Eight weeks of manual therapy for frozen shoulder, with two sessions per week, proved effective among people with and without diabetes, according to recent research.

The study, “Manual therapy is an effective treatment for frozen shoulder in diabetics: An observational study,” involved 50 people with primary frozen shoulder, 12 of whom also had diabetes. These subjects ranged in age from 40 to 65 years, with an average age of about 52 years.

Researchers divided these participants into two groups. Group one included the 12 people with type II diabetes and frozen shoulder, and group two included the remaining 38 people with frozen shoulder alone.

Both groups underwent the same intervention process, which involved two sessions per week for eight weeks. These sessions consisted of manual therapy, cold application and exercises.

“The frozen shoulder in patients with diabetes mellitus is reported to be more persistent than an idiopathic frozen shoulder and is difficult to treat,” state the study’s authors. “The aim of this study was to compare the effects of manual therapy and exercise on frozen shoulder in patients with or without [diabetes].”

The main outcome measures for this study were range of motion, functional activity status, pain level and muscle strength. These measures were assessed before and after the eight-week intervention period.

Shoulder flexion, abduction, external rotation and internal rotation range of motion were evaluated by goniometry. The Constant-Murley score system was used to assess functional activity level, and a visual analog scale was used to determine pain levels during activity, at rest and at night. A hand-held dynamometer was used to measure muscle strength of shoulder flexion, abduction, external rotation and internal rotation.

As for the manual therapy sessions, a single practitioner with a decade of experience performed all the sessions and was blinded as to which subjects were diabetic. The manual therapy techniques used during each of the 16 sessions were scapular mobilization and posterior capsule stretching. These sessions also included cold application and a posterior capsule stretching exercise, among other exercises to address frozen shoulder.

Results of the research showed that range of motion, functional activity status, muscular strength and pain levels all improved among subjects in both groups by the end of the eight-week intervention period.

“This study showed that manual therapy is an effective approach of physiotherapy for rehabilitation in diabetic and nondiabetic patients with frozen shoulder,” state the study’s authors. “We did not find any adverse effect on progression of rehabilitation in diabetic patients.”

Authors: Irem Düzgün, Gül Baltaci and Özgür Ahmet Atay.

Sources: Department of Physiotherapy and Rehabilitation, Gazi University Faculty of Health Sciences, Ankara, Turkey; and the Department of Orthopedics and Traumatology, Medical Faculty of Hacettepe University, Ankara, Turkey. Originally published in 2012 in Joint Diseases and Related Surgery, 23(2), 94-99.

This research report ran in the print edition of MASSAGE Magazine‘s July 2013 issue.

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