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The randomized controlled trail aims is to evaluate the outcome of Gongs mobilization and PNF in patients with adhesive capsulitis. The significance of this study is to compare Gong's mobilization technique with proprioceptive neuromuscular facilitation (PNF) compare their effects on pain, range of motion, and functional disability. The sample size was calculated with G-power. This study would include total 44 female participants aged 40-60 years will be recruited and randomly assigned to two groups. Group A(Gongs mobilization+ conventional therapy)and Group B(PNF+ Conventional therapy). Intervention will be provided for 4 weeks 3 session per week. Primary outcome measures are pain, ROM and functional disability via NPRS, Goniometer and U-SPADI. Outcomes will be reassessed at baseline, after 2nd week, and after 4th week.
Adhesive capsulitis ,which is also referred as frozen shoulder is described as a progressive and self-limiting condition leading to gradual onset of pain and loss of shoulder Range of motion. It restricts both Active and Passive movements due to adhesions in Glenohumeral(GH) joint capsule. which leads to fibrosis, scarring and contracture of joint capsule. As fibrosis progresses restricting the shoulder normal Range of motion. ultimately impacting person's daily activities and frequently interfering with sleep and making basic activities like combing hair , dressing and overhead activities difficult.
Gong's Mobilization(GM) serves as an effective technique in the treatment of Frozen shoulder, it was introduced by W. Gong, the mainstay of this mobilization is to correct the positional fault of the humeral head that is often medially rotated and dragged forward due to muscular tension of Subscapularis and Pectoralis Major along with the tightness of posterior capsule. Gong mobilization intends to keep the humeral head in its correct position during dynamic motion of the GH joint by keeping the affected scapula in anterior to posterior position and the humeral head in posterior to anterior direction at the same time. Proprioceptive neuromuscular facilitation (PNF) stretch is a technique commonly used in clinical environments to enhance both active and passive range of motion (ROM), with the ultimate goal of optimizing motor performance and rehabilitation
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Gongs Mobilization | Experimental | Gongs Mobilization + conventional Therapy |
|
| Proprioceptive Neuromuscular facilitation | Experimental | PNF + conventional Therapy |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Gongs Mobilization | Behavioral | Glenohumeral mobilization (GM) will be performed in a side-lying position with the therapist standing on the affected side. An anterior-to-posterior glide will be applied to the humeral head parallel to the joint plane while the opposite hand stabilizes the scapula from posterior to anterior. The patient will perform quick shoulder abduction movements with the elbow extended as the therapist applies Maitland's Grade III-IV oscillatory glides, maintaining slight joint distraction and following the motion through the abduction phase. Each session will include two sets of five repetitions with a five-minute rest between sets, for a total of twelve sessions |
| Measure | Description | Time Frame |
|---|---|---|
| Numeric Pain Rating Scale | Numeric pain rating scale is Subjective Assessment Tool used to assess level of discomfort patients are experiencing. It is eleven-point scale (0-10).whereas 0 indicates(no pain at all) and 10 indicates(worst imaginable pain). | 4 weeks |
| Goniometer | Universal goniometer is used to assess active and passive Range of motion | 4 weeks |
| Shoulder pain and Disability Index Urdu version(SPADI-U) | SPADI-U was Created to assess degree of pain and discomfort in carrying out activities of daily living by patients without any assistance. In the recent version 11-Point Numeric pain rating scale is used to rate each item. It has total 13 items, 5-items for evaluating pain and 8-items for disability. | 4 weeks |
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Inclusion Criteria:
Exclusion Criteria:
Female aged between 40-60 years having unilateral adhesive capsulitis
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Fatima Miraj, DPT | Contact | +923045938254 | fatimamiraj921@gmail.com | |
| Attiq ur Rehman, MS | Contact | +92-336-1055533 | attiq.rehman@riphah.edu.pk |
| Name | Affiliation | Role |
|---|---|---|
| Fatima Miraj, DPT | Riphah International University | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Pakistan Railway General Hospital | Recruiting | Rawalpindi | Punjab Province | 46000 | Pakistan |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 37907222 | Background | Kim DH. Outcome Measurement in Shoulder Diseases: Focus on Shoulder Pain and Disability Index (SPADI). Ann Rehabil Med. 2023 Oct;47(5):315-317. doi: 10.5535/arm.23130. Epub 2023 Oct 25. No abstract available. | |
| 40317031 | Background | Khan AH, Bhuiyan MSH, Kabir MF, Hossain MZ, Jahan S, Hossain KMA, Rahman E. Effectiveness of proprioceptive neuromuscular facilitation pattern on upper extremity and scapula in patients with adhesive capsulitis: a single-centre assessor-blinded randomised controlled trial (RCT). Trials. 2025 May 3;26(1):146. doi: 10.1186/s13063-025-08848-0. |
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| ID | Term |
|---|---|
| D002062 | Bursitis |
| D010146 | Pain |
| ID | Term |
|---|---|
| D007592 | Joint Diseases |
| D009140 | Musculoskeletal Diseases |
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |
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| ID | Term |
|---|---|
| D052580 | Muscle Stretching Exercises |
| ID | Term |
|---|---|
| D005081 | Exercise Therapy |
| D012046 | Rehabilitation |
| D000359 | Aftercare |
| D003266 | Continuity of Patient Care |
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|
| Proprioceptive Neuromuscular Facilitation | Behavioral | The therapist will use proprioceptive neuromuscular facilitation (PNF) techniques specifically employing the hold-relax method followed by the D2 pattern of flexion-extension movement. Each session will last 15 minutes, comprising 10 sets of PNF. Each set will include 5 repetitions, with a 5-second hold and a 2-second rest between repetitions. This protocol will be administered over 12 sessions. |
|
| 40095380 | Background | Fernandes MR. Adhesive capsulitis: current concepts. Musculoskelet Surg. 2026 Mar;110(1):1-10. doi: 10.1007/s12306-025-00897-7. Epub 2025 Mar 17. |
| 39905175 | Background | Amjad F, Asghar H. Comparative effects of gong's mobilization and mobilization with movement in patients with adhesive capsulitis: a randomized clinical trial. Sci Rep. 2025 Feb 4;15(1):4272. doi: 10.1038/s41598-025-88422-5. |
| D013568 |
| Pathological Conditions, Signs and Symptoms |
| D005791 |
| Patient Care |
| D013812 | Therapeutics |
| D026741 | Physical Therapy Modalities |
| D015444 | Exercise |
| D009043 | Motor Activity |
| D009068 | Movement |
| D009142 | Musculoskeletal Physiological Phenomena |
| D055687 | Musculoskeletal and Neural Physiological Phenomena |