Current evidence on physical therapy in patients with adhesive capsulitis: what are we missing?
In adhesive capsulitis, the stage of the disorder, i.e. tissue irritability and the pattern of motion loss, determines the focus of therapy. Four phases are commonly distinguished in the course of the disease: 1) the inflammatory phase; 2) the freezing phase, which is characterized by progressive motion losses and pain at night; 3) the frozen phase: stabilization of movement restrictions and a reduction in pain levels; and 4) the thawing phase, in which symptoms start to resolve.
While the majority of symptoms is initially caused by synovial inflammation and associated processes – such as fibrosis, chondrogenesis of the joint capsule and hyperresponsiveness of receptors of somatosensory neurons –, in later stages, the link between biomedical problems and experienced pain becomes less clear, as the local inflammatory response may trigger a cascade of physiological mechanisms leading to the development of central sensitization.
It is therefore important that therapists, apart from the level of tissue irritability, also take into account the possibility of central sensitization when selecting their interventions, especially in later stages of the disorder. > From: Struyf & Meeus, Clin Rheumatol (2013) (Epub ahead of print). All rights reserved to Clinical Rheumatology.