A COMPARATIVE STUDY OF INFERIOR GLIDE VERSUS MOVEMENT WITH MOBILIZATION (MWM) ON ABDUCTION IN PATIENTS OF ADHESIVE CAPSULITIS OF SHOULDER WITH GRADE-3 : Vinita Baghela *
BACKGROUND
Peri-Arthritis shoulder is characterized by pain, progressive restriction in joint range of motion due to Peri-Arthritis tightness which result in loss of function of shoulder joint over the years. The stiff shoulder was labeled initially Peri-Arthritis by duplay in 1872, then Peri-Arthritis shoulder by Codman in 1934 and later adhesive capsulitis by Neviaser in 1945 Peri-Arthritis shoulder (adhesive capsulitis) is a disorder characterized by pain and loss of motion or stiffness in the shoulder.
It effects about 2% of the population. It is more common in the woman between the age of 40 to 70 years old. The process involves thickening and contracture of the capsule surrounding the shoulder joint.
AIMS AND OBJECTIVES
To evaluate the effectiveness of the Maitland mobilization compare to the MWM to improve the joint ROM in chronic Peri-Arthritis shoulder grade -3.
To find out the effect of Maitland Mobilization to improve joint ROM.
To find out the effect of Capsular stretching to improve joint ROM.
To find out correlation difference between these two technique.
METHODOLOGY
For the present study an experimental approach with a pretest posttest design was used .population included grade 3 adhesive capsulitis patients from OPD. A treatment program of Maitland mobilization was given to Group A and movement with mobilizationwas given to Group B along with other exercises likependularexercises, shoulder wheel, finger ladder.
DISCUSSION AND RESULTS
The analysis within the group showed that both the groups showed significant improvement in pain, SPADI score and ROM. Thus both the mobilization techniques are beneficial but more significant improvement is noticed in group B, which suggest that Movement with Mobilization is more effective as compared to Maitland Mobilization inferior glide. There is significant improvement in pain and disability and ROM after both the treatments but more significant improvement occurs after application of MWM which suggest that MWM is more effective as compared to inferior glide of Maitland mobilization.
KEYWORD: Peri-Arthritis,Maitland Mobilization, capsulitis,MWM
1. Background of the Problem
Peri-Arthritis shoulder is characterized by pain, progressive restriction in joint range of motion due to Peri-Arthritis tightness which result in loss of function of shoulder joint over the years. The stiff shoulder was labeled initially Peri-Arthritis by duplay in 1872, then Peri-Arthritis shoulder by Codman in 1934 and later adhesive capsulitis by Neviaser in 1945 Peri-Arthritis shoulder (adhesive capsulitis) is a disorder characterized by pain and loss of motion or stiffness in the shoulder.
It effects about 2% of the population. It is more common in the woman between the age of 40 to 70 years old. The process involves thickening and contracture of the capsule surrounding the shoulder joint.
Some physicians have described the normal course of a Peri-Arthritis shoulder as having three stages.
STAGE ONE : in the “freezing ”stage , Which may last from 3 weeks to 9 months ,the patient develops a slow onset of pain. As the pain worsens , the shoulder loses motion.
STAGE TWO : in the “freezing ”stage , is marked by a improvement in pain but the stiffness remains. This stage generally lasts 6 months to years.
STAGE THREE : in the “freezing ”stage , is during which the shoulder motion slowly returns toward normal .this stage generally lasts 1 to 2 years.
Treatment option frozen shoulder will generally get better on its own. However , this takes sometime occasionally up to 2 to 3 years treatment is aimed at pain control and restoration of motion . The first goal is pain control.
MWM (Movement with mobilization).
Has a significant degree of inherent laxity with a surface area that is twice that of the humeral head .This redundancy allows for a wide range of motion.
The treatment of Peri-Arthritis shoulder should initially be conservative, with the emphasis on MWM of the joint structure MWM for the inferior shoulder should be perfume by the patients as a part of the motion.
2. Need and Significance of The Study
This study is concentrating on improving R.O.M. by the use of appropriate mobilization technique and also to find out the difference between maitland mobilization and MWM i.e which technique is more beneficial in improving R.O.M. in patients suffering from adhesive capsulitis of shoulder with grade -3.
3. Statment of The Problem
This study is done to find which mobilization technique is better ie whether maitland mobilization is better than MWM in improving R.O.M. in patients suffering from adhesive capsulitis shoulder grade -3
The study is entitled as
A comparative study of inferior glide versus movement with mobilization (MWM)on abduction in patients of adhesive capsulitis of shoulder with grade-3.
4. Operational Definttions
VAS Scale :- It attempts to represent measurement quantities in terms of a straight line placed horizontally or vertically on paper . The endpoint of the line are labeled with descriptive or numeric terms to anchor the extremes of the scale & provide.
A frame of reference for any point in the continuum between them. Commonly the entire visual analog line is 10cm long, but distance of 15&20cm are also used. The patients is asked to bisect the line at a point representing self assessed position on the scale. The patients score is then obtained by measuring from the zero mark to the mark bisecting the scale.
SPADI :- It is a self administered questionnaire developed to evaluate patients with shoulder pathology.It consist of 13 items in two subscales pain (5 items) and disability (8items)
5. Aims and Objectives
Aim
To evaluate the effectiveness of the maitland mobilization compare to the MWM to improve the joint ROM in chronic Peri-Arthritis shoulder grade -3.
Objectives of Study
1. To find out the effect of Maitland Mobilization to improve joint ROM.
2. To find out the effect of Capsular stretching to improve joint ROM.
3. To find out correlation difference between these two technique.
6. Hypothesis
Alternate Hypothesis
There will be significant difference in the joint ROM after application of maitland mobilization and MWM in PA shoulder.
Null hypothesis
There will be no significant difference between these two techniques after application in PA shoulder
7. Methodology in Brief
For the present study an experimental approach with a pretest post test design was used .population included grade 3 adhesive causalities patients from OPD. A treatment program of maitland mobilization was given to Group A and movement with mobilization was given to Group B along with other exercises like pendular exercises, shoulder wheel , finger ladder . Exercises regime was followed in similar fashion in both the Groups. Hot fermentation is also given before mobilization in both the group for relaxation .The tools selected for outcome measurement were VAS scale for pain and SPADI for both pain and disability caused due to pain full limitation of shoulderand R.O.M. for noticing both limitation before mobilization and improvement after mobilization statistical analysis of data is done with t-test.
2.REVIEWS R HEISER-2013
Joint mobilizations are used as an intervention for improving range of motion, decreasing pain and ultimately improving function in patients with a wide variety of upper extremity diagnoses.
GOODWILL M et al.(2012) in their self – controlled cross over study they studied the effects of lumbar PA mobilizations in 26 subjects with low back pain and divided into 2 groups which is allocated randomly . one received PA mobilizations and another received a control intervention . they concluded that lumber PAmobilizations may be a useful intervention in some low back patients17.
DETTORI J Et al (2011)In their study , compared the effects of flexion and extension back exercises and posture among the 149 subjects with acute low back pain . these subjects were divided into 3 group and received flexion exercises and posture , extension exercises and posture and no exercises and posture for 8 week. Outcome were assessed 1,2,4&8 weeks after treatment onset . lastly they concluded that exercises were slightly more effective than no exercises when patients with low back pain were treated16.
ELNAGGAR IM et al, (2010)In their study , compared the effects of spinal flexion (group1)and extension (group-II) exercise on low back pain severity and thoracolumbar spinal mobility in chronic mechanical but they concluded that flexion exercises had an advantage in increasing that sagittal mobility within a short period of time 15.
RAINVILLE J et al, (2009)this study was to find out comparison of total lumbosacral flexion and true lumber flexion measured by a dual inclinometer technique on 75 patients with chronic low back pain . their result suggest that total flexion seems to be more relevant to outcome after intensive rehabilitation and total lumbosacral flexion may be as equally relevant as true lumber flexion in the measurement of trunk mobility in the chronic low back pain patients21.
MULLIGAN’S,(2007)
There are an increasing number of report espousing the clinically beneficial effects of mulligan mobilizations with movement (MWM) treatment techniques
R.KELLY GARRETT (2006)Is a senior research fellow in the center for research on information technology in organization (CRITO) at the university of California , Irvine . he is concerned with the ways in which activists and the public are using new information and communication technologies (ICTs) to shape their engagements with contentious political topics. His recent research focuses on how people’s exposure to political information is related to their partisan beliefs. This work was the basis of a report the coauthored for the pew internet & American life project in late 2004. He has also given invited talks on this topic at the Harvard law school ,the university of north Carolina, and Michigan state university.
MARIA MOUTZOURI et al ,(2005)In this double blinded study; they studied the effects of the mulligan sustained natural Apophyseal glided (SNAG) mobilization in the lumber flexion range on 49 subjects which were randomly divided into two group .one received SNAG mobilization and another sham mobilization at the level of L3 & L4 spinal levels with active flexion in sitting were performed . they concluded that SNAG mobilization did not demonstrate significant differences in flexion ROM when compared to sham mobilization.
KIKA KONSTANTINOU et al,(2005)This study investigates the immediate effects of flexion mobilization with movement techniques (MWM) on spinal range of motion in 26 subjects with low back pain . subjects received an MWM intervention and a placebo were recorded immediately before and after each intervention using double inclinometer and visual analog scales. Their conclusion produced statistically significant , but small , immediate spinal mobility increases but no pain reduction 12.
3. RESEARCH METHODOLOGY
3.1 Research Approach
Experimental study
3.2 Research design
The study design adopted for present study was
pretest- post test design.
3.3 Study settings
The study was conducted on Grade-3 periarthritis
shoulder patients who attended the OPD.
3.4 Sample design
Sample consist of 60 patients Grade 3 periarthritis
shoulder.
3.5 Sampling method
By using convenient sampling sixty subjects studied
were divided into two groups of 30 each.
Group A- Maitland mobilization.
Group B – MWM.
Inclusion Criteria
1. Painful limitation of active shoulder abduction.
2. Pain or limitation with the functional movement pattern of hand behind back or hand behind head.
Exclusion Criteria
1. Physician diagnosis of adhesive capsulitis, calcific tendanitis confirmed by radiology.
2. Systemic or neurological disorder.
3. Cervical radiculopathy.
4. History of shoulder surgery.
5. Corticosteroid injection within the past month.
6. Subjects who had recived physical therapy treatment for their shoulder within the past three months.
3.6 Time and Duration of Study Duration of the study was 6 months Data was collected by a period of 2 months
3.7 Materials and Tools
Pen Paper
VAS Scale SPADI
Goniometer
3.8 Data Collection Process
Prior sanction was obtained for the study (Appendix – 3). The patients were taken for primary evaluation and if the patients fulfilled the inclusion criteria they were selected for the study and were divided into two groups.
Group A(Maitland Mobilization)
Group B (MWM)
Assessment was taken of all the 60 patients using VAS scale, SPADI, ROM at 0 day, 6th week and follow up at 8th week.
3.9 Procedure
After screening for inclusion and exclusion criteria patients were tested for pain by VAS, pain and disability by SPADI and availability of movement by measuring ROM by Goniometer.
Treatment Protocol
1. Pendulum Stretch – 10 Revolutions in each direction once a day as symptoms improve, diameter of swing is increased but not forced. when patient is ready for more stretch is increased by holding a light weight (3to 5 pounds) in swinging arm .
2. Towel Stretch -10 to 20 Times a day.
3. Finger walk – 10 to 20 times a day.
4. Cross body reach – hold the stretch for 15 to 20 sec. 10 to20 times a day.
5. Outward rotation- rotate the lower part of the affected arm outward 2 or 3 inches & hold for 5 sec. repeat 10 to 15 times, once a day.
6. Inward rotation -hold for 5 sec. repeat 10 to 15 times, once a day.
7. Inferior Glide-10 to 15 times, once a day.
8. MWM 3 sets of 10 repetitions were applied with one min. between sets. once a day .
9. Hot Fomentation (By Hot Packs) – Prior to exercise for 10 to 15 minutes.
3.10 Statistical Test Used
Student t test was used to compare pain, disability, ROM between groups and within groups.
Group response to treatment was analyzed using paired t test. The formula used is .
S= ? ((?d^2- n?(D ?)?^2)/)n-1
Where n = Number of patients
s = Standard deviation
d = Difference between the initial and final reading
?d^2= Mean difference between initial and final reading
4. DISCUSSION AND RESULTS
4.1 Discussion
The study is an comparative study of inferior glide versus movement with mobilization on abduction in patients of adhesive capsulitis of shoulder with grade 3.
The mean age of the subjects were almost similar in both groups and the patients were selected according to inclusion criteria.
The outcome measures taken were pain by VAS disability score by SPADI and ROM by goniometer.
The analysis within the group showed that both the groups showed significant improvement in pain, SPADI score and ROM. Thus both the mobilization techniques are beneficial but more significant improvement is noticed in group B, which suggest that Movement with Mobilization is more effective as compared to Maitland Mobilization inferior glide.
Pain was measured by VAS scale, which is simple and frequently used method for assessment of variation of intensity of pain.
On VAS the group B shows a gain of 2.6667 and group Ashows a gain of 2.2666 after treatment.
On SPADI group B shows a reduction of 22.5333 and group Ashows a reduction of 13.4 after treatment.
On ROM group B shows a gain of 4.6667 and group Ashows a gain of 4.5667 after treatment.
4.2 RESULTS
There is significant improvement in pain and disability and ROM after both the treatments but more significant improvement occurs after application of MWM which suggest that MWM is more effective as compared to inferior glide of Maitland mobilization.
5 . S U M M A R Y L I M I T A T I O N A N D SUGGESTIONS
5.1Summary
This study was performed to compare the effect of mobilization in adhesive capsulitis grade 3.
60 subjects were choosen according to inclusion criteria and randomly divided in two groups.
Student t test and paired t test was used to compare the difference in VAS score, SPADI, and ROM.
5.2 Limitations of the Study
1. This study assessed only the effect on grade 3 adhesive capsulitis.
2. Since study time was short only limited sample size is considered for study.
5.3 Suggestion
1. Large sample can be utilized in future
2. Studies on other grades can also be done.
6. BIBLIOGRAPHY
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