications for rehabilitation. Int. J. Sports Phys. Ther. 2020; 15 (6): 1110–1118. PubMed Abstract | Publisher Full Text | Free Full Text 8. Larsson R, Bernhardsson S, Nordeman L: Effects of eccentric exercise in patients with subacromial impingement syndrome: a systematic review and meta-analysis. BMC Musculoskelet. Disord. 2019; 20 (1): 446. PubMed Abstract | Publisher Full Text | Free Full Text 9. Ortega-Castillo M, Medina-Porqueres I: Effectiveness of eccentric exercise therapy in physically active adults with symptomatic shoulder impingement or lateral epicondylar tendinopathy: a systematic review. J. Sci. Med. Sport. 2016; 19 (6): 438–453. PubMed Abstract | Publisher Full Text 10. Camargo PR, Alburquerque-Sendín F, Salvini TF: Eccentric training as a new approach for rotator cuff tendinopathy: review and perspectives. World J. Orthop. 2014; 5 (5): 634–644. PubMed Abstract | Publisher Full Text | Free Full Text 11. Breckenridge JD, McAuley JH: Shoulder Pain and Disability Index (SPADI). J. Physiother. 2011; 57 (3): 197. Publisher Full Text 12. Hudes K: The Tampa Scale of Kinesiophobia and neck pain, disability and range of motion: a narrative review of the literature. J. Can. Chiropr. Assoc. 2011; 55 (3): 222–232. PubMed Abstract 13. Shah KR, Deshpande MG, Ramteke P, et al. : Use of smartphone for measuring shoulder rotational range of motion in patients with frozen shoulder: a comparative study. Panacea J. Med. Sci. 2017; 7 (2): 117–120. Publisher Full Text 14. Alghadir AH, Anwer S, Iqbal A, et al. : Test–retest reliability, validity, and minimum detectable change of visual analog, numerical rating, and verbal rating scales for measurement of osteoarthritic knee pain. J. Pain Res. 2018; 11 : 851–856. PubMed Abstract | Publisher Full Text | Free Full Text 15. Dubé MO, Langevin P, Roy JS: Measurement properties of the Pain Self-Efficacy Questionnaire in populations with musculoskeletal disorders: a systematic review. Pain Rep. 2021; 6 (4): e972. PubMed Abstract | Publisher Full Text | Free Full Text 16. Chomeya R: Quality of psychology test between Likert scale 5 and 6 points. J. Soc. Sci. 2010; 6 (3): 399–403. 17. Lewis J, Fernández-de-las-Peñas C: The shoulder: theory and practice. Edinburgh: Handspring Publishing; 2022. 18. Blume C, Wang-Price S, Trudelle-Jackson E, et al. : Comparison of eccentric and concentric exercise interventions in adults with subacromial impingement syndrome. Int. J. Sports Phys. Ther. 2015; 10 (4): 441–455. PubMed Abstract 19. Chaconas EJ, Kolber MJ, Hanney WJ, et al. : Shoulder external rotator eccentric training versus general shoulder exercise for subacromial pain syndrome: a randomized controlled trial. Int. J. Sports Phys. Ther. 2017; 12 (7): 1–11. 20. Dejaco B, Habets B, van Loon C , et al. : Eccentric versus conventional exercise therapy in patients with rotator cuff tendinopathy: a randomized, single-blinded clinical trial. Knee Surg. Sports Traumatol. Arthrosc. 2017; 25 (7): 2051–2059. PubMed Abstract | Publisher Full Text 21. Pincheira PA, Boswell MA, Franchi MV, et al. : Biceps femoris long head sarcomere and fascicle length adaptations after 3 weeks of eccentric exercise training. J. Sport Health Sci. 2022; 11 (1): 43–49. PubMed Abstract | Publisher Full Text | Free Full Text 22. Wahba MM, Selim M, Hegazy MM, et al. : Eccentric versus concentric exercises in patients with rheumatoid arthritis and rotator cuff tendinopathy: a randomized comparative study. Ann. Rehabil. Med. 2023; 47 (1): 26–35. PubMed Abstract | Publisher Full Text | Free Full Text 23. Cho CH, Bae KC, Kim DH: Treatment strategy for frozen shoulder. Clin. Orthop. Surg. 2019; 11 (3): 249–257. PubMed Abstract | Publisher Full Text | Free Full Text 24. Lorbach O, Anagnostakos K, Scherf C, et al. : Nonoperative management of adhesive capsulitis of the shoulder: oral cortisone application versus intra-articular cortisone injections. J. Shoulder Elb. Surg. 2010; 19 (2): 172–179. PubMed Abstract | Publisher Full Text 25. Hoppeler H: Moderate load eccentric exercise: a distinct novel training modality. Front. Physiol. 2016; 7 : 483. PubMed Abstract | Publisher Full Text 26. Sannasi R: data for eccentric exercise. Dataset. figshare. 2025. Publisher Full Text Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 14 Nov 2025 ADD YOUR COMMENT Comment Author details Author details 1 Insitute of Physiotherapy, Srinivas University, Mangaluru, Karnataka, India 2 Department of Physiotherapy, College of Health Sciences, Gulf Medical University, Ajman, United Arab Emirates Jishnu Mohan MP Roles: Methodology, Project Administration, Supervision, Writing – Original Draft Preparation S.Rajasekar Sannasi Roles: Conceptualization, Formal Analysis, Methodology, Supervision, Writing – Review & Editing Glenisha Ancita Dsouza Roles: Methodology, Supervision, Validation, Writing – Review & Editing Praveen Kumar Roles: Supervision, Writing – Review & Editing Competing interests No competing interests were disclosed. Grant information The author(s) declared that no grants were involved in supporting this work. Article Versions (1) version 1 Published: 14 Nov 2025, 14:1257 https://doi.org/10.12688/f1000research.167369.1 Copyright © 2025 Mohan MP J et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads F1000Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Mohan MP J, Sannasi SR, Dsouza GA and Kumar P. Effect of Eccentric Control Exercises on Patients with Frozen Shoulder and Mild to Moderate Disability: A Single-Group Pre-Post Study [version 1; peer review: 1 approved, 2 approved with reservations] . F1000Research 2025, 14 :1257 ( https://doi.org/10.12688/f1000research.167369.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 1 VERSION 1 PUBLISHED 14 Nov 2025 Views 0 Cite How to cite this report: El Melhat AM. Reviewer Report For: Effect of Eccentric Control Exercises on Patients with Frozen Shoulder and Mild to Moderate Disability: A Single-Group Pre-Post Study [version 1; peer review: 1 approved, 2 approved with reservations] . F1000Research 2025, 14 :1257 ( https://doi.org/10.5256/f1000research.184479.r440018 ) The direct URL for this report is: https://f1000research.com/articles/14-1257/v1#referee-response-440018 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 15 Jan 2026 Ahmed M. El Melhat , Cairo University, Giza, Egypt Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.184479.r440018 Thank you for the opportunity to review the article entitled “Effect of Eccentric Control Exercises on Patients with Frozen Shoulder and Mild to Moderate Disability: A Single-Group Pre-Post Study” This study addresses an important rehabilitation question and presents encouraging ... Continue reading READ ALL Thank you for the opportunity to review the article entitled “Effect of Eccentric Control Exercises on Patients with Frozen Shoulder and Mild to Moderate Disability: A Single-Group Pre-Post Study” This study addresses an important rehabilitation question and presents encouraging pre–post improvements across pain, disability, ROM, and psychosocial outcomes following a short eccentric-oriented intervention for mild to moderate FS, with gains maintained up to 6 months. Kindly, find below the comments requiring responses/ justification from the authors. General Comment: 1. Please clarify the exact mechanics of each “eccentric control” exercise: which muscle group was intended to be eccentrically loaded, what external torque was applied (direction and magnitude), how patients were instructed to resist, and the cadence/time-under-tension per repetition. Did you verify via EMG or force/torque proxies that the target muscle was active during lengthening? 2. There are inconsistencies in session frequency/dosage (20 sessions in 4 weeks vs every other day vs 5 days/week “alternatively”). What was the actual supervised schedule and total number of sessions per participant? How was home program adherence monitored during follow-up? 3. What was the predefined primary outcome, and was a sample size calculation performed? How did you handle multiple comparisons across outcomes and time points, and what effect size metrics were used for each test (please define and report CIs)? 4. ROM measurement details: Which inclinometer/smartphone app was used, what was the measurement protocol (positions, stabilization), and how was hand-behind-back quantified (units, landmarks)? you mean internal rotation of shoulder? Were intra-rater reliability checks performed for the blinded assessor? 5. Were any co-interventions (analgesics, injections, manual therapy, other exercises) allowed or recorded during the study and follow-ups? Please report adherence, adverse events (e.g., DOMS), and the missing satisfaction outcomes. 7. How do your results compare against standard-of-care interventions for FS (e.g., joint mobilization, corticosteroid injection plus exercise) in terms of magnitude of change and time course? Can you contextualize SPADI/NPRS changes relative to established MCIDs for clinical relevance? 8. Be consistent with case usage regarding the keywords. Methodology -I appreciate difficulty of recruiting this population, however, I am unsure about your criteria for inclusion, specifically had a corticosteroid injection or not. -This is a very common treatment technique in these phases of frozen shoulder and by making this part of the exclusion really limits the clinical applicability of the study itself. Also, how were patients diagnosed with frozen shoulder and by whom. Additionally, what criteria were used to determine the phases? -You mention approval but do not name the ethics committee. plz Add approval number and institution. - Patient recruitment notes that inclusion criteria were participants mild to moderate disability, please elaborate on how this was defined/tested/operationalized -Several figures show machine-based cable exercises. Was this part of the standardized protocol? If so, please detail their purpose, dosage, and progression; if not, please adjust figures to match the Methods and avoid any crowded figures. -Flow diagram text appears truncated and inconsistent; attrition over 6 months is not reported. - Tables 2: Plz add all abbreviation below table. Discussion: The claim of being the “first study” in FS may be overstated given trials comparing contraction types in adhesive capsulitis; more nuanced positioning relative to Kim et al. (2021) and other FS-specific exercise literature is needed. -No comparisons to standard-of-care approaches for FS (e.g., joint mobilization programs, corticosteroid injections, combined manual therapy and exercise) to contextualize effect sizes. considered main limitation. Conclusions: -Satisfaction outcome is listed but not reported in Results despite being used in Conclusions. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Partly Competing Interests: No competing interests were disclosed. Reviewer Expertise: Expert in musculoskeletal rehabilitation. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT El Melhat AM. Reviewer Report For: Effect of Eccentric Control Exercises on Patients with Frozen Shoulder and Mild to Moderate Disability: A Single-Group Pre-Post Study [version 1; peer review: 1 approved, 2 approved with reservations] . F1000Research 2025, 14 :1257 ( https://doi.org/10.5256/f1000research.184479.r440018 ) The direct URL for this report is: https://f1000research.com/articles/14-1257/v1#referee-response-440018 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Nanayakkara I. Reviewer Report For: Effect of Eccentric Control Exercises on Patients with Frozen Shoulder and Mild to Moderate Disability: A Single-Group Pre-Post Study [version 1; peer review: 1 approved, 2 approved with reservations] . F1000Research 2025, 14 :1257 ( https://doi.org/10.5256/f1000research.184479.r437368 ) The direct URL for this report is: https://f1000research.com/articles/14-1257/v1#referee-response-437368 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 02 Jan 2026 Indu Nanayakkara , University of Peradeniya, Peradeniya, Central Province, Sri Lanka Approved VIEWS 0 https://doi.org/10.5256/f1000research.184479.r437368 The study purely looks at the effect of eccentric exercise affecting FS. It does not compare it with any other protocol or a control group. Knowing that FS has a natural course of action to become better over time (self ... Continue reading READ ALL The study purely looks at the effect of eccentric exercise affecting FS. It does not compare it with any other protocol or a control group. Knowing that FS has a natural course of action to become better over time (self limiting) we do not know whether the effect of the natural course of the disease is taken into account when these results are put forward. So I think when the authors make conclusions, they have to take this fact into account. Other than that, the article is written well and can be indexed with making the above mentioned improvement to the discussion and conclusion. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes Competing Interests: No competing interests were disclosed. Reviewer Expertise: Physiotherapy interventions, autonomic function testing I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Nanayakkara I. Reviewer Report For: Effect of Eccentric Control Exercises on Patients with Frozen Shoulder and Mild to Moderate Disability: A Single-Group Pre-Post Study [version 1; peer review: 1 approved, 2 approved with reservations] . F1000Research 2025, 14 :1257 ( https://doi.org/10.5256/f1000research.184479.r437368 ) The direct URL for this report is: https://f1000research.com/articles/14-1257/v1#referee-response-437368 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Views 0 Cite How to cite this report: J M. Reviewer Report For: Effect of Eccentric Control Exercises on Patients with Frozen Shoulder and Mild to Moderate Disability: A Single-Group Pre-Post Study [version 1; peer review: 1 approved, 2 approved with reservations] . F1000Research 2025, 14 :1257 ( https://doi.org/10.5256/f1000research.184479.r440019 ) The direct URL for this report is: https://f1000research.com/articles/14-1257/v1#referee-response-440019 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 30 Dec 2025 Mohanakeishnan J , Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, Puducherry, India Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.184479.r440019 1) Pls mention why mild to moderate disability was selected 2) Was the irritability assessed ,if so kindly highlight and justify the same 30 Pls explain why abduction was not selected in your study for isolated eccentric protocol ... Continue reading READ ALL 1) Pls mention why mild to moderate disability was selected 2) Was the irritability assessed ,if so kindly highlight and justify the same 30 Pls explain why abduction was not selected in your study for isolated eccentric protocol 4) Was there any undesirable effects reported in this study 5) In discussion "...................recovery in shoulder range of motion (ROM) may be attributed to an increase in sarcomere length and alterations in passive tension within the rotator cuff muscles or surrounding connective tissue structures." Pls explain how was this observed and pls justify your claim 6) Kindly discuss the variability of the patient's response between mild and moderate disability and pain. 7) Also adding a paragraph in discussion to describe the fear component in both the groups and the impact of eccentric exs on the same would add value to the paper 8) Discussion has to be elaborated with your observations...... Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? I cannot comment. A qualified statistician is required. Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes Competing Interests: No competing interests were disclosed. Reviewer Expertise: Shoulder, Knee , chronic pain and Yoga therapy I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT J M. Reviewer Report For: Effect of Eccentric Control Exercises on Patients with Frozen Shoulder and Mild to Moderate Disability: A Single-Group Pre-Post Study [version 1; peer review: 1 approved, 2 approved with reservations] . F1000Research 2025, 14 :1257 ( https://doi.org/10.5256/f1000research.184479.r440019 ) The direct URL for this report is: https://f1000research.com/articles/14-1257/v1#referee-response-440019 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 14 Nov 2025 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 2 3 Version 1 14 Nov 25 read read read Mohanakeishnan J , Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India Indu Nanayakkara , University of Peradeniya, Peradeniya, Sri Lanka Ahmed M. El Melhat , Cairo University, Giza, Egypt Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert Browse by related subjects keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2026 El Melhat A. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 15 Jan 2026 | for Version 1 Ahmed M. El Melhat , Cairo University, Giza, Egypt 0 Views copyright © 2026 El Melhat A. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Thank you for the opportunity to review the article entitled “Effect of Eccentric Control Exercises on Patients with Frozen Shoulder and Mild to Moderate Disability: A Single-Group Pre-Post Study” This study addresses an important rehabilitation question and presents encouraging pre–post improvements across pain, disability, ROM, and psychosocial outcomes following a short eccentric-oriented intervention for mild to moderate FS, with gains maintained up to 6 months. Kindly, find below the comments requiring responses/ justification from the authors. General Comment: 1. Please clarify the exact mechanics of each “eccentric control” exercise: which muscle group was intended to be eccentrically loaded, what external torque was applied (direction and magnitude), how patients were instructed to resist, and the cadence/time-under-tension per repetition. Did you verify via EMG or force/torque proxies that the target muscle was active during lengthening? 2. There are inconsistencies in session frequency/dosage (20 sessions in 4 weeks vs every other day vs 5 days/week “alternatively”). What was the actual supervised schedule and total number of sessions per participant? How was home program adherence monitored during follow-up? 3. What was the predefined primary outcome, and was a sample size calculation performed? How did you handle multiple comparisons across outcomes and time points, and what effect size metrics were used for each test (please define and report CIs)? 4. ROM measurement details: Which inclinometer/smartphone app was used, what was the measurement protocol (positions, stabilization), and how was hand-behind-back quantified (units, landmarks)? you mean internal rotation of shoulder? Were intra-rater reliability checks performed for the blinded assessor? 5. Were any co-interventions (analgesics, injections, manual therapy, other exercises) allowed or recorded during the study and follow-ups? Please report adherence, adverse events (e.g., DOMS), and the missing satisfaction outcomes. 7. How do your results compare against standard-of-care interventions for FS (e.g., joint mobilization, corticosteroid injection plus exercise) in terms of magnitude of change and time course? Can you contextualize SPADI/NPRS changes relative to established MCIDs for clinical relevance? 8. Be consistent with case usage regarding the keywords. Methodology -I appreciate difficulty of recruiting this population, however, I am unsure about your criteria for inclusion, specifically had a corticosteroid injection or not. -This is a very common treatment technique in these phases of frozen shoulder and by making this part of the exclusion really limits the clinical applicability of the study itself. Also, how were patients diagnosed with frozen shoulder and by whom. Additionally, what criteria were used to determine the phases? -You mention approval but do not name the ethics committee. plz Add approval number and institution. - Patient recruitment notes that inclusion criteria were participants mild to moderate disability, please elaborate on how this was defined/tested/operationalized -Several figures show machine-based cable exercises. Was this part of the standardized protocol? If so, please detail their purpose, dosage, and progression; if not, please adjust figures to match the Methods and avoid any crowded figures. -Flow diagram text appears truncated and inconsistent; attrition over 6 months is not reported. - Tables 2: Plz add all abbreviation below table. Discussion: The claim of being the “first study” in FS may be overstated given trials comparing contraction types in adhesive capsulitis; more nuanced positioning relative to Kim et al. (2021) and other FS-specific exercise literature is needed. -No comparisons to standard-of-care approaches for FS (e.g., joint mobilization programs, corticosteroid injections, combined manual therapy and exercise) to contextualize effect sizes. considered main limitation. Conclusions: -Satisfaction outcome is listed but not reported in Results despite being used in Conclusions. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Partly Competing Interests No competing interests were disclosed. Reviewer Expertise Expert in musculoskeletal rehabilitation. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (0) El Melhat AM. Peer Review Report For: Effect of Eccentric Control Exercises on Patients with Frozen Shoulder and Mild to Moderate Disability: A Single-Group Pre-Post Study [version 1; peer review: 1 approved, 2 approved with reservations] . F1000Research 2025, 14 :1257 ( https://doi.org/10.5256/f1000research.184479.r440018) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-1257/v1#referee-response-440018 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2026 Nanayakkara I. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 02 Jan 2026 | for Version 1 Indu Nanayakkara , University of Peradeniya, Peradeniya, Central Province, Sri Lanka 0 Views copyright © 2026 Nanayakkara I. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions The study purely looks at the effect of eccentric exercise affecting FS. It does not compare it with any other protocol or a control group. Knowing that FS has a natural course of action to become better over time (self limiting) we do not know whether the effect of the natural course of the disease is taken into account when these results are put forward. So I think when the authors make conclusions, they have to take this fact into account. Other than that, the article is written well and can be indexed with making the above mentioned improvement to the discussion and conclusion. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes Competing Interests No competing interests were disclosed. Reviewer Expertise Physiotherapy interventions, autonomic function testing I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (0) Nanayakkara I. Peer Review Report For: Effect of Eccentric Control Exercises on Patients with Frozen Shoulder and Mild to Moderate Disability: A Single-Group Pre-Post Study [version 1; peer review: 1 approved, 2 approved with reservations] . F1000Research 2025, 14 :1257 ( https://doi.org/10.5256/f1000research.184479.r437368) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-1257/v1#referee-response-437368 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2026 J M. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 30 Dec 2025 | for Version 1 Mohanakeishnan J , Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, Puducherry, India 0 Views copyright © 2026 J M. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions 1) Pls mention why mild to moderate disability was selected 2) Was the irritability assessed ,if so kindly highlight and justify the same 30 Pls explain why abduction was not selected in your study for isolated eccentric protocol 4) Was there any undesirable effects reported in this study 5) In discussion "...................recovery in shoulder range of motion (ROM) may be attributed to an increase in sarcomere length and alterations in passive tension within the rotator cuff muscles or surrounding connective tissue structures." Pls explain how was this observed and pls justify your claim 6) Kindly discuss the variability of the patient's response between mild and moderate disability and pain. 7) Also adding a paragraph in discussion to describe the fear component in both the groups and the impact of eccentric exs on the same would add value to the paper 8) Discussion has to be elaborated with your observations...... Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? I cannot comment. A qualified statistician is required. Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes Competing Interests No competing interests were disclosed. Reviewer Expertise Shoulder, Knee , chronic pain and Yoga therapy I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (0) J M. Peer Review Report For: Effect of Eccentric Control Exercises on Patients with Frozen Shoulder and Mild to Moderate Disability: A Single-Group Pre-Post Study [version 1; peer review: 1 approved, 2 approved with reservations] . F1000Research 2025, 14 :1257 ( https://doi.org/10.5256/f1000research.184479.r440019) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. 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