Physiotherapy research international : the journal for researchers and clinicians in physical therapy · 2026
The Added Value of Neural Mobilization Techniques to Proprioceptive Neuromuscular Facilitation in Patients With Adhesive Capsulitis: Randomized Controlled Trial.
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Hegazy MMA, Alrawaili SM, El Negamy TE, Rizk FM
Аннотация
BACKGROUND AND PURPOSE: Although neural mobilization techniques (NMTs) and proprioceptive neuromuscular facilitation (PNF) are well-known therapeutic techniques among physical therapists, evidence regarding the additional benefit of combining these approaches in the management of adhesive capsulitis (AC) remains limited. This study was established to determine the effectiveness of combined NMTs and PNF techniques on pain intensity, functional disability and passive ROM of the shoulder joint in patients with AC.
METHODS: Fifty-six patients with AC of both genders were randomly assigned to two groups of equal size. The experimental group received combined slider median nerve NMTs, PNF and conventional physical therapy, while the control group received PNF and the same conventional physical therapy, three sessions per week for 6 weeks. Patients were evaluated for pain intensity, functional disability and passive ROM of the shoulder joint at baseline and after the 6th week.
RESULTS: After adjusting for baseline values using ANCOVA, the experimental group demonstrated significantly greater improvements across all outcomes. The adjusted between-group differences (95% CI) were: VAS (0-10 scale) - 0.88 (-1.24, -0.52; p < 0.001, η2 = 0.313); SPADI -5.69 (-9.83, -1.55; p = 0.008, η2 = 0.125); abduction 14.08° (11.22, 16.94; p < 0.001, η2 = 0.647); external rotation 6.71° (5.26, 8.16; p < 0.001, η2 = 0.619); and internal rotation 1.83° (0.94, 2.72; p < 0.001, η2 = 0.244). When evaluated against established MCID thresholds, the 14.08° improvement in shoulder abduction was the only outcome that approached the established MCID and exceeded measurement error, indicating a possible clinically meaningful benefit. Conversely, changes in pain and disability did not reach their respective MCID thresholds and should therefore be interpreted cautiously, with confirmation in larger studies warranted.
DISCUSSION: The combination of NMTs with PNF and conventional physical therapy resulted in statistically significant short-term improvements in pain, disability, and passive shoulder ROM. However, the between-group difference in pain and disability did not reach the reported MCID limits, and shoulder abduction had the most potential therapeutic value. Consequently, the results indicate that NMTs may provide additional advantages, especially for shoulder mobility, but do not show a clinically significant effect on other outcomes. Larger trials with longer follow-up are necessary to corroborate these findings.
TRIAL REGISTRATION: NCT06664437.
METHODS: Fifty-six patients with AC of both genders were randomly assigned to two groups of equal size. The experimental group received combined slider median nerve NMTs, PNF and conventional physical therapy, while the control group received PNF and the same conventional physical therapy, three sessions per week for 6 weeks. Patients were evaluated for pain intensity, functional disability and passive ROM of the shoulder joint at baseline and after the 6th week.
RESULTS: After adjusting for baseline values using ANCOVA, the experimental group demonstrated significantly greater improvements across all outcomes. The adjusted between-group differences (95% CI) were: VAS (0-10 scale) - 0.88 (-1.24, -0.52; p < 0.001, η2 = 0.313); SPADI -5.69 (-9.83, -1.55; p = 0.008, η2 = 0.125); abduction 14.08° (11.22, 16.94; p < 0.001, η2 = 0.647); external rotation 6.71° (5.26, 8.16; p < 0.001, η2 = 0.619); and internal rotation 1.83° (0.94, 2.72; p < 0.001, η2 = 0.244). When evaluated against established MCID thresholds, the 14.08° improvement in shoulder abduction was the only outcome that approached the established MCID and exceeded measurement error, indicating a possible clinically meaningful benefit. Conversely, changes in pain and disability did not reach their respective MCID thresholds and should therefore be interpreted cautiously, with confirmation in larger studies warranted.
DISCUSSION: The combination of NMTs with PNF and conventional physical therapy resulted in statistically significant short-term improvements in pain, disability, and passive shoulder ROM. However, the between-group difference in pain and disability did not reach the reported MCID limits, and shoulder abduction had the most potential therapeutic value. Consequently, the results indicate that NMTs may provide additional advantages, especially for shoulder mobility, but do not show a clinically significant effect on other outcomes. Larger trials with longer follow-up are necessary to corroborate these findings.
TRIAL REGISTRATION: NCT06664437.