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Shoulder & Upper Limb

Physio Nexus Academy · Clinical Treatment Framework

Adhesive Capsulitis

Management is stage- and irritability-sensitive. Education, pain control, mobility and progressive strengthening are used without repeatedly provoking severe post-treatment flares.

Assess → classifyTreat → reassessLoad → progress

Clinical decision pathway

A structured plan, not a recipe

Clinician-led · Individualised
01

Understand

Screen safety, identify the likely clinical pattern and agree meaningful goals.

02

Select

Choose only interventions that match the patient's impairments and preferences.

03

Reassess

Repeat the same comparable sign or functional task after key interventions.

04

Progress

Build capacity and participation using measurable response, not session count.

Before choosing an intervention

Clinical reasoning

  1. 1Match treatment intensity to irritability. A very painful shoulder often needs gentle movement, not aggressive stretching.
  2. 2Expect recovery to be gradual. The goal is steady improvement in function and sleep, not forcing normal range in one session.
  3. 3Differentiate true capsular restriction from rotator-cuff pain, arthritis or neurological disease.

A practical starting sequence

First-session workflow

  1. 1Measure active/passive ROM, SPADI, night pain and functional reach.
  2. 2Identify whether pain or stiffness is the dominant problem.
  3. 3Teach gentle assisted ROM that does not create a prolonged flare.

Assessment & examination

  1. 1Capsular-pattern loss of active and passive ROM
  2. 2Pain irritability and sleep disturbance
  3. 3Strength as pain allows
  4. 4Screen cervical contribution
  5. 5Diabetes/thyroid history when relevant

Red flags & safety screen

  1. 1Trauma with suspected fracture
  2. 2Acute neurological loss
  3. 3Systemic illness
  4. 4Atypical severe unremitting pain

Indication · dosage · response

Manual therapy application

  1. 1High irritability: Grade I–II glenohumeral mobilization for pain modulation.
  2. 2Lower irritability/stiffness dominant: progress posterior/inferior/anterior glides with careful reassessment.
  3. 3Scapulothoracic mobilization can be added if it improves functional reach.

Adapt to irritability and capacity

Exercise prescription & dosage

  1. 1Pendulum or relaxed movement: 30–60 seconds × 2–3 bouts.
  2. 2Assisted flexion/external rotation: 5–10 slow reps, several times/day.
  3. 3Low-load stretching: 20–30 seconds × 3–5 reps when irritability allows.
  4. 4Later cuff/scapular strength: 2–3 sets × 8–15 reps.

Modalities & adjuncts

  1. 1Heat 10–15 minutes before mobility if helpful.
  2. 2TENS can be used short term for pain.

Progression & regression rules

  1. 1Increase stretch intensity only when post-treatment flare is small and short-lived.
  2. 2Progress from assisted to active motion, then resistance and overhead function.
  3. 3If progress is very limited with severe pain, coordinate medical options such as injection when appropriate.

Home programme

  1. 1Frequent gentle movement
  2. 2Avoid forcing into severe pain
  3. 3Sleep-position modification when useful

Outcome measures

  1. 1SPADI
  2. 2NPRS
  3. 3Shoulder ROM
  4. 4Patient-specific function

Common clinical mistakes

  1. 1Aggressive end-range mobilization in the painful stage.
  2. 2Forcing through severe pain because the shoulder is stiff.
  3. 3Neglecting strength as motion improves.
  4. 4Promising a rapid cure.

Patient education & self-management

  1. 1Explain the slow natural course in simple language.
  2. 2Encourage frequent gentle movement rather than rare aggressive stretching.
  3. 3Teach comfortable sleep positioning.

Referral & escalation

  1. 1Medical review for severe persistent pain, diagnostic uncertainty or consideration of injection/hydrodilatation/surgical options

Clinical use & safety note

This is an educational clinical framework, not an individual prescription or a substitute for diagnosis, medical assessment, local protocols or professional judgement. Exercise dose, manual techniques and adjuncts must be adapted to examination findings, irritability, comorbidities, precautions, patient goals and response. Obtain informed consent, work within training and scope, and refer when indicated. Do not apply every intervention listed to every patient.

The PNA treatment principle

The best plan is not the one with the most techniques. It is the one that identifies the patient's main problem, selects a defensible intervention, measures the response and steadily restores meaningful function.