Manual therapy and exercise for adhesive capsulitis: a systematic review with meta-analysis.

Adhesive capsulitis, a stiffening of the shoulder joint that affects about 1 in 100 people, is often treated with manual therapy (hands-on techniques) and exercise. Researchers wanted to find out whether these treatments actually work and, if they do, how much of each one patients need. They looked at 16 well-designed studies comparing manual therapy alone, exercise alone, or the two combined against other treatments.

What they found was surprising: across all the measures they looked at (pain, disability, and shoulder rotation), neither manual therapy nor exercise showed clear benefits compared to control groups in the short or long term. The quality of evidence was low across the board, which means the studies themselves were quite different from each other in how they were run, what techniques they used, and how long treatment lasted.

This review looked at whether manual therapy and exercise actually help adhesive capsulitis, and the honest answer is that the current research doesn't show a clear effect one way or the other. That doesn't mean these treatments don't help some people, but rather that the studies done so far haven't been able to prove it convincingly.

The studies varied a lot in what they tested, how they did it, and how long they treated people, which makes it hard to draw firm conclusions. What this means is that there is still genuine uncertainty about what works best for this condition. The good news is that research is continuing, and better-designed studies may eventually give clearer answers about which treatments are most helpful and how much treatment people really need.

This is a summary of research, not medical advice. Talk to your own healthcare provider about anything affecting your care.

This systematic review adds a note of caution to our current practice with adhesive capsulitis. While manual therapy and exercise are widely used, the meta-analyses across 16 trials showed non-significant effects on pain, disability, and external rotation across both short and long-term timeframes, with very low to low quality of evidence overall.

The real obstacle to stronger conclusions appears to be methodological: included studies differed substantially in their manual therapy techniques, dosing protocols, and treatment duration, making it almost impossible to identify which approaches, if any, offer genuine benefit. The secondary finding about dosage is particularly relevant to practice. The authors found very little consistency in how much treatment patients received across studies, and they could not synthesize meaningful guidance on optimal visit frequency or duration.

This gap suggests that many clinicians are making dosing decisions based on experience or local convention rather than evidence. The low-to-very-low evidence quality across all analyses means caution is warranted before strong claims about efficacy, though the non-significant findings do not prove these treatments are ineffective, only that current evidence has not demonstrated superiority over comparators.