Effectiveness of manual therapy for shoulder pain, range of motion, and function of patients with frozen shoulder

Abstract

Current guidelines for the physical therapy management of patients with primary frozen shoulder include patient education, activity modification, exercise, stretching, and manual therapy. Two systematic reviews of the effectiveness of manual therapy for frozen shoulder have been published since the publication of the Clinical Practice Guidelines. A qualitative analysis showed moderate evidence for joint mobilization, and a meta-analysis supported the effectiveness of mobilization with movement. In order to provide optimal physical therapy for patients with frozen shoulder in a clinical setting, there is a need to clarify the effectiveness of manual therapy. This paper summarizes the currently available evidence to answer the question, "Are there any manual therapies supported by systematic reviews and meta-analyses as a treatment for patients with primary frozen shoulder?" Among the 17 systematic review articles related to manual therapy for primary frozen shoulder published through October 2022, meta-analyses were conducted in 5. Based on the results of these meta-analyses, mobilization with movement and joint mobilization may be effective in reducing shoulder pain and improving range of motion for patients with primary frozen shoulder in the freezing or frozen phase. The applicability of manual therapy for patients in the inflammatory phase, the optimal dosage of manual therapy treatments (frequency and total duration), and the expected benefits when combined with exercise therapy remain unknown and are subjects for future research.