Physical Therapy
Although studies have shown the efficacy of physical therapy, no current evidence has suggested that physical therapy alone improves function in the treatment of FS.[15, 16, 17, 18] However, physical therapy associated with an intra-articular injection of corticosteroid improves function and ROM more rapidly than does intra-articular corticosteroid injection alone.[15, 19]
Therapeutic exercises
Although many therapeutic exercises are described, few have been evaluated in the treatment of FS. Therapeutic exercises that have been studied include articular stretching and pulley therapy.[20, 21, 22] Passive articular stretching exercises improve ROM. The superiority of supervised versus home exercise programs has yet to be demonstrated.[23]
Manual therapy
Data from 2 studies support the use of manual therapy to improve ROM in the short term. One study showed that passive mobilization in the end-range position of the glenohumeral joint was more effective for improving ROM and function than was passive mobilization in the pain-free zone.[24] However, the overall difference between the interventions was small. In addition, patients appeared to achieve greatest improvement in ROM when treatment was administered early.[25]
In summary, the findings indicated that patients with FS improve with physical therapy regardless of when it is administered after the onset of FS but that they achieve the greatest improvement in their ROM when treatment is administered early.
Physical modalities
Many electroanalgesic and thermoanalgesic modalities are often used in physical therapy. Prospective, randomized, placebo-controlled clinical trials have demonstrated the inefficacy of bipolar interferential electrotherapy, TENS (transcutaneous electrical nerve stimulation) pulsed ultrasound therapy, laser therapy, and magnetotherapy with electromagnetic fields in the treatment of painful shoulder disorders. Indeed, a systematic review of randomized clinical trials has demonstrated that little evidence supports the use of common physiotherapeutic modalities to treat shoulder pain. (Nonetheless, clinical observations suggest that electroanalgesia and heat can provide some temporary relief to patients with severe shoulder pain and that they can do so without side effects.)
In summary, physical therapy alone has not been shown to improve function. However, when associated with an intra-articular corticosteroid injection, physical therapy improves ROM and function more rapidly than does intra-articular corticosteroid injection alone. The effectiveness of physical modalities has not been demonstrated. However, therapeutic exercises and manual therapy do improve ROM (see above).
Given the paucity of evidence supporting the effectiveness of physical therapy, the present authors believe that clinicians should be most conservative in designing a physical therapy program for patients with FS. An intermittently supervised, home-based articular stretching and strength-maintenance program can be combined with manual therapy, the appropriate analgesic medications, and the judicious use of electroanalgesia and warm packs. This approach generally suffices to provide adequate pain relief in most patients while the disease runs its usual, favorable course. (For additional information, see Home Exercises for the Stiff Shoulder, on the University of Washington School of Medicine Web site
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