Efficacy of Adding Neural Mobilization to Joint Mobilization in Patients With Adhesive Capsulitis

Patients were in supine lying position during the whole treatment. The techniques were performed in a rhythmic way, with 2 seconds of glide distraction and then a 2-second break. Each technique was done for 2 minutes \[36\]. Posterior gliding was performed by maintaining lateral humeral distraction with the glenohumeral in abduction range and the scapula stabilized. Then the therapist applied posterior glide in an oscillating manner. For inferior gliding, with the scapula stabilized, the therapist maintained lateral humeral distraction while applying inferior glide in the resting position of the glenohumeral joint. Patients had 3 sessions of joint mobilization per week for 6 weeks.

Patients also in this group remained in supine lying position. Median nerve mobilization was performed by placing the scapula in a depressed position with one hand while placing the elbow in 90° flexion, forearm in supination, and wrist and fingers in extension with the other hand. Then, the therapist passively abducted the shoulder into 90- 100° and available external rotation ROM of the arm. Then from this position, the therapist extended the elbow with or without contra lateral side bending of the neck (tensioner or slider technique, respectively). Patients performed 30 repetitions of slider median nerve mobilization by performing elbow extension and wrist extension, with the neck placed in ipsilateral side bending or performing elbow flexion and wrist flexion with the neck placed in contralateral side bending. \[35\]. Tensioner technique was performed by applying simultaneous elbow extension with contralateral side bending of the neck and hold for 15 sec and relax for 10 sec .