Comparative Effects of High-Velocity Low-Amplitude (HVLA) Thrust and Muscle Energy Technique (MET) on Shoulder Mobility and Pain in Patients with Adhesive Capsulitis
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Abstract
Background: Adhesive capsulitis is a painful shoulder disorder characterized by capsular fibrosis, progressive stiffness, and restriction of active and passive glenohumeral range of motion. Manual therapy is commonly used in rehabilitation, but direct comparative evidence between high-velocity low-amplitude thrust manipulation and post-isometric relaxation muscle energy technique remains limited. Objective: To compare the short-term effects of HVLA thrust manipulation plus conventional therapy and PIR-MET plus conventional therapy on pain and shoulder range of motion in patients with Stage II–III adhesive capsulitis. Methods: Ethical approval of this study was obtained from the Ethics Committee of Green International University under Approval Clinical trial Reg# NCT07600372. This single-center randomized controlled trial included 66 patients with Stage II–III adhesive capsulitis, allocated equally into HVLA + CT and PIR-MET + CT groups. Both groups received 4 weeks of intervention. Pain was assessed using the Visual Analogue Scale, while active and passive shoulder flexion, abduction, external rotation, and internal rotation were measured using a universal goniometer. Between-group and within-group comparisons were analyzed using parametric tests, with effect sizes and 95% confidence intervals reported. Results: Baseline characteristics and outcome measures were comparable between groups. Both interventions significantly improved pain and all ROM outcomes after 4 weeks (p<0.001). PIR-MET + CT produced greater improvements than HVLA + CT, including larger VAS pain reduction (5.32 cm vs 3.12 cm) and greater active and passive ROM gains across all shoulder movements. Post-intervention between-group comparisons significantly favored PIR-MET + CT for pain and all mobility outcomes (p<0.001). Conclusion: PIR-MET combined with conventional therapy produced superior short-term pain reduction and shoulder mobility improvement compared with HVLA thrust manipulation combined with conventional therapy in Stage II–III adhesive capsulitis.
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