The Effect of Osteopathic Visceral Manipulation on Pain, Mobility and Functional Disability in Patients With Right Shoulder Adhesive Capsulitis

The aim of this study was to evaluate the effects of adding osteopathic visceral manipulation (OVM) to a standard physical therapy program on pain, functional disability, and range of motion (ROM) in patients diagnosed with right shoulder adhesive capsulitis (AC). A total of 49 patients aged between 40 and 65 years who were diagnosed with right shoulder AC were included in the study. Randomized patients received a standard physical therapy program for three weeks, consisting of 15 sessions (5 days per week) in both treatment groups. The standard program included hot pack application to the shoulder region for 20 min, conventional transcutaneous electrical nerve stimulation (TENS) for 20 min, and ultrasound therapy at 1.5 W/cm² for 10 min. In addition to the standard physical therapy program, Group 1 (n=25) received OVM once weekly, while Group 2 (n=24) received sham OVM once weekly. Pain was evaluated using the Visual Analog Scale (VAS), while functional disability was evaluated using the Shoulder Pain and Disability Index (SPDI). The ROM values were also recorded.

Inclusion Criteria: * Age between 18 and 65 years * Presence of pain originating from the right shoulder region persisting for at least 6 weeks * Availability of two-view shoulder radiographs obtained prior to the study to exclude causes of shoulder pain other than AC * No local corticosteroid injection for shoulder pain within the previous 6 months * No physical therapy administered for shoulder pain within the previous 6 months * No use of non-steroidal anti-inflammatory drugs (NSAIDs) during the study period * Availability of laboratory assessments including: * Complete blood count (CBC) * Erythrocyte sedimentation rate (ESR) * Liver function tests (AST, ALT) * C-reactive protein (CRP) * Pain intensity score of at least 4 cm on the Visual Analog Scale (VAS, 0-10 cm) Exclusion Criteria: * History of shoulder fracture on the affected side * Prior shoulder surgery * History of traumatic shoulder instability (subluxation or dislocation) * History of shoulder or visceral organ surgery within the past 6 months * History of systemic or inflammatory disease or malignancy * Presence of metabolic or endocrine bone disease * Pregnancy * Neurological disorders affecting upper extremity function * Psychiatric disorders that could interfere with treatment compliance or symptom evaluation * Use of antiplatelet medication * Previous osteopathic treatment