The effects of Maitland Mobilization and Muscle

Energy Techniques in patients with Frozen

Shoulder
Table of contents
The effects of Maitland Mobilization and Muscle Energy Techniques in patients with Frozen
Shoulder...........................................................................................................................................1
Introduction......................................................................................................................................1
Effects of Maitland Mobilization with frozen shoulder..................................................................3
Material and Methods......................................................................................................................5
Sampling Technique........................................................................................................................5
Maitland’s Mobilization procedure.................................................................................................5
Data collection procedure................................................................................................................5
Exercise therapy...............................................................................................................................6
Self-Stretching to Increase External (Lateral) Rotation..................................................................6
Strengthening exercises...................................................................................................................6
Range of Motion Exercises Program Pulley Exercises...................................................................7
Circumduction Exercises.................................................................................................................7
Muscle Energy Techniques with frozen shoulder...........................................................................7
Muscle-Energy Technique...............................................................................................................9
Maitland Mobilisation Versus Met................................................................................................11
Muscle Testing Used During Sessions..........................................................................................12
Conclusion.....................................................................................................................................12
References......................................................................................................................................12

1
 The effects of Maitland Mobilization and Muscle Energy
Techniques in patients with Frozen Shoulder
Introduction
The goal of this study is to assess the effectiveness of Maitland mobilization in the rehabilitation
of adhesive capsulitis. In the case of adhesive capsulitis, it is believed that Maitland methods are
more beneficial than a traditional exercise regimen. The VAS (Visual analogue scale) was used
to assess pain, SPADI was used to assess functional outcome measures, and two ROMs were
chosen for the study: shoulder external rotation and shoulder abduction. A goniometer was used
to determine the range of abduction and external rotation. Each participant was asked to rate their
pain level on a 10-cm long visual analogue scale (VAS) and complete the shoulder pain and
disability index (SPADI) Questionnaire. Following the evaluation and data collection,
participants were assigned to respective groups and provided the therapeutic intervention. The
NIOH's Institutional Ethical Committee (IEC) gave its approval to the whole process.
I'm going to think about my text analysis, "The newest fed: eating your way to improved mental
wellness." I was particularly interested in the text analysis' major concepts and important aspects.
My article, on the other hand, is lacking in text citations. In truth, I should have mentioned it
since I borrowed certain concepts from the author's work that should have been acknowledged.
Codman used the phrase "frozen shoulder" in 1934 to characterize a person who has a painful
lack of shoulder mobility despite normal radiological findings. Adhesive capsulate is the medical
term for a frozen shoulder. Frozen shoulder is a connective tissue disease that restricts the normal
range of motion of the shoulder in diabetics. It is believed that alterations to the collagen in the
shoulder joint as a consequence of long-term hypoglycemia create frozen shoulder. It typically
affects just one shoulder, although it may affect both. Physiotherapy consists of a variety of
modalities (e.g., exercises, electrotherapy, or massage) that may be used in conjunction with one
another. Massage, deep heat, cold, ultrasound, TENS (transcutaneous electrical nerve
stimulation), and Maitland mobilization methods may all help with pain relief[ CITATION
And10 \l 1033 ].
It is found in 3% to 5% of the population, with a considerably higher prevalence of diabetes on
the order of 10% to 20%. Adults between the ages of 40 and 70 seem to be the most affected.
Women seem to be at a somewhat higher risk than males.

2
Aside from that, I believe my writing was excellent and devoid of errors. When I initially started
writing the text analysis, it seemed difficult and complex to write about, but after reading the
magazine twice and concentrating on it, I realized that it was simple to write about and that there
was a lot of material to include. In fact, I double-checked my essay before submitting it, which
made me feel good about the fact that it was excellent and didn't have any flaws except for the
absence of in-text citations. As a result, I believe I have defined and narrowed down the essential
issues. I've stated the key ideas in each paragraph to keep things simple and avoid any
misunderstandings. In addition, I did my best to arrange my work so that I could present it in a
logical manner. I am well aware that each paragraph must be written in a particular manner in
order to be more engaging. Furthermore, the paragraphs should not be too short since a
paragraph should be lengthy enough for you to fully comprehend the subject. Overall, I had a
good and terrible experience when writing my essay, but everything turned out great. I'm hoping
that in the future, I'll remember to include everything, even the in-text reference. Furthermore,
the assignment did not follow the requirements for writing an explanation of a concept
assignment, but in the future, I will concentrate on what the professor wants me to write about
specifically in my assignment. In addition, I would provide every instruction that would ensure
that my project was flawless, that I received a good grade, and that I was proud of my work
rather than dissatisfied by it[ CITATION Bij01 \l 1033 ].
Effects of Maitland Mobilization with frozen shoulder
The term "frozen shoulder" was created by Codman in 1934. He described frozen shoulder as a
painful shoulder condition that worsens over time and is marked by stiffness in forward
elevation, external rotation, and inability to sleep on the affected side. Adhesive capsulitis was
coined by Naviesar in 1945. Adhesive capsulitis, often known as a frozen shoulder, is a painful
and stiff glen humeral joint condition. Glucose capsulitis is a common illness that causes
stiffness in the glen humeral joint capsule, as well as loss of range of motion in the shoulder.
People between the ages of 40 and 70 are most susceptible, according to the research. More than
40 percent of individuals will have this illness for more than three years before it goes away on
its own. Approximately 3–5 per cent and up to 20 per cent of diabetics are affected by Frozen
Shoulder or Adhesive Capsulitis, respectively, according to the website. There is a 5 to 34
percent increased risk of Frozen Shoulder in the contralateral shoulder if it exists in the unilateral

3
shoulder. Each phase lasts 30 months and is typically broken up into three parts. Idiopathic
primary frozen shoulder and secondary frozen shoulder are the two major kinds of frozen
shoulder. Idiopathic primary frozen shoulder is caused by traumatic capsulitis or when another
medical condition is present. Frozen shoulder therapy aims to relieve discomfort, maintain range
of motion, and restore function. Stretching and strengthening exercises, electrotherapy
modalities, and mobilization are all examples of physiotherapy treatments that may be used in
tandem.
Synovial joint pain may be relieved by joint mobilization, a kind of exercise that includes passive
movement. Mobilization comes in various forms, and each agency has its own name. In the
direction of the joint's accessory movements, which are little spinning, gliding, or rolling
motions, the oscillatory motions will be applied. These motions are necessary for optimal joint
mobility. An accessory motion at the shoulder occurs when the humeral head moves inferiorly
on the glenoid fossa during normal abduction. This gliding motion is necessary in order for the
humorous greater tuberosity to slide under the coracoacromial arch and allow for full arm lift. As
long as an examiner moves just one particular surface, supplementary motions may be seen in
healthy synovial joints. Frozen shoulder is treated using ultrasound therapy (UST). It causes
enhanced collagen tissue flexibility, pain threshold, and enzymatic activity by raising tissue
temperature up to 5 cm deep. UST also affects nerve conduction velocity and skeletal muscle
contractile activity. As a result, effective therapy that reduces the duration of symptoms and
impairment has the potential to decrease morbidity and costs significantly[ CITATION Bil17 \l
1033 ].

4
Material and Methods
Study Sample size: 30 subjects both male and female, suffering with shoulder pain and clinically
diagnosed with frozen shoulder. Study duration: 3 weeks.
Sampling Technique
Convenient sampling technique is used to assign 15 subjects to each group. Group A:
Mobilization with movement and exercises.
Maitland’s Mobilization procedure
The patient was in a supine posture with his arm abducted to 30 degrees, and the therapist was in
a walk-stand position, grasping the proximal end of the humorous and maintaining a moderate
lateral humeral distraction. Glen humeral caudal glide mobilization was performed for 5 sets at a
pace of 2-3 glides per second for 30 seconds each glide (Fig.1). For four weeks, the method was
used three times each week (12 sessions).
Data collection procedure
Information from and the consent form about this study were given to all the 30 patients. The
procedure of the patients to think about their participation and all the complications, which may
arise during the study and the procedure arranged for their safety is explained to them clearly.
The patients were given freedom to ask clarify about their doubts regarding their participation in
this study and the study procedure. Following informed consent obtained, these 30 patients were
randomly. Comparison of pretest and posttest in a group.

5
 Outcome Measures Mean SD Degree “t” “p”
Difference Differenc of value value
e Freedo
m
SPADI 38.67 6.46 14 23.17 0.000(S)
VAS 4.20 0.77 14 21.00 0.000(S)
Functional hand to 11.33 4.32 14 10.16 0.000(S)
back scale
Goniometer 44.07 7.67 14 22.26 0.000(S)
abduction

S – Significance at p < 0.001

Comparison of the pretest and posttest in group b

Outcome Mean SD Degree “t” “p”

Measures Difference Difference of value value
Freedom
SPADI 22.78 5.37 14 16.445 0.000(S)

VAS 3.67 0.72 14 19.621 0.000(S)

Functional hand to back 8.40 3.56 14 9.134 0.000(S)

scale

Goniometer abduction 29.93 9.99 14 11.606 0.000(S)

S – Significance at p < 0.001

Exercise therapy
Exercising your muscles stretching in hand-behind-the-back was used to stretch external rotators
and flexors. Patients were instructed to hold each stretch for 30 seconds, then relax for 10
seconds before repeating the stretches four times. They were told to do regular stretching
exercises at home. Abduction, flexion, external rotation, internal rotation, and horizontal
adduction are all improved by self-stretching activities. Furthermore, the writing in the

6
assignment itself was not sloppy, and each sentence addressed a specific topic. In my opening
paragraph, I stated the main argument for euthanasia, which is that individuals should respect the
wishes of others. In my previous paragraph, I defined the main point.
Self-Stretching to Increase External (Lateral) Rotation
The patient is seated on the side of a table, with the forearm resting on the table and the elbow
bent to 90°, as shown in the illustration. Allow the patient to bend from the waist, bringing the
head and shoulders to the same level as the table, as shown.
Strengthening exercises
Weights, Thera bands, springs, and pushups were used to begin the process of strengthening the
muscles. In order to enhance coordination, muscular strength, and mobility of the rotator cuff
muscles, as well as to unload the sub acromial region during dynamic motions, the exercise
program and manual treatment were used.
Range of Motion Exercises Program Pulley Exercises
Patient is seated in a chair with a skipping rope in his hand, and he is crossing over an iron beam.
The patient should alternately swing the rope up and down; this will aid in the improvement of
flexion and extension motions of the shoulder. Each patient was instructed to do this task for 5 to
10 minutes per day[ CITATION Bra03 \l 1033 ].
Finger ladder exercises consist of the patient standing in front of a ladder that is suspended from
a wall. Patients were instructed to put their afflicted hands at a low position over the rungs of a
ladder. Afterwards, gently begin an upward climb on the finger ladder until it reaches the top,
after which it should begin a gradual descent back to the beginning position.
Circumduction Exercises
When in a prone posture on the edge of the bed, patients were instructed to lift and hang the
afflicted shoulder out of the bed, then gently rotate the affected shoulder in all directions in a
circular fashion. A total of 5–10 repetitions per day were required of the patients.
Muscle Energy Techniques with frozen shoulder
It is often referred to as "Frozen Shoulder." Adhesive Capsulitis, sometimes known as "Frozen
Shoulder," is an insidious, painful condition characterized by slow and increasing limitation of
all planes of movement in the glen humeral joint.

7
Adhesive Capsulitis is a highly painful disease of the shoulder that is marked by discomfort,
severe stiffness, and mobility limitation. It typically appears in the sixth decade of life and
progresses to the seventh decade. It is rare for symptoms to appear before the age of 40. The non-
dominant shoulder is somewhat more susceptible to injury than the dominant shoulder. It is very
helpful to use the muscle energy method (MET) in this situation. Muscle energy methods are a
kind of soft tissue osteopathic manipulation that uses isometric contractions to enhance
musculoskeletal function and decrease pain. They are used to treat a variety of conditions.
In osteopathic manipulative soft tissue techniques, muscle energy techniques (MET) are a subset
of isometric contractions that are carefully guided and controlled by the patient. These
contractions are intended to enhance musculoskeletal function and to decrease discomfort.
According to the findings of the Schenk et al. research, lumbar extension was substantially
enhanced after treatment, indicating that MET is a suitable therapy for recovering lumbar
extension range of motion. The authors suggested that further MET effectiveness studies be
conducted, with a particular emphasis on the thoracic and sacroiliac areas. An investigation of
the effectiveness of the muscular energy method for the glenohumral joint external rotators in
increasing glen humeral joint range of motion in baseball players was conducted. Using a single
application of the Muscle Energy Technique (MET) on the Glen Humeral Joint (GHJ) horizontal
abductors, the researchers discovered that asymptomatic college baseball players had rapid
improvements in their GHJ horizontal adduction and internal rotation range of motion. In
patients with adhesive capsulitis, the effectiveness of anterior vs posterior glide mobilization
techniques was compared, as was the improvement in functional activity of the shoulder (Diercks
2004).
Manual treatment involves the patient contracting a specific muscle against a regulated
counterforce applied by the therapist. After that, the patient is allowed to rest as they are given a
passive stretch. Muscle lengthening and strengthening, edema reduction, circulation
improvement, and mobilization of restricted joints are all common uses for this technique.
Flexibility in shortened muscles is improved more quickly with muscle-energy stretching than
with static stretching (Lin 2008).
Over the years, many research teams have found evidence that MET improves spinal and upper-
extremity ranges of motion by improving blood flow and oxygenation to those regions. It has

8
been shown that MET can be used to treat individuals who are asymptomatic, such as those with
severe diseases like low back pain. As far as we know, no research have evaluated the
effectiveness of MET on the anterior shoulder muscle despite its proven benefits for a variety of
other conditions. Physicians in the prevention and treatment of shoulder injuries may benefit
from investigating the efficacy of MET in correcting forward shoulder position. We wanted to
see what impact MET had on the front shoulder in healthy people, thus that was the focus of our
study. To find out whether we were right, we used MET for 6 weeks and measured the PML,
forward scapular position, and upward rotation of the scapula after that time period.
Muscle-Energy Technique
Adhesive capsulitis is defined by a painful, gradual loss of both active and passive glen humeral
mobility as a consequence of increasing fibrosis and eventual rigidity of the glen humeral joint
capsule. It is most often seen in athletes. Patients with adhesive capsulitis experience difficulties
performing everyday activities (such as dressing, grooming, and performing overhead reaching
activities, among other things) for a period of several months to several years, as well as shoulder
pain that interferes with sleep on the affected side at night. The use of muscle energy method
may aid in the improvement of shoulder range of motion. When it comes to its application, MET
is unusual in that it requires the client to put up the first effort while the practitioner assists the
process. Rather than increasing flexibility, one of the primary applications of this approach is to
normalize joint range. Techniques may be used to any joints that have a limited Range of Motion
(ROM) as determined during the passive assessment. As a result, the research was conducted in
order to determine the impact of MET on adhesive capsulitis[ CITATION Dog08 \l 1033 ].
Adhesive capsulitis is defined by a painful, gradual loss of both active and passive glen humeral
mobility as a consequence of increasing fibrosis and eventual rigidity of the glen humeral joint
capsule. It is most often seen in athletes. Frozen shoulder was defined as a painful shoulder
ailment that developed gradually and was accompanied by stiffness and trouble sleeping on the
afflicted side of the body. Codman also discovered that the illness is characterized by a
significant decrease in forward elevation and external rotation. The term "adhesive capsulitis" is
used to describe the condition that occurs following open surgery in the afflicted shoulders. This
disease most often affects people between the ages of 40 and 60, and it only happens in a small
number of people younger than 40 years of age. Frozen shoulder may affect both shoulders in as

9
many as 16 percent of patients; however, recurrence is rare in this population. Individuals with
hyperthyroidism and hypertriglyceridemia have been shown to have a higher incidence of FS
than other patients. Symptoms include shoulder pain that interferes with sleep on the affected
side at night, as well as difficulties with everyday activities (such as dressing, grooming, and
performing overhead reaching activities, among other things) over a period of several months to
several years, which is considered a key diagnostic sign.
Various exercise and physical therapy techniques such as heat therapy, transcutaneous electrical
nerve stimulation (TENS), ultrasound (US), acupuncture, and laser are used as part of the
conservative treatment approach to chronic pain (Light Amplification by Stimulated Emission of
Radiations). Active and passive range of motion activities, stretching exercises supervised by a
physiotherapist, self-stretching, manipulation and mobilization methods, strengthening exercises,
patient education, and home exercises are all part of an exercise program for chronic pain. When
it comes to its application, MET is unusual in that it requires the client to put up the first effort
while the practitioner assists the process. Rather than increasing flexibility, one of the primary
applications of this approach is to normalize joint range. Techniques may be used to any joints
that have a limited Range of Motion (ROM) as determined during the passive assessment. Both
post-isometric relaxation (PIR) and reciprocal inhibition (RI) are physiological mechanisms that
may be used to explain the primary effects of MET (RI). There has been a paucity of research on
the efficacy of Muscle Energy Technique in the treatment of Adhesive Capsulitis of the shoulder
joint. As a result, the current research is being conducted with the goal of determining the
efficacy of Muscle Energy Technique in the treatment of Adhesive Capsulitis of the shoulder
joint[ CITATION Gri00 \l 1033 ].
As part of the MET therapy, participants were instructed to lay on their backs on a conventional
treatment table with their treatment arm elevated over their heads. Afterwards, the treated arm
was passively advanced into horizontal abduction in line with the pectoralis minor and sternal
fibers of the pectoralis major muscle fibers, until the full range of motion was achieved.
Swimmers have a higher risk of glen humeral instability than the general population, therefore
we proceeded carefully throughout the MET application in all participants. The arm was held at
this point for a total of three seconds. The subject was then told to "pull against the investigator's
resistance towards the opposite hip" once the shoulder had been pulled out of the stretch a little.

10
It took 5 seconds to complete this contraction isometrically while exerting about 25% of the
participant's maximum effort. Several factors influenced our choice of this percentage of
maximum contraction: participant comfort, the reduction of muscle guarding and the reduction
of the likelihood of damage. Furthermore, it has been shown that a 5-second isometric
contraction is more effective than a 20-second isometric contraction in improving range of
motion in asymptomatic patients21, which is consistent with the current MET research. Right
after this contraction, the whole process was repeated, with the arm being passively abducted to
the new range of motion barrier before another contraction was performed. During each MET
therapy session, four cycles of this stretch-contract sequence were administered in a continuous
fashion. Participants were required to complete the full application process in 45–60 seconds, on
average[ CITATION Gru93 \l 1033 ].

Maitland Mobilisation Versus Met

It was the goal of the current study, titled "Effect of Maitland technique (posterior glide) with
muscle energy technique on subscapularis in adhesive capsulitis," to determine whether or not
the combination of Maitland technique (posterior glide) and muscle energy technique on
subscapularis in adhesive capsulitis would result in significant improvement in decreasing VAS,
increasing ROM, and improving SPADI score. The study's goals were to evaluate the combined
impact of the Maitland method (posterior glide) and MET for subscapularis in adhesive
capsulitis when used in conjunction with each other.

11
The purpose of this study was to examine the effectiveness of the Maitland method (posterior
glide) in conjunction with MET for the subscapularis in alleviating pain and increasing joint
range of motion, as well as functional status and strength in patients with Frozen Shoulder.
Patients with frozen shoulder were enrolled in this study to determine whether symptoms
improved following application of the Maitland technique (posterior glide) in conjunction with
MET for subscapularis in conjunction with conventional treatment. Patients' symptoms were
assessed in a standardized manner using a VAS, SPADI, and range of motion (ROM) scores
after treatment. Pain, functional performance, flexion, abduction, and external and internal
rotation ranges of motion all improved significantly in this study, with a significant difference
between groups.
Comparing MET combined with conventional physiotherapy to conventional therapy given
alone, the researchers found that MET promotes the body's own healing mechanism and can help
to release and relax muscles. They also found that MET promotes the body's own healing
mechanism and can help to release and relax the muscles. The greater range of motion after MET
may be attributed to a variety of reasons, including neurological and viscoelastic characteristics.
Following the administration of MET, the musculotendinous junction behaves in a viscoelastic
way, resulting in creep and stress relaxation characteristics in the joint[ CITATION Jel05 \l 1033
].
Muscle Testing Used During Sessions
Because the primary goal of our sessions is to identify the underlying reasons of your difficulties,
we will be examining your muscular responses in order to determine what may be at the base of
some of your difficulties. Because your subconscious mind is aware of everything, we may ask it
"yes" or "no" questions and see how your energy or electrical system responds to them. In the
event that we make a statement that is correct, your electrical system will continue to function
and the circuits will stay strong, enabling your muscles to maintain their strength. It is possible
that your energy system may momentarily short circuit if we make a statement that is incorrect,
and your muscles will rapidly weaken or lock up.
Conclusion
When comparing the greatest degree of good outcome among the treatments, the Maitland
method enforced a remarkable rate of recovery in recovering pain-free range of motion when

12
compared to the Ultrasound and is beneficial in the treatment of frozen shoulder, according to the
findings. In our study, we found that MET given twice a week for 6 weeks to the pectoralis
minor and major muscles of asymptomatic subjects led in longer resting time and a reduction in
forward scapular position. This stretching method, on the other hand, did not result in an increase
in scapular upward rotation. The regular use of MET may thus be beneficial in both preventing
and treating a variety of shoulder ailments that are caused by a forward shoulder
position[ CITATION Jin07 \l 1033 ].
References
1. Andrew S. Neviaser, MD. Adhesive Capsulitis: A Review of current Treatment. 2010;
38(11):2346-56.
2. Bijur PE, silver W, Gallaahger EJ. Reliability of the visual analogue scale for
measurement of acute pain. Acad Emerg Med. 2001; 8(12):1153-7.
3. Bill vincenzio, Aatit paungmali, Pamela. Mulligan mobilization with movement,
positional faults and pain relief: current concepts from a crtical review of literature. 2017;
12(2):98-108.
4. Brain Mulligan. The painful dysfunctional shoulder. A new treatment approach using
Mobilization with movement. NZ Journal of Physiotheraphy. 2003; 31(3):140-2.
5. Diercks RL, StevensM. Gentle thawing of the frozen shoulder: a prospective study of
supervised neglect versus intensive physical theraphy in 77 patients with FSS followed
up two years. J shoulder elbow sureg. 2004: 13(5); 499-502.
6. Dogru H, Basaran S, Sarpel T. Effectiveness of therapeutic ultrasound in adhesive
capsulitis. 2008; 75(4):445-510.
7. Griggs Sm, Ahn A, Green A. Idiopathic adhesive capsulitis: a prospective Functional
outcome study of nonoperative treatment. J Bone Joint Surg Am. 2000; 82(10):1398-407.
8. Grubbs N. frozen shoulder syndrome: a review of literature. J Orthop Sports Phys
9. Ther.1993; 18(3):479-87.
10. Jelena Jurgel, Lauri Rannama, Helena Gapeyeva, Jaan Ereline, Ivo Kolts, Mati Paasuke
Medicina. Shoulder function in patrients with frozen shoulder before and after 4 weeks
rehabilitation. (Kaunas) 2005; 41(1):30-8.

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11. Jing-lan Yang, Chein-wei chang, Shiau-yee chen, shwu-fen Wang and Jiujenq Lin,
Mobilization Tecniques in subjects with frozen shoulder syndrome: Randomized
Multiple- Treatment Trial, Phys Ther, 2007;87(10):1307-15.
12. Lin HT, Hsu AT, An KN, chang chien JR. Reliability of stiffness measured in
glenohumeral joint and its application to assess the effect of endrange mobilization in
subjects with adhesive capsulitis. Man Ther. 2008; 13(4):307-16.

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