Effectiveness of PNF Pattern in Regular Physical Therapy Sessions on Functional Mobility in Frozen Shoulder  : PNF Pattern in Frozen Shoulder Therapy

Sidra Ghias; Subhan ur Rehman Burki; Hina Saeed; Mansoor Ahmed; Muhammad Faisal; Tariq Ahmed Solangi; Hafiz Ali Bin Asim; Sameen Arshad; Jawad Ahmad

doi:10.54393/tt.v5i01.197

Authors

Sidra Ghias Riphah International University, Islamabad, Pakistan
Subhan ur Rehman Burki Northwest Institute of Health Sciences, Peshawar, Pakistan
Hina Saeed Iqra University North Campus, Karachi, Pakistan
Mansoor Ahmed Iqra University North Campus, Karachi, Pakistan
Muhammad Faisal Ziauddin University, Karachi, Pakistan
Tariq Ahmed Solangi Sindh Institute of Medical and Allied Sciences, Karachi, Pakistan
Hafiz Ali Bin Asim Foundation University College of Physical Therapy, Islamabad, Pakistan
Sameen Arshad Department of Physiotherapy, King Edward Medical University, Lahore, Pakistan
Jawad Ahmad Department of Physical Therapy, Government College University Faisalabad, Faisalabad, Pakistan

DOI:

https://doi.org/10.54393/tt.v5i01.197

Keywords:

Physical Therapy, PNF Pattern, Adhesive Capsulitis, Codman Exercise, Functional Mobility

Abstract

Frozen shoulder, or adhesive capsulitis, is a musculoskeletal condition that presents with symptoms such as discomfort, nocturnal pain, and limited range of motion. Abduction and external rotation are significantly reduced. Objective: To investigate the effectiveness of combining proprioceptive neuromuscular facilitation (PNF) patterns into routine physical therapy sessions for patients with frozen shoulder. Methods: A six-week quasi-experimental study was conducted on a total of 30 participants, divided into group A (n=15) and group B (n = 15), selected from the outpatient department (OPD). Pain, disability, and range of motion were evaluated as outcome measures. The group A received proprioceptive neuromuscular facilitation (PNF) patterns in addition to their usual physical therapy sessions, and group B only received conventional physical therapy sessions. Disabilities of the Arm, Shoulder and Hand (DASH), VAS (Visual Analog Scale) and goniometer were used to assess pain, disability and range of motion (ROM). Data were analyzed using SPSS version 23.0. Results: Both groups showed a significant reduction in DASH and VAS scores and an increase in ROMs, as group A showed a better result in terms of DASH score and abduction range (p<0.05). Conclusions: Both the experimental and control groups had statistically significant outcomes. The PNF pattern and Codman exercises both have a positive impact on rehabilitation. However, PNF is more advanced because it involves a combination of movements that are also useful in daily activities. Additionally, PNF helps develop memory for correct patterned movements. On the other hand, Codman exercises are only effective for retaining and improving shoulder ranges.

References

Ryan V, Brown H, Minns Lowe CJ, Lewis JS. The pathophysiology associated with primary (idiopathic) frozen shoulder: A systematic review. BMC Musculoskeletal Disorders. 2016 Dec; 17: 1-21. doi: 10.1186/s12891-016-1190-9.

Manna S and Nankar AY. Frozen shoulder: A brief review. Journal on Musculoskeletal Ultrasound in Pain Medicine. 2020 Jan; 6(1): 29-32. doi: 10.5005/jp-journals-10046-0162.

Toprak M and Erden M. Sleep quality, pain, anxiety, depression and quality of life in patients with frozen shoulder. Journal of Back and Musculoskeletal Rehabilitation. 2019 Jan; 32(2): 287-91. doi: 10.3233/BMR-171010.

Millar NL, Meakins A, Struyf F, Willmore E, Campbell AL, Kirwan P et al. Frozen shoulder. Nature Reviews Disease Primers. 2022 Sep; 8(1): 59. doi: 10.1038/s41572-022-00386-2.

Abrassart S, Kolo F, Piotton S, Chiu JC, Stirling P, Hoffmeyer P et al. ‘Frozen shoulder’is ill-defined. How can it be described better? EFORT Open Reviews. 2020 May; 5(5): 273-9. doi: 10.1302/2058-5241.5.190032.

Akbar M, Crowe LA, McLean M, Garcia-Melchor E, MacDonald L, Carter K et al. Translational targeting of inflammation and fibrosis in frozen shoulder: Molecular dissection of the T cell/IL-17A axis. Proceedings of the National Academy of Sciences. 2021 Sep; 118(39): e2102715118. doi: 10.1073/pnas.2102715118.

Cui J, Lu W, He Y, Jiang L, Li K, Zhu W et al. Molecular biology of frozen shoulder-induced limitation of shoulder joint movements. Journal of Research in Medical Sciences. 2017 Jan; 22(1): 61. doi: 10.4103/jrms.JRMS_1005_16.

Page RS, McGee SL, Eng K, Brown G, Beattie S, Collier F et al. Adhesive capsulitis of the shoulder: protocol for the adhesive capsulitis biomarker (AdCaB) study. BMC Musculoskeletal Disorders. 2019 Dec; 20: 1-6. doi: 10.1186/s12891-019-2536-x.

Neviaser AS and Neviaser RJ. Adhesive capsulitis of the shoulder. JAAOS-Journal of the American Academy of Orthopaedic Surgeons. 2011 Sep; 19(9): 536-42. doi: 10.5435/00124635-201109000-00004.

De V. Proprioceptive neuromuscular facilitation patterns and techniques. 3ED Harper and Row. 1985: 298-311.

Yugal S. A systematic literature review on the use of proprioceptive neuromuscular facilitation in neuromuscular rehabilitation. [Thesis]. Finland: Satakunta University of Applied Sciences; 2013.

Beckers D and Buck M. PNF in practice: an illustrated guide: Springer Nature; 2021. doi: 10.1007/978-3-662-61818-9.

Hindle K, Whitcomb T, Briggs W, Hong J. Proprioceptive neuromuscular facilitation (PNF): Its mechanisms and effects on range of motion and muscular function. Journal of Human Kinetics. 2012 Mar; 31(2012): 105-13. doi: 10.2478/v10078-012-0011-y.

Lim WS, Shin HS, Kim IS, Hur SG, Bae SS. The effects of scapular pattern and hold-relax technique of PNF on the ROM and VAS in frozen shoulder patients. The Journal of Korean Physical Therapy. 2002; 14(1): 15-26.

Samson MF. Effects of dynamic and static stretching protocols within activity specific and general warm ups. [Doctoral dissertation]. Canada: Memorial University of Newfoundland; 2011.

Lempke L, Wilkinson R, Murray C, Stanek J. The effectiveness of PNF versus static stretching on increasing hip-flexion range of motion. Journal of Sport Rehabilitation. 2018 May; 27(3): 289-94. doi: 10.1123/jsr.2016-0098.

Mehta H, Joshi P, Trambadia H. Effectiveness of pnf stretching and selfstretching in patients with adhesive capsulitis-a comparative study. Indian Journal of Physiotherapy & Occupational Therapy-An International Journal. 2013: 47-51.

Lee BK. Effects of the combined PNF and deep breathing exercises on the ROM and the VAS score of a frozen shoulder patient: Single case study. Journal of Exercise Rehabilitation. 2015 Oct; 11(5): 276. doi: 10.12965/jer.150229.

Gao P, Tang F, Liu W, Mo Y. The effects of proprioceptive neuromuscular facilitation in treating chronic low back pain: A systematic review and meta-analysis. Journal of Back and Musculoskeletal Rehabilitation. 2022 Jan; 35(1): 21-33. doi: 10.3233/BMR-200306.

Kim CH, Kang TW, Kim BR. The Effect of Proprioceptive Neuromuscular Facilitation Exercise on the Range of Motion, Pain, and Functional Activity of Total Knee Arthroplasty Patients. PNF and Movement. 2018; 16(1): 75-83.