Current evidence on physical therapy in patients with adhesive capsulitis: what are we missing?

Filip Struyf, Mira Meeus

Adhesive capsulitis is, in most cases, a self-limiting condition of poorly understood etiology that results in shoulder pain and large mobility deficits. The socio-economic burden will increase as with continuous aging of our population. In addition, both prevalence and incidence figures of adhesive capsulitis are increasing. No literature overview solely focuses on the physiotherapeutic options in patients with adhesive capsulitis and their scientific evidence. Moreover, although some physiotherapeutic interventions show evidence regarding reducing pain or increasing mobility, there is little evidence to suggest that the disease prognosis is affected and this raises the need for new, innovative research in the area of adhesive capsulitis and its treatment. By presenting its current evidence, we hope to retrieve several gaps in the present management of adhesive capsulitis by physiotherapists and provide us with new insights for improving the physiotherapists' policy in treating adhesive capsulitis patients, e.g., continuously increasing nociceptive impulse activity, as in early stages of adhesive capsulitis, could lead to peripheral and subsequently long-lasting central sensitization, as well as to an increased activity of the sympathetic nervous system. But up to now the involvement of central sensitization in adhesive capsulitis has not been studied yet and remains speculative. Finally, when selecting a physical treatment method for adhesive capsulitis, it is extremely important to consider the patient's symptoms, stage of the condition, and recognition of different patterns of motion loss. Guidelines for clinical assessment will be presented in this scoping review.