Influence Of Adding Mulligan Mobilization to Low Level Laser Therapy in Treatment of Patients with Shoulder Adhesive Capsulitis: A Double Blinded, Randomized Controlled Trial

Abstract

Purpose: To investigate the influence of adding Mulligan mobilization with movement (MWM) to low level laser therapy (LLLT) on pain intensity, shoulder range of motion (ROM), functional outcomes, and sleep quality in patients with shoulder adhesive capsulitis (AC).
Methods: Sixty-four patients with AC were randomly assigned into two groups: study group (n=32) and control group (n=32). A total of nine treatment sessions were administered to both groups, three times weekly on alternate days for 3 weeks. Patients in the study group received MWM combined with LLLT applied to the affected shoulder in addition to a standardized therapeutic exercise program, while participants in the control group received LLLT alone along with the same standardized therapeutic exercise program. The primary outcome variable was pain intensity assessed using the Visual Analog Scale (VAS). Secondary outcome measures included shoulder ROM (flexion, abduction, and external rotation) assessed using a standard goniometer, shoulder pain and disability assessed using the Shoulder Pain and Disability Index (SPADI), and sleep quality evaluated using the Pittsburgh Sleep Quality Index (PSQI). Measurements were obtained before and after the 3-week intervention period.
Results: After the 3-week intervention, both groups demonstrated significant improvements in all outcome measures compared with baseline values (p < 0.05). Nevertheless, the study group exhibited significantly greater improvements than the control group across all outcome measures, with between-group comparisons revealing large effect sizes favoring the study group for pain reduction, functional improvement, and sleep quality enhancement.
Conclusion: The combination of MWM with LLLT and therapeutic exercises was more effective than LLLT alone with therapeutic exercises in reducing pain and disability, improving shoulder ROM, and enhancing sleep quality in patients with AC.