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Gentle thawing of the frozen shoulder: a prospective study of supervised neglect versus intensive physical therapy in seventy-seven patients with frozen shoulder syndrome followed up for two years

PainSci » bibliography » Diercks et al 2004
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Tags: treatment, bad news, stretch, exercise, self-treatment, muscle

One article on PainSci cites Diercks 2004: Complete Guide to Frozen Shoulder

PainSci commentary on Diercks 2004: ?This page is one of thousands in the PainScience.com bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided wherever possible.

These researchers chose to express their results in an interesting way, declaring that “neglect” worked better than “intensive physical therapy.” It makes for a great headline, but the more conventional way to put it would be just “passive stretching and mobilization don’t work better than exercise within the pain limits,” which is what they actually tested — and the difference between them was trivial. “Neglect” seems like a poor word for “exercise within pain limits,” which is actually a promising management strategy.

~ Paul Ingraham

original abstract †Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

Seventy-seven patients with idiopathic frozen shoulder syndrome were included in a prospective study to compare the effect of intensive physical rehabilitation treatment, including passive stretching and manual mobilization (stretching group) versus supportive therapy and exercises within the pain limits (supervised neglect group). There were no significant differences in age, sex, time elapsed since onset, and disease severity at inclusion. All patients were followed up for 24 months after the start of treatment. In the patients treated with supervised neglect, 89% had normal or near-normal painless shoulder function (Constant score > or =80) at the end of the observation period. This end result was reached by 64% within 12 months. In contrast, of the group receiving intensive physical therapy treatment, only 63% reached a Constant score of 80 or higher after 24 months. Both the level of the Constant score at the end of the study and the moment a Constant score of 80 or higher was reached confirm that supervised neglect yields better outcomes than intensive physical therapy and passive stretching in patients with frozen shoulder.

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