THE INFLUENCE OF MOBILIZATION AND ISCHEMIC COMPRESSION ON PAIN AND DISABILITY IN ADHESIVE CAPSULITIS AND MYOFASCIAL PAIN SYNDROME

The purpose of the study: to investigate the effect of end-range mobilization and ischemic compression on pain and disability scores among patients with adhesive capsulitis of the shoulder joint and myofascial pain syndrome in the thoracic region. Materials and methods. Goniometry of the shoulder joint, assessment of pain at the end points of the range of motion and trigger points (when applying a pressure of 2.5 kg×cm-2), as well as the Shoulder Pain and Disability Index questionnaire were used before the intervention and after physical therapy. Physical therapy began after an examination and consultation with an orthopedic traumatologist. The majority of patients received 15 planned procedures of end-range mobilization performed by a physical therapist within 3 weeks, only two patients received 14 and 16 procedures. Mobilization from I to V degrees of intensity according to the Maitland classification was used. The patient performed ischemic compression independently after instruction (determination of the localization of trigger points, formation of their map, training in exposure techniques). Compression was performed with an average level of pain or more than average; duration of 30 seconds for each point. Results. The proportion of male patients was 20.8%. In the examined group of patients, the values of Me (25%; 75%) for age were 53.5 (48.25; 58.5) years, and for the duration of symptoms 4 (2; 5.5) months. Localization of adhesive capsulitis on the right side was observed in 9 patients (37.5%), and on the dominant upper limb in 8 (33.3%) patients. In five patients, the lesion was on the dominant right limb. The evaluation of the transfer of end-range mobilization procedures at the end of the first, sixth, eleventh and last procedure established that the maximum pain on a 10-point scale during mobilization was, respectively: 10 (9; 10) points, 8 (7.25; 9) points, 7 (5 ; 8) points and 4 (3; 5) points. In the course of physical therapy, the indicators of amplitudes of movements and pain at maximum amplitude, as well as at trigger points, improved statistically. The median value for active abduction increased by 74.5° and for active flexion increased by 116.5°. The median value for active internal rotation increased by 77.5°, and for active external rotation, flexion increased by 75°. The median value of pain when reaching the maximum amplitude of active abduction decreased by 6 points, and for active flexion, internal and external rotation, the median dynamics indicator was similar. It should be noted that the pain index at the trigeminal point at the first assessment was 9 (9; 9) points, and at the final assessment it statistically improved and was 4 (3; 4) points (Z = -4.340; p<0.001). All items of the Shoulder Pain and Disability Index questionnaire improved statistically, leading to improvements in domain values and the index itself. Іndicators Me (25%; 75%) of the pain domain decreased from 93 (63; 100) points to 16 (6.5; 20) points (Z = -4.287; p<0.001), and the disability domain from 83.8 (56.9; 91.6) points to 5.6 (3.8; 10.9) points (Z = -4.286; p<0.001). Тhe median indicator of the pain domain decreased by 77 points, and the disability domain by 78.2 points. The index decreased from 88.7 (54.1; 94.4) points to 10.5 (4.2; 15.4) points. (Z = -4.286; p<0.001). Conclusions. The use of a combination of end-range mobilization and ischemic compression was effective in reducing the index of shoulder pain and disability among the examined patients.