TITLE OF THE TOPIC : COMPARITIVE EFFECT OF PROPRIOCEPTIVE NEUROMUSCULAR FACILITATION STRETCHING AND CAPSULAR STRETCHING ON RANGE OF MOTION AND FUNCTIONAL ACTIVITES IN FROZEN SHOULDER

                        Frozen shoulder, or adhesive capsulitis, describes the common shoulder condition characterized by painful and limited active and passive range of motion (ROM). Frozen shoulder is reported to affect 2% to 5% of the general population increasing to 10% to 38% in patients with diabetes and thyroid disease. Individuals with primary frozen shoulder are commonly between 40 and 65 years old, and the incidence appears higher in females than males.The occurrence of frozen shoulder in 1 shoulder increases the risk of contralateral shoulder involvement by 5% to 34%, and simultaneous bilateral shoulder involvement occurs as often as 14% of the time. Based on the etiology adhesive capsulitis can be classified as primary or secondary. Primary adhesive capsulitis is an idiopathic condition, where the exact underlying cause is unknown. Adhesive capsulitis associated with a known underlying disorder is considered to be secondary. adhesive capsulitis is described  in four stages, Stage I: Preadhesive stage in which lining of the joint (synovium) is inflamed depicts little or no restriction of glenohumeral motion, Stage II (Freezing stage): Acute adhesive synovitis with proliferative synovitis and scar formation of the underlying capsule, Stage III (Frozen stage): Marked stiffness due to scar formation in the capsule with loss of axillary fold, Stage IV (Thawing stage): Chronic stage presenting with fully mature adhesions with notable restriction of ROM. In Stages II and III of frozen shoulder, ROM is significantly restricted. Restriction of movement is in the capsular pattern, that is, external rotation is most limited, followed by limitation in abduction and internal rotation respectively.

Research question:

                        Is there a significant difference in the effectiveness between proprioceptive neuromuscular facilitation stretching and capsular stretching in improving the Range of motion and functional activities in individulas with frozen shoulder?

Hypothesis:

           Null hypothesis:

                 There is no significant difference in the effectiveness between proprioceptive neuromuscular facilitation stretching and capsular stretching in improving the Range of motion and functional activities in individuals with frozen shoulder.

           Alternate hypothesis:

                  There is significant difference in the effectiveness between proprioceptive neuromuscular facilitation stretching and capsular stretching in improving the Range of motion and functional activities in individuals with frozen shoulder.

OBJECTIVE OF THE STUDY: To compare the effectiveness between proprioceptive neuromuscular facilitation  stretching and capsular stretching in improving the Range of motion and functional activities in frozen shoulder.

PROCEDURE: The subjects falling within the inclusion criteria will be included in the study and then they will be randomly assigned into two groups. Three outcome measures will be taken for the individuals that is both pre and post treatment outcome measures by using goniometry for range of motion, visual analogue scale for pain and shoulder pain and disability index for functional limitation.

 GROUP-A:- The individuals in Group –A will be receiving first moist heat therapy  for  10 to 20 minutess followed by proprioceptive neuromuscular facilitation stretching in supine lying to improve flexion, abduction and external rotation of the glenohumeral joint in D2 proprioceptive neuromuscular facilitation stretching in Flexion and Extension pattern. The stretch will be given for 8 repetitions per set consisting of 2 sets per session with one single session per day for 10 days in two weeks with each repetition or stretch maintained for  a duration of 5–10 seconds. This will be followed by Active assisted range of motion exercises, Pendulum exercises and Finger ladder exercises.

GROUP-B:- The individuals in Group­-B will also be receiving first the moist heat therapy for 10 to 20 minutes followed by capsular stretching in four directions (Passive forward elevation, external rotation, Horizontal adduction and internal rotation) the stretching will be maintained for 10 seconds within pain limits, with 10–15 repetitions. The sets of exercises should be performed twice a day for ten days in two weeks. This will be followed by Active assisted range of motion exercises, Pendulum exercises and Finger ladder exercises.