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Is Aggressive Stretching Effective for a Frozen Shoulder?

Should stretching or resistance training be prioritized for our patients? I stress ‘prioritized’ as it is never one or the other. There is no reason a trainer or physio cannot implement both stretching and resistance training into a training program. Studies often limit treatment groups to one or the other to test potential differences in effects. When translating research to practical application, we rarely use the exact protocol, limiting our variables the way a study might. Rather, we integrate the information along with other research, our clinical experience and expertise, and the patient's or client's values and goals.

Many people with adhesive capsulitis achieve good outcomes within conservative care (within a 2-year window), however, up to 40% have functional and mobility deficits at 3 years and 15% have a permanent disability. To combat the high prevalence of poor outcomes, high-intensity mechanical stretch therapy (HIS) has been implemented in some trials. The goal of HIS is to increase the total volume of the maximal total end range time. The hydraulic devices allow patients to replicate stretches applied by physical therapists in their homes.

This study (PMID: 36175903) was a retrospective design, assessing the outcomes of patients who were prescribed HIS. Patients were given the device if they plateaued in their rehabilitation and received at least 4 weeks of care. Patients were treated for a variety of shoulder conditions, not strictly adhesive capsulitis, but they all had range of motion concerns. The patients were instructed to use the device 3 times a day. Each session was 10 minutes of stretching the maximum tolerable stretch followed by 10 minutes of rest and a second 10-minute stretch.

The study included 1871 patients who were prescribed the device for an average of 69 days. On average, patients improved external rotation by 29.9°, abduction by 40.5° degrees, forward flexion by 30.3°, and internal rotation by 15.2°. Improvements were greatest for patients with the lowest starting measurements. Strength and muscle mass were not assessed, but given the results of the Warnecke studies, it would not surprise me if those measures improved. Regardless, this is another study that demonstrates aggressive stretching over multiple weeks can yield substantial improvement in mobility.


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