The Combined Effect of Mulligan Technique and Scapular Mobilization in Shoulder Adhesive Capsulitis

January 27, 2026 updated by: Deraya University

The shoulder joint capsule is a fibrous sheath that encloses and stabilizes the structures of the shoulder joint, extending from the anatomical neck of the humerus to the rim of the glenoid fossa. It is normally lax, allowing a wide range of motion. Shoulder adhesive capsulitis, or frozen shoulder, is a common musculoskeletal condition characterized by pain and restricted movement due to thickening and contraction of this capsule. Proper coordination between the scapula and humerus-known as the scapulohumeral rhythm-is essential for normal shoulder motion. Disruption of this rhythm contributes to movement limitation and pain in adhesive capsulitis.

This randomized, single-blind clinical trial aims to investigate the combined effect of the Mulligan technique and scapular mobilization on improving shoulder range of motion, pain, disability, and scapulohumeral rhythm in patients with adhesive capsulitis. Thirty-eight participants aged 30 to 60 years, diagnosed with unilateral adhesive capsulitis, will be randomly assigned to two groups. Group A will receive Mulligan mobilization techniques for shoulder elevation, internal and external rotation, along with scapular mobilization. Group B will receive conventional physical therapy consisting of hot packs, ultrasound, stretching, and range-of-motion exercises. Both groups will undergo treatment three times per week for four weeks.

Primary outcomes include changes in shoulder range of motion (measured using a digital goniometer), pain and disability (measured by the Shoulder Pain and Disability Index [SPADI]), and scapulohumeral rhythm (assessed using tape measurement). The study is expected to provide clinical evidence on whether combining Mulligan and scapular mobilization techniques yields superior functional recovery compared with conventional physiotherapy alone in patients with shoulder adhesive capsulitis.

Study Overview

Status

Not yet recruiting

Conditions

Intervention / Treatment

Detailed Description

The shoulder joint capsule is a fibrous structure that surrounds the shoulder joint and connects the anatomical neck of the humerus to the rim of the glenoid fossa. It provides stability to the joint while allowing extensive mobility. In adhesive capsulitis, also known as frozen shoulder, the capsule becomes inflamed, thickened, and contracted, leading to pain, stiffness, and a progressive loss of both active and passive range of motion. This condition is most common in middle-aged individuals and can significantly limit daily function.

Normal shoulder motion depends on a coordinated movement pattern between the scapula and the humerus, known as the scapulohumeral rhythm. During shoulder elevation, approximately two degrees of glenohumeral motion are accompanied by one degree of scapulothoracic movement. Disruption of this rhythm contributes to movement dysfunction, altered biomechanics, and pain. Rehabilitation approaches that restore this coordination are therefore critical for effective management of adhesive capsulitis.

The Mulligan mobilization technique involves the application of sustained accessory glides by the therapist concurrent with the patient's active movement. This technique aims to correct positional faults, reduce pain, and improve joint mobility without provoking discomfort. Scapular mobilization is a manual therapy approach designed to restore normal motion of the scapula on the thoracic cage and to improve the scapulohumeral rhythm during shoulder elevation.

This study is designed as a randomized, single-blind clinical trial to evaluate the combined effect of Mulligan mobilization and scapular mobilization in patients with adhesive capsulitis. Thirty-eight participants aged between 30 and 60 years with unilateral adhesive capsulitis will be randomly assigned into two groups. Group A will receive Mulligan techniques for shoulder elevation, internal rotation, and external rotation in addition to scapular mobilization. Group B will receive conventional physical therapy consisting of hot packs, pulsed ultrasound at 1 MHz and 0.8 W/cm² for five minutes, posterior capsule stretching, and range-of-motion exercises. Both groups will receive therapy three times per week for four weeks.

Outcome assessments will include shoulder range of motion using a digital goniometer, pain and disability using the Shoulder Pain and Disability Index (SPADI), and scapulohumeral rhythm using a tape measurement method. Measurements will be taken before and after the four-week intervention period. It is hypothesized that the combined Mulligan and scapular mobilization protocol will produce greater improvements in pain reduction, joint range, and scapulohumeral coordination compared to conventional physiotherapy alone.

Study Type

Interventional

Enrollment (Estimated)

38

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Locations

  • Egypt
    • Menia Governorate
      • Minya, Menia Governorate, Egypt
        • faculty of physical therapy, Deraya University
        • Contact:

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • Medically stable and willing to provide informed consent to participate in the study.
  • Age between 30 and 60 years.
  • Both male and female participants.
  • Unilateral shoulder involvement with pain and limited active and passive range of motion in lateral rotation, abduction, and internal rotation for more than three months compared with the unaffected side.
  • Clinically diagnosed with adhesive capsulitis (frozen shoulder).

Exclusion Criteria:

  • History of shoulder surgery.
  • History of radiotherapy or chemotherapy.
  • Presence of acute infection in the area to be treated.
  • History of skin disease.
  • History of cervical radiculopathy within the past six months.
  • Secondary adhesive capsulitis, rotator cuff tears, shoulder fractures, or dislocations.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Single

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Active Comparator: Conventional Physiotherapy

Participants in this group will receive conventional physiotherapy consisting of:

Hot pack application for 10 minutes

Ultrasound therapy in pulsed mode (1 MHz frequency, 0.8 W/cm²) for 5 minutes

Posterior capsule stretching (2 sets × 3 repetitions, 30-second holds)

Active and active-assisted range of motion exercises for elevation, internal rotation, external rotation, and pendulum exercises.

Treatment will be administered three times per week for four weeks. This intervention represents standard physiotherapy care for adhesive capsulitis.
Other: Conventional Physiotherapy
Standard physiotherapy including hot packs, ultrasound, posterior capsule stretching, and active/assisted range-of-motion exercises. Three sessions per week for four weeks.
Experimental: Mulligan Technique with Scapular Mobilization

Participants in this group will receive the Mulligan mobilization technique for shoulder elevation, internal and external rotation, combined with scapular mobilization.

Each session will include three sets of ten repetitions with a two-minute rest between sets.

Treatment sessions will occur three times per week for four weeks.
Other: Mulligan Technique with Scapular Mobilization
Participants in this group will receive the Mulligan mobilization technique for shoulder elevation, internal rotation, and external rotation combined with scapular mobilization. Each session will include three sets of ten repetitions with a two-minute rest between sets. Treatment sessions will be conducted three times per week for four weeks. The intervention aims to improve shoulder joint mobility, reduce pain, and enhance scapulohumeral rhythm.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Change in Shoulder Range of Motion (Flexion, Internal Rotation, External Rotation, and Abduction)
Time Frame: Baseline and at 4 weeks post-intervention
Shoulder joint range of motion (flexion, internal rotation, external rotation, and abduction) will be assessed using a digital goniometer. Each movement will be measured three times, and the mean value will be used for analysis.
Baseline and at 4 weeks post-intervention
Change in Shoulder Pain and Disability (SPADI Score)
Time Frame: Baseline and at 4 weeks post-intervention
Pain and functional disability will be assessed using the Shoulder Pain and Disability Index (SPADI). The SPADI includes 13 items: a 5-item pain subscale and an 8-item disability subscale. Each item is scored on a 0-10 scale, with higher scores indicating greater pain and disability.
Baseline and at 4 weeks post-intervention
Change in Scapulohumeral Rhythm
Time Frame: Baseline and at 4 weeks post-intervention
Scapulohumeral rhythm will be evaluated using a tape measurement method during shoulder elevation to assess the coordination between scapular and humeral motion.
Baseline and at 4 weeks post-intervention

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Deraya University

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Estimated)

February 1, 2026

Primary Completion (Estimated)

July 1, 2027

Study Completion (Estimated)

August 1, 2027

Study Registration Dates

First Submitted

January 13, 2026

First Submitted That Met QC Criteria

January 13, 2026

First Posted (Actual)

January 21, 2026

Study Record Updates

Last Update Posted (Actual)

January 28, 2026

Last Update Submitted That Met QC Criteria

January 27, 2026

Last Verified

January 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • Shoulder Adhesive Capsulitis

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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