Current evidence on physical therapy in patients with adhesive capsulitis: what are we missing?

Adhesive capsulitis is, in the majority of cases, a self-limiting condition of with an etiology that is not well understood, which results in shoulder pain and large mobility deficits. The socio-economic burden will increase as with the ongoing aging of the population. In addition, both prevalence and incidence figures of adhesive capsulitis are rising. No literature overview solely focuses on the physiotherapeutic options in patients with adhesive capsulitis and their scientific evidence. Moreover, although some physiotherapeutic interventions exhibit evidence regarding reducing pain or increasing mobility, there is not much evidence to indicate that the disease prognosis is affected and this raises the need for new, innovative research in the area of adhesive capsulitis and its treatment. By presenting its current evidence, this study aims to retrieve several gaps in the present management of adhesive capsulitis by physiotherapists and provide us with new insights for improving the physiotherapists’ policy in treating adhesive capsulitis patients, e.g., continuously increasing nociceptive impulse activity, as in early stages of adhesive capsulitis, could lead to peripheral and subsequently long-lasting central sensitization, as well as to an increased activity of the sympathetic nervous system. But up to now the involvement of central sensitization in adhesive capsulitis has not been examined and remains speculative. Finally, when deciding on a physical treatment method for adhesive capsulitis, it is very important to consider the patient’s symptoms, stage of the condition, and recognition of different patterns of motion loss. Guidelines for clinical assessment will be presented in this scoping review.