The Indian Journal of Occupational Therapy : Vol. XXXVI : No.

II (August-November ‘04)
†
PASSIVE EXERCISES COUPLED WITH THERAPEUTIC ACTIVITIES — A
COMPARATIVE STUDY IN THE MANAGEMENT OF FROZEN SHOULDER.
* MANISH SAMNANI, M.O.Th.-I
* Dr. Rajendra Jain Hospital,Bhilai (C.G).

Abstract
To test the effectiveness of using passive exercises coupled with therapeutic activities to improve functional hand-to-back
in Frozen Shoulder.
A standardize test of functional hand-to-back served as a pre-test and post-test to compare two groups (n=20) comprising
both male and female diagnosed of having Frozen Shoulder. The therapeutic activities program was the same for both
groups, but the treatment group was given passive exercise while the control group was not.
The degree of improvement was significantly higher in the treatment group to achieve functional hand-to-back as
compared to control group.
The study supports a passive exercise program alongwith therapeutic activities as a means for the improvement of
functional hand-to-back in Frozen Shoulder.

INTRODUCTION Clinical observations show that all motions increase

significantly when treated with therapeutic activities except
Frozen shoulder or Periarthritis is a distinct clinical syndrome medial rotation and hence to achieve functional hand-to-
associated with pain and restricted range of active and passive back.Nicholson(1985) through a study stated that medial
glenohumeral motion. rotation did not improve significantly when shoulders with
Patients having no positive findings in their history,clinical periarthritis were treated with active exercises alone.
examination,or radiographic review that could explain their This study seeks to find out whether the use of passive ROM
pain and and a decrease in shoulder motion are classified as exercises could produce more significant results to achieve
having Primary Idiopathic Frozen Shoulder. medial rotation & hence functional hand-to-back when given
The non-traumatic stiff shoulder is usually limited in all in conjunction with the therapeutic activities.
directions but the two functionally important movements to
the patient are flexion and the combined movements of
METHOD
glenohumeral extension,adduction,medial rotation which A same subject experimental design was used for the study.
enables to get hand behind the back.
INCLUSION CRITERIA
Limitation in ROM occurs due to structural changes in the
1. Diagnosed primary idiopathic periarthritis of shoulder.
periarticular tissues.These changes include shortening of
capsule,ligament or muscle as well as adhesion formation. 2. Unilateral involvement.
Treatment of limited ROM and function is geared towards 3. Previous treatment by analgesics only.
applying tensile forces in an effort to cause elongation of the 4. Experiencing symptoms of pain & limited ROM for not
restricting tissues. longer than 3 months.
EXCLUSION CRITERIA

Correspondence: 1. Any significant radiological finding.

* Dr. Manish Samnani 2. Signs of acute joint inflammation & muscle spasm.
Occupational Therapist
Department of Rehabilitation Sciences, 3. Any neurological deficit.
5th floor,Central Library Building,
Jamia Hamdard, Hamdard Nagar, 20 such patients,9 male and 11 female were included for the
New Delhi-110 062. study.All the subjects were aged between 35-60years.Written
E-mail: msamnani@rediffmail.com informed consent was taken from the subjects before
† Presented in the 41st Annual National Conference of AIOTA at New participating in the study.
Delhi, in the year 2004.

IJOT : Vol. XXXVI : No. 2 37 August - November 2004

The subjects were randomly allocated to one of the two Passive ROM to the shoulder by the therapist from this
groups,A & B of 10 each. initial position to maximal external rotation available.
The outcome variable,functional hand-to-back was measured 5.Patient in supine:
using an ordinal scale as follows: Shoulder flexed to less than or equal to 90 degree, elbow
flexed 90 degree:
Dorsum of hand to lateral thigh :0
Passive circumductory ROM to the shoulder.
Dorsum of hand to buttock :2
6.Supraspinatus stretching.
Dorsum of hand to lumbosacral region :4 Passive exercises were given for a period of 15min. after
Dorsum of hand to waist (L3 level) :6 the therapeutic activities,6 times a week.
Dorsum of hand to 12th dorsal vertebra :8 The scores for performing functional hand-to-back was
reassessed for each subject of group ‘A’ & ‘B’ after 6 weeks
Dorsum of hand to interscapular region : 10 of therapy and data was recorded.
PROCEDURE The data collected was then statistically analyzed to compare
the functional outcome scores after using the two treatment
Each subject was asked to take his or her hand to the protocols.
back,keeping arm adducted,at a position that he or she is
able to hold. RESULTS
The score of the assessment at baseline,for each subject The mean pretest scores for the subjects of control group
was thus noted using the scale. ‘A’ was 1.6 while the post-test score for the same subject
The patients belonging to control group ‘A’ received group was 2.6 (t=0.29,p=0.77).
therapeutic activity program & active exercises as follows: The mean pretest scores for the subjects of control group
1. Codman Pendulum Exercises. ‘B’ was 1.8 while the post-test score for the same subject
2. Pulley Exercises. group was 5.8 (t=4.5,p=0.002).
3. Shoulder Wheel. The mean difference in the pre and post-test scores for group
4. Active ROM Exercises using dowel. ‘A’ was 1.0 while that for group ‘B’ was 4.0
5. Finger stepping and corner stretch. Thus the results were found to be very significant for the
6. Reaching out tasks. group ‘B’ treated with passive exercises (p=0.002).
The treatment was given for a period of 45min.,6 times a These results suggest that there is more improvement to
week. achieve functional hand-to-back when treated with passive
The subjects belonging to group ‘B’ were treated with the exercises along with therapeutic activities than when treated
same therapeutic activities as given to subjects of group ‘A’ with therapeutic activities alone.
but they were also given Passive ROM Exercises as follows: TABLE - I
1.Patient in supine:
Baseline Characteristics of Study Subjects
Passive ROM to the shoulder by the therapist from neutral
position to maximal flexion available. Control Experimental
Group Group
2.Patient in supine:
(Active (Active +
Passive ROM to the shoulder by the therapist from neutral Alone) Passive)
position to maximal adduction available.
Total no. Of
3.Patient in supine: Subjects 10 10
Shoulder abducted to less than or equal to 90 degree, elbow SEX
flexed 90 degree:
Male 6 3 X² =0.81,p=0.17
Passive ROM to the shoulder by the therapist from this
initial position to maximal internal rotation available. Female 4 7
4.Patient in supine: MEAN AGE 42.7(9.0) 42.9(6.5) t =0.05,p=0..95
(S.D.)
Shoulder abducted to less than or equal to 90 degree, elbow
flexed 90 degree:

IJOT : Vol. XXXVI : No. 2 38 August - November 2004

 TABLE - II
Comparison of Pre and Post Therapy Scores
Scores Control Group Experimental Group
(Active Alone) (Active + Passive)
Pre Therapy 1.6(1.57) 1.8(1.4) t =0.29,p=0..77
Post Therapy 2.6(0.9) 5.8(1.9) t =4.57,p=0.002
Difference of Pre 1.0(1.05) 4.0(2.1) t=4.12,p=0.0008
and Post Therapy

GRAPH-I GRAPH – II
Comparison of Means of Pre and Post Therapy Comparison of Means of Difference of Pre and Post
Scores Therapy Scores

5
6 4
5 3
4 2
PRE-THERAPY
3 1
POST THERAPY 0
2
DIFF IN PRE-THERAPY DIFF IN POST THERAPY
1
0
CONTROL EXPERIMENTAL

DISCUSSION CONCLUSION
The ability to achieve functional hand-to-back improves The study supports a passive exercise program alongwith
significantly when treated with a program consisting of passive therapeutic activities as a means for the improvement of
exercises alongwith other therapeutic activities. functional hand-to-back in Frozen Shoulder.
Nicholson(1985),also found that all ranges improved ACKNOWLEDGEMENT
significantly when treated with passive joint mobilization.
I extend my sincere thanks to Dr.Rajendra Jain for allowing me to
According to Carolyn Wordsworth passive exercises have conduct the study in his hospital and Dr.R.M.Pandey for conducting
multiple benefits. Gentle passive exercises short of pain and the Statistics.
the pathologic limit of motion reduce pain.Theoretically this
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