Comparison of capsular stretching and passive joint mobilisation in idiopathic adhesive capsulitis of the shoulder: A randomised controlled trial

Maria Safdar, Safdar M, Ramsha Tariq, Tariq R, Ayesha Bashir, Bashir A, Muhammad Affan Iqbal, Iqbal MA, Nadia Ishtiaq, Ishtiaq N, Nimrah Kanwal, Kanwal N
JPMA. The Journal of the Pakistan Medical Association · 2026 · vol. 76(6) , pp. 821–825 · doi:10.47391/jpma.21437 · PMID:42363316
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This trial compared passive joint mobilisation and capsular stretching for shoulder adhesive capsulitis, finding both improved pain and motion, though mobilisation yielded greater gains in flexion, extension, abduction, and disability scores.

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This randomized controlled trial compared the efficacy of passive joint mobilisation versus capsular stretching for treating idiopathic stage-II adhesive capsulitis of the shoulder. The study enrolled 38 patients aged 30 to 50 years who received twelve sessions of their assigned therapy over four weeks at hospitals in Pakistan. Results indicated that both interventions significantly improved pain, range of motion, and disability scores, with passive mobilisation yielding superior gains in flexion, extension, abduction, and overall disability metrics. Conversely, capsular stretching produced greater improvements in internal rotation, while external rotation outcomes were comparable between the two groups. The paper does not explicitly discuss endometriosis or adenomyosis; it was included in the corpus via a keyword match in the upstream search index.

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Abstract

OBJECTIVE: To compare the effects of passive joint mobilisation versus capsular stretching on pain, range of motion and quality of life in patients with stage-II adhesive capsulitis of the shoulder joint. METHODS: The randomised control trial was conducted at Lady Reading Hospital and Khyber Teaching Hospital, Peshawar, Pakistan, from February to July 2023, and comprised patients aged 30-50 years diagnosed with idiopathic stage-II adhesive capsulitis of the shoulder joint. The patients were randomised into control group A and experimental group B. Group A was treated with Maitland mobilisation, while group B was treated with capsular stretching. The treatment lasted 12 sessions delivered 3 times a week for four weeks. Pre- and post-intervention assessment was done using a goniometer for shoulder range of motion, Numeric Pain Rating Scale for pain intensity, and the Shoulder Pain and Disability Index to measure disability associated with the affected joint. Data was analysed using SPSS 22. RESULTS: Of the 38 participants mean age was 45.50±4.14 years. Baseline values showed no significant differences between groups (p> 0.05). Both groups demonstrated significant intragroup improvements in shoulder flexion, extension, abduction, internal and external rotation, and SPADI scores following intervention (p<0.001). Postintervention, the control group showed significantly greater improvements in flexion, extension, abduction, and SPADI scores (p<0.001), while internal rotation improved more in the experimental group (p=0.003). No significant intergroup difference was observed for external rotation (p=0.228). Significant time-group interaction effects were observed for flexion, extension, and SPADI, with the largest effect size for SPADI (η² = 0.605). Pain severity improved in both groups, with a shift from predominantly severe pain at baseline to mainly mild and moderate pain post intervention. CONCLUSIONS: Both interventions significantly improved shoulder range of motion and reduced pain and disability. However, greater improvements were observed in shoulder flexion, extension, abduction, and SPADI scores in the control group, while internal rotation improved more in the experimental group, with similar gains in external rotation. RANDOMISED CONTROLLED TRIAL NO: NCT05903768.
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Objective

To compare the effects of passive joint mobilisation versus capsular stretching on pain, range of motion and quality of life in patients with stage-II adhesive capsulitis of the shoulder joint.

Method

The randomised control trial was conducted at Lady Reading Hospital and Khyber Teaching Hospital, Peshawar, Pakistan, from February to July 2023, and comprised patients aged 30-50 years diagnosed with idiopathic stage-II adhesive capsulitis of the shoulder joint. The patients were randomised into control group A and experimental group B. Group A was treated with Maitland mobilisation, while group B was treated with capsular stretching. The treatment lasted 12 sessions delivered 3 times a week for four weeks. Pre- and post-intervention assessment was done using a goniometer for shoulder range of motion, Numeric Pain Rating Scale for pain intensity, and the Shoulder Pain and Disability Index to measure disability associated with the affected joint. Data was analysed using SPSS 22.

Results

Of the 38 participants mean age was 45.50 ± 4.14 years. Baseline values showed no significant differences between groups (p> 0.05). Both groups demonstrated significant intragroup improvements in shoulder flexion, extension, abduction, internal and external rotation, and SPADI scores following intervention (p <0.001). Post-intervention, the control group showed significantly greater improvements in flexion, extension, abduction, and SPADI scores (p<0.001), while internal rotation improved more in the experimental group (p=0.003). no significant intergroup difference was observed for external rotation (p=0.228). Significant time–group interaction effects were observed for flexion, extension, and SPADI, with the largest effect size for SPADI (n² = 0.605). Pain severity improved in both groups, with a shift from predominantly severe pain at baseline to mainly mild and moderate pain post intervention.

Conclusion

Both interventions significantly improved shoulder range of motion and reduced pain and disability. However, greater improvements were observed in shoulder flexion, extension, abduction, and SPADI scores in the control group, while internal rotation improved more in the experimental group, with similar gains in external rotation. Randomised Controlled Trial No: NCT05903768

Keywords

Adhesive capsulitis, Range of motion, Shoulder pain and disability index, Numeric pain rating scale. Downloads Published How to Cite Issue Section License Copyright (c) 2026 Journal of the Pakistan Medical Association This work is licensed under a Creative Commons Attribution 4.0 International License.

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MeSH descriptors

Bursitis Bursitis Bursitis Muscle Stretching Exercises Shoulder Joint Shoulder Joint Shoulder Pain Shoulder Pain Shoulder Pain Adult Female Humans Male Middle Aged Pain Measurement Quality of Life Range of Motion, Articular

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