Adhesive capsulitisis a common shoulder condition that causes pain and gradually reduces shoulder movement.1 It is estimated that between 2% and 5% of the general population develop adhesive capsulitis, a condition that affects both men and women equally.People between the ages of 40 and 60 account for the majority of instances.Adhesive capsulitis is idiopathic since its precise frequency and prevalence are unknown; nevertheless, diabetes mellitus and thyroid dysfunction are two disorders that are traditionally linked to it.2 A range of treatments were used to help patients with adhesive capsulitis regain mobility and reduce pain. The goal was to reduce the long-term need for medication and surgery for adhesive capsulitis in the long run. Physiotherapy is the most extensively utilized treatment approach for adhesive capsulitis, which involves heat therapy, physical exercises, and joint mobilization techniques.3 The adhesive capsulitisare typically categorized into three distinct phases. The painful stage (Stage 1), marked by pain, typically persists for 2-9 months. In the adhesive stage (Stage 2) Pain gradually goes away, but there is noticeable stiffness., lasting for 4-12 months. In the recovery stage (stage 3), the range of motion (ROM) improves, and the pain subsides.

Pain associated with shoulder movement is commonly alleviated with standard anti-inflammatory medications; however, in more severe cases, corticosteroids may be required. Many patients with adhesive capsulitis experience difficulty sleeping and are unable to lie on the affected side because of pain. Limited range of motion (ROM) and weakened shoulder muscles are primary contributors to the physical disability experienced by these individuals. Various treatment options have been explored to manage this debilitating condition, including physical therapy, corticosteroid injections, and manual therapy techniques.4, 5 Among these, Mulligan’s Mobilization with Movement (MWM) and Kaltenborn posterior mobilization are two manual therapeutic approaches that have shown promise in reducing pain and improving shoulder mobility. Mulligan’s MWM involves applying a mobilization technique combined with active movement to improve joint function and reduce pain. Conversely, Kaltenborn’s posterior mobilization focuses on restoring joint mobility through sustained, passive mobilization of the shoulder joint. Despite their widespread use, few studies have directly compared the effectiveness of these two techniques in handling shoulder pain and disability in patients with adhesive capsulitis. This study aimed to evaluate and compare the effects of Mulligan’s MWM and Kaltenborn posterior mobilization helps people with adhesive capsulitis with their shoulder discomfort and diability.

The study involved 40 individuals, both men and women, ages 35 to 70, and was carried out using a quasi-experimental methodology, who had been diagnosed with adhesive capsulitisat the Krupanidhi Physiotherapy Centre, Bangalore. The ethical clearance was acquiredfrom the Institutional Ethics Committee (IEC). All the participants provided informed consent. Participants were excluded if they had undergone previous anaesthesia-assisted manipulation, diabetes, neurological issues, shoulder fractures, skin conditions, shoulder lesions, sensory impairments, or had experienced recent shoulder dislocations or surgeries. Additionally, those with open wounds in the shoulder area or those unable to understand the Visual Analog Scale (VAS) and the Shoulder Pain and Disability Index (SPADI) were not included in the study.

The participants were randomly assigned to two groups, Group A and Group B, with 20 participants in each group. Group A received Keltenborn’s posterior mobilization, while Group B received Mulligan’s mobilization with movement. Data were analyzed by comparing pre- and post-treatment scores using paired and independent 't' tests. For Group A, participants were positioned supine and relaxed, and then received Keltenborn’s posterior mobilization, which was combined with ultrasound therapy (3 MHz) and conventional treatments.For three weeks, this treatment was given in 10-minute sessions five days a week. In Group B, participants were instructed to sit comfortably, and Mulligan’s mobilization technique, combined with ultrasound therapy (1 MHz) and conventional treatments, was applied. This involved three sets of 10 repetitions with 1-minute breaks between each set, five days a week, over three weeks. The effectiveness of the treatments was assessed using the VAS and SPADI scales, both at the beginning and end of the 21-day treatment period.

The purpose of the current study was to evaluate how well Kaltenborn's posterior mobilization and Mulligan's mobilization with movement reduced pain and disability in patients suffering from adhesive capsulitis. Table 1 provides a within-group examination of pain and disability scores using the VAS and SPADI scales for both treatment groups. Group A, which received Kaltenborn's posterior mobilization, showed a significant reduction in both pain and disability scores. The pre-test scores were VAS = 5.6 ± 1.23 and SPADI = 66.3 ± 9.91, while the post-test scores were VAS = 3.6 ± 0.87, and SPADI = 43.3 ± 10.12, with a p-value of < 0.001. Similarly, Group B, which received Mulligan's mobilization with movement, also exhibited a significant reduction in pain and disability. The pre-test scores for Group B were VAS = 5.8 ± 1.15 and SPADI = 66.5 ± 11.14, and the post-test scores were VAS = 2.05 ± 1.09 and SPADI = 28.4 ± 10.17, with a p-value < 0.001. These results show that in patients with adhesive capsulitis, both mobilization strategies were successful in lowering discomfort and enhancing shoulder function (Table 1).

Table 2 presents the between-group analysis of the VAS and SPADI index scores for both groups using an independent t-test. The mean VAS score for Group A was 1.95 ± 1.50, while for Group B it was 3.75 ± 1.44. Similarly, the mean SPADI index for Group A was 22.9 ± 11.7, and for Group B it was 38.1 ± 11.7.Both groups showed significant reductions in pain and shoulder disability, but Group B demonstrated a more pronounced improvement than Group A. These results suggest that while both treatment techniques were effective, Mulligan's mobilization with movement (Group B) led to a more substantial reduction in both pain and disability. In contrast to the values that are tabulated, the calculated 't' values were found to be significant, with a p-value of < 0.05. This indicates that the differences observed between the groups were statistically significant, further supporting the effectiveness of both treatment techniques in reducing pain and disability in individuals with adhesive capsulitis (Table 2).

In this study, the efficacy of Kaltenborn's posterior mobilization and Mulligan's mobilization with movement (MWM) in lowering pain and disability in patients with adhesive capsulitis was compared. The results showed that both therapeutic techniques were effective in reducing discomfortand improving shoulder function, consistent with the existing literature that supports the efficacy of mobilization methods in managing adhesive capsulitis. However, variations in the speed and extent of improvement have been noted across different studies, emphasizing the need for a more thorough understanding of these treatments.

Kaltenborn’s mobilization has been shown in multiple randomized controlled trials (RCTs) to significantly reduce pain and improve range of motion (ROM) within 2 to 6 weeks.6 However, when compared to other techniques such as muscle energy techniques, Kaltenborn was found to be less effective in improving ROM.7 Another study suggested that while Kaltenborn was effective, muscle energy techniques were superior in reducing pain and disability.5 On the other hand, Mulligan’s mobilization has demonstrated significant improvements in pain, ROM, and functional activity over 2 to 3 months, with some cases showing immediate relief.6 A comparative study found Mulligan’s mobilization more effective than positional release therapy in improving shoulder ROM and reducing functional disability. 8

Both techniques in the present study were effective, but Mulligan’s mobilization with movement seemed to offer quicker and more substantial improvements in ROM and functional activity when compared to Kaltenborn, as evidenced by the significant reduction in SPADI scores in the current study.8 The choice of technique could depend on the specific goals of treatment and whether immediate pain relief or long-term functional improvement is prioritized. Recent studies have suggested that combining mobilization techniques with therapeutic exercises enhances outcomes, particularly in the earlier stages of adhesive capsulitis.8 However, other methods, such as scapular mobilization and manual stretching, have shown similar effectiveness. 9

The findings of the current study showed that Group A, which received Kaltenborn’s posterior mobilization, had significantly lower pain and disability scores than Group B, which received Mulligan’s mobilisation with movement (p < 0.05). This aligns with the existing literature that supports the efficacy of different mobilization methods in treating adhesive capsulitis. In particular, Mulligan’s mobilization with movement provided greater improvements in pain relief and functional capacity than Kaltenborn’s mobilization, confirming the results of systematic reviews and integrative studies. 10, 11

Further comparative insights from the literature indicate that while Kaltenborn’s mobilization is effective, Mulligan’s technique has shown greater benefits in pain relief and functional improvement.12 Combining mobilization techniques with therapeutic exercises has been found to enhance treatment outcomes, particularly in the earlier stages of adhesive capsulitis.9 In addition, other studies comparing scapular mobilization and manual stretching techniques found no significant differences in effectiveness, suggesting that various mobilization methods can be beneficial in improving shoulder function.10 Nonetheless, individual patient factors, such as the disease stage and comorbidities, remain crucial in determining the success of treatment. 11

In patients with adhesive capsulitis, this study demonstrated that Mulligan's mobilization with movement, in conjunction with traditional therapy and ultrasound, resulted in statistically and clinically significant improvements in pain reduction and function.

These findings are consistent with other studies, such as those by Deepali Rathod et al., who found Mulligan’s mobilization more efficient than Kaltenborn’s in improving shoulder function in individuals with adhesive capsulitis.13 Similarly, research by A. K. M. Rezwan et al. demonstrated that Kaltenborn mobilization was more effective than traditional physiotherapy treatments for adhesive capsulitis.3 Studies by Ujwal et al. and Walling et al. also support the effectiveness of Mulligan’s mobilization in enhancing ROM and alleviating pain in adhesive capsulitis patients.14, 15 The results of the present study align with these findings, confirming that Mulligan’s mobilization, in conjunction with conventional therapy, led to greater improvements in shoulder function and pain reduction.

Both Kaltenborn’s and Mulligan’s mobilization techniques are effective for managing adhesive capsulitis; nevertheless, Mulligan’s mobilization with movement demonstrated more significant improvements in pain reduction, ROM, and functional capacity. Despite the efficacy of both techniques, individual patient factors, including disease stage, symptom severity, and comorbidities, can significantly influence treatment outcomes.11 Future research should include a larger sample size and extended treatment periods to explore long-term outcomes and determine whether combining these techniques could optimize treatment efficacy for patients with adhesive capsulitis.

To sum up, both Mulligan's mobilization with movement and Kaltenborn's posterior mobilization proved efficient in lowering disability and painin individuals with adhesive capsulitis. However, Mulligan's technique hasshown notable gains in functional ability, range of motion, and pain reduction. These findings suggest that Mulligan's mobilization may offer a more favourable approach for managing adhesive capsulitis, although patient-specific factors should be considered when selecting the most appropriate treatment.