Cervical and Thoracic Mobility Training in Patients With Adhesive Capsulitis

Adhesive capsulitis is a musculoskeletal disorder characterized by pain, stiffness, and a significant reduction in joint range of motion (ROM) in the shoulder joint, severely limiting daily living activities and functional capacity. The stiffness observed in the muscles and ligaments around the shoulder, especially after immobilization, leads to increased pain and restricted joint range of motion in the shoulder. All these pathological processes create a functional limitation cycle in the shoulder joint.

Postural imbalances and hypomobility occurring in the cervical and thoracic spine regions have a significant effect on the shoulder joint. The cervical and thoracic spine regions directly affect the biomechanics of the shoulder joint. Functional disorders in these regions cause decreased shoulder range of motion, irregular muscle activation, and increased pain. Postural disorders, particularly increased thoracic kyphosis and cervical protraction, negatively affect glenohumeral joint movements by altering the alignment of the shoulder girdle. These biomechanical abnormalities alter the normal position of the scapula, cause imbalance in muscle activation, and lead to functional impairment in the long term. When cervical alignment abnormalities are combined with thoracic hypomobility, the scapulothoracic rhythm is further disrupted, leading to increased shoulder pain.

Recent clinical studies have shown that thoracic mobility exercises are effective in treating adhesive capsulitis. Joint mobility exercises activate proprioceptive receptors, supporting pain modulation in the central nervous system and normalizing muscle activation patterns. Some studies have reported that adding thoracic mobility exercises to conventional physical therapy programs resulted in greater pain reduction, increased joint range of motion, and functional improvement compared to groups receiving physical therapy alone. These findings demonstrate that thoracic mobility exercises have both local and systemic effects.

According to relationship between the shoulder and thoracic spine, dysfunction in one anatomical region can lead to pain or restricted movement in a distant region. In this context, it is important to include not only the shoulder joint but also the thoracic and cervical spine in the treatment process for adhesive capsulitis. This ensures functional integrity, balances muscle activation, and accelerates the healing process.

Sensory inputs from the cervical spine play a role in head position and the synchronized functioning of the scapular muscles. In cases of cervical hypomobility, these proprioceptive inputs decrease, scapular stability is compromised, and postural control weakens. Therefore, cervical mobility exercises are important for supporting proprioceptive functions, correcting postural alignment, and restoring coordination of the scapular muscles. In conclusion, the current literature shows that cervical and thoracic mobility exercises are effective in reducing pain, increasing joint range of motion, correcting posture, and improving functional capacity in individuals with adhesive capsulitis.

However, the limited number of studies directly examining the effects of combined exercises targeting these two regions highlights the importance of randomized controlled trials in this area.