Cervical and Thoracic Mobility Training in Patients With Adhesive Capsulitis

February 25, 2026 updated by: Eda AKBAŞ, Zonguldak Bulent Ecevit University

The Effect of Cervical and Thoracic Mobility Training on Posture, Shoulder Pain, Range of Motion, and Shoulder Functionality in Patients With Adhesive Capsulitis

The aim of this study is to investigate the effect of cervical and thoracic mobilization training on posture, shoulder pain, joint range of motion and shoulder function in patients with adhesive capsulitis.

Study Overview

Status

Not yet recruiting

Conditions

Intervention / Treatment

Detailed Description

Adhesive capsulitis is a musculoskeletal disorder characterized by pain, stiffness, and a significant reduction in joint range of motion (ROM) in the shoulder joint, severely limiting daily living activities and functional capacity. The stiffness observed in the muscles and ligaments around the shoulder, especially after immobilization, leads to increased pain and restricted joint range of motion in the shoulder. All these pathological processes create a functional limitation cycle in the shoulder joint.

Postural imbalances and hypomobility occurring in the cervical and thoracic spine regions have a significant effect on the shoulder joint. The cervical and thoracic spine regions directly affect the biomechanics of the shoulder joint. Functional disorders in these regions cause decreased shoulder range of motion, irregular muscle activation, and increased pain. Postural disorders, particularly increased thoracic kyphosis and cervical protraction, negatively affect glenohumeral joint movements by altering the alignment of the shoulder girdle. These biomechanical abnormalities alter the normal position of the scapula, cause imbalance in muscle activation, and lead to functional impairment in the long term. When cervical alignment abnormalities are combined with thoracic hypomobility, the scapulothoracic rhythm is further disrupted, leading to increased shoulder pain.

Recent clinical studies have shown that thoracic mobility exercises are effective in treating adhesive capsulitis. Joint mobility exercises activate proprioceptive receptors, supporting pain modulation in the central nervous system and normalizing muscle activation patterns. Some studies have reported that adding thoracic mobility exercises to conventional physical therapy programs resulted in greater pain reduction, increased joint range of motion, and functional improvement compared to groups receiving physical therapy alone. These findings demonstrate that thoracic mobility exercises have both local and systemic effects.

According to relationship between the shoulder and thoracic spine, dysfunction in one anatomical region can lead to pain or restricted movement in a distant region. In this context, it is important to include not only the shoulder joint but also the thoracic and cervical spine in the treatment process for adhesive capsulitis. This ensures functional integrity, balances muscle activation, and accelerates the healing process.

Sensory inputs from the cervical spine play a role in head position and the synchronized functioning of the scapular muscles. In cases of cervical hypomobility, these proprioceptive inputs decrease, scapular stability is compromised, and postural control weakens. Therefore, cervical mobility exercises are important for supporting proprioceptive functions, correcting postural alignment, and restoring coordination of the scapular muscles. In conclusion, the current literature shows that cervical and thoracic mobility exercises are effective in reducing pain, increasing joint range of motion, correcting posture, and improving functional capacity in individuals with adhesive capsulitis.

However, the limited number of studies directly examining the effects of combined exercises targeting these two regions highlights the importance of randomized controlled trials in this area.

Study Type

Interventional

Enrollment (Estimated)

40

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 Contact Backup

Study Locations

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
  • Older Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • Diagnosis of unilateral adhesive capsulitis
  • Being between the ages of 20 and 70

Exclusion Criteria:

  • Presence of glenohumeral joint osteoarthritis, dislocation, subluxation, fracture, tumor
  • Rotator cuff injury
  • Diagnosis of radiculopathy, rheumatological or neurological disease
  • Presence of Thoracic Outlet Syndrome
  • History of surgery on the affected upper extremity
  • Any mental problem that would prevent compliance with tests and exercises

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: Control Group
This group will undergo a program that includes posture exercises, wand exercises, Codman exercises, finger ladder exercises, and shoulder wheel exercises.
Other: Convantional rehabilitation
This group will have convantional rehabilitation exercises.
Experimental: Intervention Group
This group will undergo a program that includes posture exercises, wand exercises, Codman exercises, finger ladder exercises, and shoulder wheel exercises and cervical and thoracic mobilization exercises in three sessions per week.
Other: Cervical and Thoracic Mobilization Exercises
This group will have convantional exercises, cervical mobilization and thoracic mobilization.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Digital Goniometer Evaluation
Time Frame: 3 weeks
Shoulder range of motion will be evaluated via digital goniometer. Flexion, extension, internal rotation and external rotation ranges will be recorded in degrees.
3 weeks

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Craniovertebral Angle Measurement
Time Frame: 3 weeks
To assess head posture, craniovertebral angle measurement will be performed. A device with the relevant software installed will be used for the measurement. The angle will be measured for both the symptomatic and asymptomatic sides. Results will be recorded in degrees.
3 weeks
Scapular Tilt
Time Frame: 3 weeks
The distance between the acromion and the bed will be measured while the shoulders are relaxed and retracted on supine position. The results will be recorded in centimeters.
3 weeks
Lateral Scapular Slide Test
Time Frame: 3 weeks
This test is performed to determine the position of the scapula in the 0°, 45°, and 90° abduction positions of the shoulder. It is performed by determining the distance of the lower angle of the scapula from the corresponding thoracic spinal protuberance in the horizontal plane. All measurements will repeated 3 times and the results will be recorded in centimeters.
3 weeks
Scapular Location Test
Time Frame: 3 weeks
This test is performed to determine scapular elevation and rotation. Measurement points are marked by palpating the spinous process at the level of the medial end of the scapular spine, the medial end of the scapular spine, the lateral end of the scapular spine, the spinous process of the vertebra at the level of the lower end of the scapula, the lower end of the scapula, and the T12 spinous process. Using a tape measure, the distance between the spinous process of the vertebra at the same level as the medial end of the scapular spine and the spinous process at the level of the distal end of the scapula and the distance between the spinous process at the level of the distal end of the scapula and the spinous process of T12 will be measured and recorded in centimeters.
3 weeks
Cervical and Thoracic Posture Assessment
Time Frame: 3 weeks
The flexicurve tool will be used during the evaluation. Results will be recorded using millimeter measurement paper.
3 weeks
Disabilities of the Arm, Shoulder and Hand Questionnare (DASH)
Time Frame: 3 weeks
The DASH scale is a patient-reported questionnaire used to assess upper extremity function. The scale consists of 30 items scored from 1 to 5. When at least 27 items are completed, the responses to all items are summed to calculate the score. An algorithm is used to adjust for missing data, and the results are expressed as a standardized total score ranging from 0 to 100. This 30-item scale assesses upper extremity function, including pain and activities of daily living.
3 weeks
Shoulder Pain and Disability Index (SPADI)
Time Frame: 3 weeks
It was developed to assess the degree of shoulder pain and discomfort experienced by patients while performing daily living activities. The scale consists of a total of 13 items; 5 of these are pain-related, while 8 are disability-related. Each item is scored numerically from 0 to 10. The pain scale consists of 5 questions and is scored from 0 for "no pain" to 10 for "the most severe pain imaginable." The disability scale consists of 8 questions and is scored from 0 "no limitations" to 10 "unable to do." The total SPADI score is calculated by taking the percentage average of the pain and disability subscales. This score indicates the degree of the patient's shoulder pain and functional limitations in daily living activities.
3 weeks
Visual Analog Scale (VAS)
Time Frame: 3 weeks
The Visual Analog Scale (VAS) will be used to evaluate pain for rest, activity and night periods. The data will be recorded in centimeters.On this scale, which is assessed by marking a line 10 centimetres long, the value "0" represents no pain, while the value "10" represents the most severe pain. As the score increases, the pain aggravates.
3 weeks

Collaborators and Investigators

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

Sponsor

Zonguldak Bulent Ecevit University

Investigators

  • Principal Investigator: Merve DEMİRCİ, MD, Zonguldak Atatürk State Hospital
  • Study Chair: Eda AKBAŞ, PhD, Zonguldak Bülent Ecevit University
  • Study Chair: Öznur GÜNEY, MSc, Zonguldak Bülent Ecevit University

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)

April 1, 2026

Primary Completion (Estimated)

July 1, 2026

Study Completion (Estimated)

August 1, 2026

Study Registration Dates

First Submitted

February 20, 2026

First Submitted That Met QC Criteria

February 20, 2026

First Posted (Actual)

February 25, 2026

Study Record Updates

Last Update Posted (Actual)

February 27, 2026

Last Update Submitted That Met QC Criteria

February 25, 2026

Last Verified

February 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • BEUN-AKBAS-4

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

UNDECIDED

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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