Rajiv Gandhi University of Health Sciences, Karnataka,

Bangalore.

ANNEXURE-II

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1 Name of the Candidate

& Address

DHARITRI RAJBANGSHIC/O MR. BINOD KR. RAJBANGSHIBILI BHAWAN, PANDAV NAGARHOUSE #2, LANE #4GUWAHATI-780012ASSAM

2 Name of the Institution DAYANANDA SAGAR COLLEGE OF PHYSIOTHERAPY, BANGALORE

3 Course of study and subject MASTER OF PHYSIOTHERAPY (Physiotherapy in Musculoskeletal disorders & Sports physiotherapy)

4 Date of admission to course 15th June; 2012

5 TITLE OF THE TOPIC:

“COMBINED EFFECT OF ACTIVE RELEASE TECHNIQUE AND CAPSULAR STRETCH

IN TREATING PATIENTS WITH FROZEN SHOULDER”

6 Brief resume of the intended work:

6.1 INTRODUCTION

The shoulder is considered the most mobile joint in the human body.[1, 2] The synchronous motion of

the entire shoulder girdle working in concern with the spine provides tremendous mobility. Shoulder

rehabilitation specialists focus on restoring and maintaining normal range of motion at the shoulder

girdle.[3]

Adhesive capsulitis is characterised by insidious and progressive onset of pain and loss of active and

passive mobility of glenohumeral joint. The term adhesive capsulitis, periarthritis of shoulder are used

at times with a meaning synonymous with frozen shoulder. It was first described by Duplay in 1972

and named frozen shoulder by Codman in 1934[4] and thereafter Neviaser[5] noted that the pathology

of this condition was actually located in the capsule of the shoulder joint and therefore called it

‘adhesive capsulitis’. A stiff and painful shoulder is often casually labeled as a frozen shoulder. The

incidence of frozen shoulder has been estimated to be from 3-5% in general population with a

significant incidence amongst diabetics in order of 10-20%. It appears to be most common in adults

between the age group of 40-70yrs. Women are at a greater risk (4:1) and non-dominant arm is most

commonly affected. Idiopathic frozen shoulder is most commonly associated with diabetes mellitus.[6,7,8,9]

Adhesive capsulitis has been divided into two types:

i) Primary adhesive capsulitis which refers to idiopathic form of a painful and stiff shoulder.

ii) Secondary adhesive capsulitis indicated as a loss of motion resulting from many disposing

factors such as trauma, stroke, upper extremity fractures or surgery with mobilization [10,11]

Pain particularly in the first phase of adhesive capsulitis of the shoulder, i.e. -freezing phase often

keeps patients from performing activities of daily living. In the second phase, i.e. -frozen phase there

are restrictions in active motion which limit the patient in personal care, ADL, or occupational

activities. In the third phase, i.e.-thawing phase there is slow increase in the mobility, which leads to

full or almost full recovery. The first phase lasts for 2 1/2 -9 months, second phase for 4-12 months and

third phase for 5-26 months.[12,13,14,15]

Various physiotherapy approaches have been suggested for shoulder musculoskeletal disorders,

including manual therapy, electrotherapy, acupuncture and exercise therapy.[16]

Active Release Techniques (ART) is a new and highly successful non-invasive hands-on technique, It

is a patented state of the art soft tissue system/movement based massage technique method to address

problems in the soft tissues of the body, including the muscles, tendons, ligaments, fascia, and nerves.

Active Release Techniques treatment is a collection of soft tissue techniques for examination,

diagnosis, and treatment of soft tissue disorders. [17]

It is designed to identify and treat scar tissue adhesions that are interfering with the normal function

of the body. It allows the therapist to:

Break-up restrictive adhesions,

Restore normal sliding of the muscles tendons and nerves

Active Release separates, releases, and stretches the connective tissue adhesions, restores vascular

and lymphic circulation, and increases your range of motion, flexibility, and strength. One of the best

things about ART is it achieves results very quickly , especially when combined with other

conventional physical therapy treatments. Although each case is unique, and there are several factors

that will determine the length of time it will require to fully resolve a condition, we usually find a

significant improvement can be gained in just 5 – 8 treatments.[17]

In frozen shoulder the joint capsule tends to be contracted, thickened and closely adherent to the

humeral head contributing to limitation of movement.[18] In frozen shoulder limitation of external

rotation with the arm in abduction typically is associated with an antero-inferior capsular restriction

whereas limited internal rotation and cross body adduction are associated with posterior capsular

restriction. The capsular pattern is designated by a hard end feel at the end limitation of all 3 passive

movements in fixed proportions. Therefore stretching for anterior, inferior, and posterior shoulder

should be performed.[19]

The current study will try to find out whether Active Release Technique with capsular stretch will

yield better results in patients with frozen shoulder, along with the conventional treatment of

therapeutic ultrasound.

6.2 Need for the study :

Adhesive capsulitis or frozen shoulder is a common cause of shoulder pain and disability in the

general population. Patients generally complain of an inability to sleep on the affected side. Although

it is a self-limiting ailment, its rather long, restrictive and painful course forces the affected person to

seek treatment.

Frozen shoulder presents mainly with 2 characteristics: pain and contracture. All gross ranges of

motions are greatly decreased, and pain is felt in all directions. This tends to be due to scar tissue

build up that occurs from non-use. Restricted glenohumeral elevation and external rotation, together

with unremarkable radiographic findings, are also observed[20].Conservative management remains the

mainstay treatment of adhesive capsulitis. This includes therapeutic modalities, mobilization,

exercise, soft tissue therapy, chiropractic manipulation of the shoulder, non-steroidal anti-

inflammatory drugs, and steroid injections.

Active release technique is also one of the treatment options considered now a days by many health

practitioners for the treatment of frozen shoulder. Active release technique helps to break the

adhesions formed around the shoulder joint. It also releases and stretches the connective tissue around

the shoulder, restores vascular and lymphic circulation, and increases the range of motion. However,

none of the reviews have focused upon effect of Active release technique on Frozen shoulder. The

objective of this review is to evaluate the Effect of Active release technique on patients with frozen

shoulder or adhesive capsulitis.

Capsular stretching also causes significant reduction in pain and improvement in function in patients

with adhesive capsulitis.[21]

Many combination of treatments have been used in the past for the treatment of adhesive capsulitis

and they have been found to be effective.

But no studies have been done in the past to compare the combined effectiveness of Active release

technique along with capsular stretch in patients with Adhesive capsulitis and their effectiveness in

reducing pain, increasing joint mobility and functional activities.

6.3 Hypothesis:

Null hypothesis (H0): There will no significant difference in the results between Active release

technique and capsular stretch, and capsular stretch only in patients with frozen shoulder.

Experimental hypothesis (H1): There will be a significant difference in the results between Active

release technique and capsular stretch, and capsular stretch only in patients with frozen shoulder.

6.2 Review of Literature:

Outcome measures

Visual Analogue scale and goniometer

Boonstra,Anne M.;Schiphorst Preuper,Henrica R.;Reneman,Michiel F.(2008). Did a study to

determine the reliability and validity of the visual analogue scale for disability in patients with

chronic musculoskeletal pain and they concluded that reliability of the VAS for disability is moderate

to good and a strong correlation with the VAS for pain[22]

Mc Cormac HM, Horne DJ, Sheather S. (1998). In their study of critical review of clinical

application of visual analogue scale stated that visual analogue scale is established as valid and

reliable in range of clinical and research application[23]

Dan L Riddle, Jules M Rothstein, Robert L. Lamb (1987). Conducted a study. The purpose of the

study was to examine the intratester and intertester reliabilities for clinical goniometric measurements

of shoulder passive range of motion (PROM) using two different sizes of universal goniometers. The

results of the study shows that Goniometric PROM measurements for the shoulder appear to be

highly reliable when taken by the same physical therapist, regardless of the size of the goniometer

used. The degree of intertester reliability for these measurements appears to be range of motion

specific.[24]

Frozen Shoulder

Wong P L K, Tan H C A (2010). In their study they stated that of all the joints in the human body,

the shoulder has the greatest range of motion. This allows complex movements and functions to be

carried out, and is of vital importance to the activities of daily living and work. Any restriction or pain

that involves the joint puts a huge amount of strain on patients, especially those who are in their most

productive years of life. Frozen shoulder, a frequently encountered disorder of the shoulder, has been

well recognized since the early 1900s. Although benign, it has great impact on the quality of life of

patients. This article aims to provide an overview of the nature and the widely accepted management

of this condition based on other studies.[25]

Martin J. Kelley, Phillip W. Mcclure, Brain G, Leggin (2009). They conducted this study to

present an overview of the classification, etiology, pathology, examination, and plan of care for

frozen shoulder.[26]

Dias R, Cutts. S. (2005). Frozen Shoulder is characterized by pain and loss of motion or stiffness in

the shoulder. It affects about 2% of the general population. Frozen Shoulder most commonly affects

patients between the ages of 40 and 60 years, with no clear predisposition based on sex, arm

dominance or occupaction.[27]

Watson. E, Sumaband D (2001). Frozen Shoulder Syndrome is a condition of uncertain etiology

characterized by a progressive loss of both active and passive shoulder motion. Clinical Syndromes

include pain, a limited range of motion, and muscle weakness from disuse. The natural history is

uncertain. So many authors suggest that it is a more chronic disorder causing long-term disability.[28]

Sean M. Griggs MD; Anthony MD (2000). Frozen Shoulder, medically referred to as Adhesive

Capsulitis, the connective tissue surrounding the gleno-humeral joint of the shoulder, becomes

inflamed and stiff, a grows together with abnormal bands of tissue, called adhesions, greatly

restricting motion and causing chronic pain.[29]

Carolyn T. Wadsworth (1986). In this study he concluded that the widespread use of the label

"frozen shoulder" as a diagnosis for any stiff and painful shoulder condition has led to its becoming a

rather meaningless, catchall term. In addition to confounding both the lay public and health care

professionals, this indiscriminate labeling may prevent a patient from receiving appropriate treatment.

In this article, he defined frozen shoulder and reviewed its pathologic and etiologic factors,

epidemiology, natural history, and diagnosis. He presented this information in correlation with an

examination process to assist physical therapists in identifying suspected cases of frozen shoulder. He

also presented the current options for treatment, including physical therapy management with

physical agents and exercise.[30]

Intervention:

Therapeutic Ultrasound

Robertson VJ, Baker KG (2001). They performed a systematic review of randomized controlled

trials in which ultrasound was used to treat people in conditions like musculoskeletal injuries and soft

tissue lesions. Each trial was assigned to investigate the contributions of active and placebo

ultrasound to the patient’s outcome measured. Thirty-five randomized clinical trials were published.

10 of the 35 RCTS were judged to acceptable methods using criteria based on those developed by

Sackett et al. of these RCTS, the results of two trials suggested that therapeutic ultrasound is more

effective in treating some clinical problems than placebo ultrasound, and the results of 8 trial suggest

that it is not and concluded there is little evidence that active therapeutic ultrasound is more effective

than placebo ultrasound for treating people with pain /a range of musculoskeletal injuries/ or for

promoting soft tissue healing.[31]

Zancan A, Gialanella B, Luisa A, Della Marta ME, D'Alessandro G, Casale R (1993). The aim of

their study was the instrumental evaluation of ultrasonic therapy in patients with periarthiris of the

shoulder for their real effectiveness of the anti- inflammatory action of the ultrasound. Two groups of

subjects were studied, periarthritis versus normal patients. Results of their study demonstrate a real

influence of ultrasound therapy on periarthritis shoulder to improve the functional outcome.[32]

Hamer J, Kirk JA (1976). Conducted research on the effectiveness of ultrasound and ice on frozen

shoulder in a series of patients. Results showed that both of these methods can shorten the painful

stage of the condition and in conjunction with specific exercise hasten recovery of shoulder ROM.[33]

Active Release Technique:

Joel Hund (2009). This study provides an overview of literature in regards to common rotator cuff

disorders and how they affect shoulder range of motion. In his study he concluded that rotator cuff

disorders are one of the most common musculoskeletal conditions seen in populations over thirty

years old. Effective treatment of this region can be rendered from a conservative care perspective for

most patients. In this study he has mentioned that soft tissue treatment like Active release technique,

graston technique, can be performed on entire shoulder, neck and upper back to lengthen tissues,

break up adhesions or fibrous tissues that has formed as a result of impingement and lack of mobility.[34]

Andreo A. Spina;(2007). The study concluded that Active Release Techniques, or ART, is a soft

tissue treatment method that focuses on relieving tissue tension via the removal of fibrosis/adhesion

that develops in tissue that is overloaded with repetitive use. In this case of external coxa saltans, the

underlying cause of the condition was increased tissue tension leading to increased friction of the

proximal Iliotibial band (ITB) complex over the greater trochanter. Utilizing ART resulted in a

complete resolution of this athlete’s symptoms and may be a good treatment option for external coax

saltans.[35]

Guy Hains (2002). The purpose of this article is to review the most common etiologies of shoulder

pain, focusing on those conditions of a myofascial origin. In addition to a review of the literature, the

author draws upon his own clinical experience to describe a method to diagnose and manage, patients

with shoulder pain of myofascial origin using ischemic compression techniques. This hands-on

therapeutic approach conveys several benefits including: positive therapeutic outcomes; a favorable

safety profile and; it is minimally strenuous on the doctor and well tolerated by the patient. In this

study it has been stated that Active release technique is a new and a useful technique to treat

myofacial symptoms.[36]

Capsular Stretch:

M.A.Harrast, Anita G.Rao (2004). They have mentioned the use of a typical exercise program of

active and passive stretching with the goal of maintaining and regaining range of motion in frozen

shoulder. The basis of this program is four-quadrant stretching of shoulder joint capsule which

includes forward flexion, internal rotation, external rotation and cross-body adduction. These

exercises should be prescribed 4-5 times daily in the supine position in order to stabilize the scapula

and stretch the glenohumeral joint capsule. Stretching slightly past the point of pain is necessary to

make forward progression in range of motion. At the initiation of the exercise, application of heat can

be helpful to reduce pain and facilitate stretching. After stretching, ice application can help reduce

inflammation and irritation.[37]

James K. Mantone, Wayne Z. Burkhead Jr. & Joseph Noonan (2000). They have documented the

importance of stretching exercises for the anterior, posterior and inferior shoulder capsule as a part of

the motion programme to improve the joint range of motion in stiff shoulder.[38]

6.5 Objective of the study :

7

To find out the effectiveness of capsular stretch in reducing pain and increasing ROM in

frozen shoulder.

To find out the combined effectiveness of active release technique along with capsular stretch

in reducing pain and increasing ROM in frozen shoulder.

Materials and Methods:

7.1 Source of data :

Physiotherapy OPD clinic, Dayananda Sagar College of physiotherapy, Bangalore.

Sagar hospital, Jayanagar, Bangalore.

Sagar hospital, Banashankari, Bangalore.

7.2 Method of collection of data:

Population :- Subjects diagnosed with Frozen Shoulder

Setting :- Hospital & out–patient department

Sample design :- Convenience sampling

Sample size :- 50

Study design : - Experimental study with pre & post-test design.

Duration :- 6 months

7.3 Inclusion Criteria: Patient diagnosed with frozen shoulder.

Age group between 40-70 years.

Both males and females.

unilateral involvement.

Restriction of shoulder capsular movement and ROM.

Patient with mini mental score of, equal to or greater than 25

7.4 Exclusion Criteria: History of surgery on the particular shoulder.

Rotator cuff rupture.

Painful stiff shoulder after a serious trauma.

Fracture of the shoulder complex.

Presence of osteoarthritis, or signs of bony damage.

Inflammatory diseases such as rheumatoid arthritis.

Tendon calcification.

Patients with diabetes mellitus.

Patients who have undergone previous physiotherapy treatment.

7.5 Materials used: Couch/treatment table

Therapeutic ultrasound

Ultrasound gel

Cotton

Towel

Paper and pen

Hot pack

Measuring tools: Visual Analogue Scale (VAS).

Goniometer

7.6 Methodology

Intervention to be conducted on the participants:

Subjects who fulfill the inclusion and exclusion criteria will be randomly divided into two Groups by

simple random sampling, Group A and Group B. Informed consent will be taken from each of the

subjects prior to participation. Instructions will be given to the subjects about techniques performed.

This will be followed by Subjective as well as Objective assessment of the involved shoulder for

tenderness, temperature, swelling, pain and its intensity in terms of the Visual Analog Scale (VAS).

In addition to this functional assessment based on ROM will be carried out using universal

goniometer.

A total of 50, Group A (n=25) and Group B (n=25). Group A will receive active release technique

and capsular stretch along with therapeutic ultrasound and Group B will receive capsular stretch and

therapeutic ultrasound.

Before & after intervention pain assessment will be taken by Visual Analogue scale (VAS) every day.

Functional assessment will be taken by using goniometer.

Testing procedure :

GROUP A:

Will receive Active release technique and capsular stretch along with conventional therapy

(therapeutic ultrasound)

Capsular stretch: Subjects will first be applied with hot pack for 10 minutes before starting

the capsular stretches [39, 40]. After hot pack treatment will be followed by capsular stretching

for the anterior, inferior and posterior capsules of the shoulder. To stretch the anterior capsule

the subject will be positioned either in side lying with the affected arm upwards or in high

sitting and the shoulder and arms will be brought backwards into extension and this stretch

will be maintained for a minimum of 30 seconds and maximum duration up to the point of

pain experienced by the patient. Posterior capsule stretching will be performed with the

subject in supine position and therapist will perform cross body adduction. Antero- inferior

capsule will be stretched with the subject in supine position. To stretch the antero inferior

capsule the affected arm will be taken towards the extreme of attainable elevation and counter

pressure will be maintained at the patient’s sternum to prevent spinal extension. Each stress is

gentle but firm and will not be released until pain rather than discomfort is experienced.

Patients will receive capsular stretching of 5 repetitions per set, 5 sets per session, 1 session

per day for 5 days till 3 weeks.[41]

Active release technique: Position of the patient will be supine lying. The therapist will first

passively slightly abduct the supine patients humerus and will place the flat of his/her thumb

on the coracobrachialis, following it just before the coracoid process. At this point, the

therapist will slide off the tendon medially onto the anterior capsule. A firm tension will be

maintained on the capsule as the humerus will be slowly abducted and externally rotated. If no

spasm is created, the patient will actively abduct and externally rotate the shoulder while the

therapist will maintain the tension. Frequency is Alternate days for 3 weeks. [42]

Therapeutic ultrasound: The skin surface to be treated should be inspected; inflammatory

skin conditions should be avoided, and the nature of the treatment explained to the patient.

The patient should be in a comfortable position so that the area to be treated is accessible and

supported. The couplant should be applied to the skin surface. The treatment head is placed on

the skin before the output is turned on. The treatment head is moved continuously over the

surface while even pressure is maintained in order to iron out the irregularities in the sonic

field the emitting surface must be kept parallel to the skin surface. The dosage of ultrasound

must be decided upon area, depth and nature of the lesion. Frequency of 1 MHz, Intensity of

1.0 W/cm2, continuous mode, 8 minutes treatment time is to be given [43].

GROUP B:

Will receive Capsular stretch and conventional therapy (therapeutic ultrasound)

Capsular stretch: Subjects will first be applied with hot pack for 10 minutes before starting

the capsular stretches [39, 40]. After hot pack treatment will be followed by capsular stretching

for the anterior, inferior and posterior capsules of the shoulder. To stretch the anterior capsule

the subject will be positioned either in side lying with the affected arm upwards or in high

sitting and the shoulder and arms will be brought backwards into extension and this stretch

will be maintained for a minimum of 30 seconds and maximum duration up to the point of

pain experienced by the patient. Posterior capsule stretching will be performed with the

subject in supine position and therapist will perform cross body adduction. Antero- inferior

capsule will be stretched with the subject in supine position. To stretch the antero inferior

capsule the affected arm will be taken towards the extreme of attainable elevation and counter

pressure will be maintained at the patient’s sternum to prevent spinal extension. Each stress is

gentle but firm and will not be released until pain rather than discomfort is experienced.

Patients will receive capsular stretching of 5 repetitions per set, 5 sets per session, 1 session

per day for 5 days till 3 weeks.[41]

Therapeutic ultrasound: The skin surface to be treated should be inspected; inflammatory

skin conditions should be avoided, and the nature of the treatment explained to the patient.

The patient should be in a comfortable position so that the area to be treated is accessible and

supported. The couplant should be applied to the skin surface. The treatment head is placed on

the skin before the output is turned on. The treatment head is moved continuously over the

surface while even pressure is maintained in order to iron out the irregularities in the sonic

field the emitting surface must be kept parallel to the skin surface. The dosage of ultrasound

must be decided upon area, depth and nature of the lesion. Frequency of 1 MHz, Intensity of

1.0 W/cm2, continuous mode, 8 minutes treatment time is to be given [43].

Outcome Measures :

Visual Analogue Scale

Goniometer

Statistics:

Statistical analysis will be performed by using SPSS software for windows (version 17) & probability value (p value) will be set as 0.05

Descriptive statistics will be used to find out mean, standard deviation for demographic & outcome variable.

Paired t-test will be used to find out homogenecity for baseline & demographic & ratio

outcome variable within the group.

Unpaired t-test will be used to find out homogenecity for baseline & demographic & ratio outcome variable between the group.

Wilcoxon Signed Rank test will be used to find out the significant difference for ordinal scale within the groups.

Mann-Whitney U test will be used to find out the significant difference for ordinal scales between the groups.

Microsoft word, excel will be used to generate graphs & tables, etc.

8 List of References:

1. Norkin CC, Levangie PK. Joint structure and Function. A comprehensive analysis.

Philadelphia: F.A.Davis, 1992 second edition, chapter 8, pp. 255-310.

2. Frankal VH, Nordin M. Basic biomechanics of the skeletal system. Philadelphia: Lea and

Febiger, 1980 second edition, pp. 153-161.

3. Donatelli R. physical therapy of the shoulder .New York: Churchill Livingstone,1997.

4. Codman E. Rupture of the supraspinatus tendon and other lesions in or about the subacromial

bursa. In: The shoulder. Boston: Thomas Todd;1934:216-24.

5. Neviaser J. Adhesive capsulitis of the shoulder: a study of the pathological findings in

periarthritis of the shoulder. J Bone Joint Surg 1945;27:211-22.

6. Wiley AM,Arthoscopic appearance of frozen shoulder. Arthoscopy 1991;7:138-143.

7. Corrigan B, Maitland GD,Practical Orthopaedic Medicine London,United Kingdom:

Butterworths:1983.

8. Bertoft ES. Painful shoulder disorder from a physiotherapeutic view:a review of literature,

critical reviews in physical and rehabilitation medicine. 1991;11:229-277.

9. Bulgen DY,Binder AI,Hazleman BL, et al. Frozen shoulder:prospective clinical study with an

evaluation of three treatment regimes. Ann Rheu Dis 1984;43:353-360.

10. Mao CY,Jaw WC,Cheng HC. The Pathology of Frozen Shoulder.Journal of Bone and Joint

Surgery. 77:677-683.

11. Molie Beyer, Peter Bonetti. Frozen shoulder. Balliere’s clinical Rheumatology. 1989;3:551-

556.

12. Neviaser TJ. Intra-articular inflammatory diseaseof the shoulder. Instr Course Lect.

1989;38:199-204.

13. Neviaser TJ. Adhesive capsulitis. Orthop clin North Am. 1987;18:439-443

14. Bunker TD, Anthony PP. The pathology of frozen shoulder: a dupuytren like disease. J Bone

Joint Surg Br. 1995;77:677-683

15. Reeves B. The natural of the frozen shouldersyndrome. Scand J Rheumatol. 1975;4:193-196

16. The Effectiveness of Manual therapy in the management of musculoskeletal disorders of the

shoulder:a systematic review.Manual therapy (2009)463-474.

17. Warren I Hammer. Functional soft tissue Examination and treatment using manual

methods.2007 Third edition;713-728

18. J.H Cyriax and P.J Cyriax, Cyriax illustrated manual of orthopaedic medicine.1983, 2nd ed.

Butterworth and Heinneman.

19. Mark A. Harrast and Anita G Rao. The stiff shoulder Physical medicine and rehabilitation

clinics of North America 2004;15;557-573

20. Codman EA. The Shoulder: Rupture of the Supraspinatus Tendon and other Lesions in or

about the Subacromial Bursa. Boston: Thomas Todd Co, 1934.

21. Umit Bingol, Lale Altan. Photomedicine and laser surgery: Low Power Laser Treatment for

shoulder pain. 2005 October;23(5):459-464.

22. Boonsrta Anne M,Schiphorst preuper HR,Reneman MF.Reliability and validity of the visual

analogue scale for disability in patients with chronic musculoskeletal pain.Int J Rehabil:l

Res.2008;31(2):165-9.

23. Mc Cormac HM,Horne DJ,Sheather S.Clinical applications of visual analogue scale:A critical

review;phycol med.1998;18(4):1007-19.

24. Dan L Riddle,Jules M Rothstein and Robert L Lamb.Goniometric reliability in a clinical

setting.1987;67(5):673.

25. Wong P L K, Tan H C A, A review on frozen shoulder, Singapore Medical journal 2010;

51(9):694

26. Martin J. Kelley, Phillip W. Mcclure, Brain G, Leggin, Frozen Shoulder: Evidence and a

Proposed Model Guiding Rehabilitation journal of orthopaedic & sports physical therapy

2009 february volume 39 number 2

27. Dias R, Cutts. S. frozen Shoulder BMJ, dec 2005;331(7530): 1453-1456

28. Watson. E, Sumaband D, shoulder problems-A Guide to common disorders, Modern medicine

of Ireland 2001,31.2.

29. Sean M. Griggs MD; Anthony MD; Idiopathathic Adhesive Capsulitis. The journal of Bone

and Joint Surgery 2000,82:1398.

30. Carolyn T. Wadsworth. Frozen Shoulder. PHYS THER. 1986; 66:1878-1883.

31. Robertson VJ, Baker KG. A review of therapeutic ultrasound: effectiveness studies. Phys

Therapy. 2001 July;Vol 81: Number 7 :1339 –1350.

32. Zancan A, Gialanella B, Luisa A, Della Marta ME, D'Alessandro G, Casale R,

Telethermographic effects and a comparative clinical assessment of the treatment of shoulder

periarthritis using ultrasound, 1993 Jan-Jul; 15(1-4) :55-8.

33. Hamer J, Krik JA. Physiotherapy and frozen shoulder: a comparative trial of ice and ultrasonic

therapy. N Z Med J.1976 March 24; 83(560):191-2

34. Joel Hund, Effects of Rotator Cuff Disorder on Shoulder ROM, 2009 February, page 10

35. Andreo A. Spina: External coxa saltans (snapping hip) treated with active release techniques:

a case report. J Can Chiropr Assoc 2007; 51(1)23-29

36. Guy Hains, Chiropractic management of shoulder pain and dysfunction of myofascial origin

using ischemic compression techniques, JACC 2002; 46(3):192-200

37. Mark A. Harrast & Anita G. Rao. The stiff shoulder. Physical Medicine & Rehabilitation

journal of North America 2004; 15:557-573.

38. James K. Mantone, Wayne Z. Burkhead Jr. & Joseph Noonan Jr.. Non operative treatment of

rotator cuff tears. Orthopaedic Clinics of North America 2000; 31:295-311.

39. Warren CG, Lehmann JF, Koblanski JN.Heat and stretch procedures: an evaluation using rat

tail tendon. Arch Phys Med Rehabil. 1976 Mar;57(3): 122-6.

40. Sheila Kitchen, Sarah Bazin. Electrotherapy Evidence – Based Practise. 11 th Edition.

Elsevier:Churchill Livingstone; 2006. 211-230.

41. S. Brent Brotzman, Kevin E. Wilk; Clinical Orthopaedic Rehabilitation; shoulder injuries,

2003 second edition, chapter 3; second edition.

42. Warren I Hammer. Functional soft tissue Examination and treatment using manual methods.

2007 Third edition;713-728

43. John Low and Ann Reed; Therapeutic Ultrasound and Laser Therapy Electrotherapy

Explained principles and practice; 1990 August, Second edition . pages 148- 329.

9 Signature of Candidate

10 Remarks of the Guide

11 Name and Designation of

11.1 Guide : Dr. Mathew Anand

11.2 Signature

11.3 Co-Guide : Dr. Sujoy Kumar

11.4 Signature

11.5Head of Department : Dr. Anil T. John

11.6Signature

12 12.1Remarks of the Chairman & Principal:

12.2Signature

DAYANANDA SAGAR COLLEGE OF PHYSIOTHERAPY

THE INSTITUTIONAL ETHICAL COMMITTEE

ETHICAL CLEARENCE CERTIFICATE

The Institutional Ethical Committee of Dayananda Sagar College of

Physiotherapy has reviewed the research proposal of Ms. DHARITRI

RAJBANGSHI, MPT student, Dayananda Sagar College of Physiotherapy,

Kumaraswamy layout, Bangalore –78, certificates that the research proposal is

ethically satisfactory.

Reference: Ethical guide lines for biomedical resource on human Council Of

Medical Research.

New Delhi- 2000

CHAIR PERSON SECRETARY

Basic medical scientists:

1)

2)