The effectiveness of mirror therapy in patients with frozen shoulder

Frozen shoulder (Adhesive capsulitis) is characterized by shoulder pain accompanied by progressive limitation of both active and passive glenohumeral joint movements at all directions. Mirror therapy was first applied by Ramachandran and Rogers to treat phantom pain after amputation in 1993. Subsequent studies had reported successful results in the treatment of brachial plexus avulsion, peripheral nerve injuries, CPRS, stroke and musculoskeletal injuries. Based on these results, the aim of this study is to investigate the efficacy of physical therapy combined with mirror therapy in frozen shoulder patients. Thirty patients who were diagnosed with frozen shoulder and were planned for 10 session of physical therapy programme, were evaluated in our randomized controlled-single blind study. Patients were divided equally into two groups. After each physical therapy session mirror therapy group were done active ROM exercises with reflected side of the mirror, control group were done active ROM exercises with non- reflected side of the mirror (The mirror has placed midline of the patients body while exercises were performed). Patients were evaluated for shoulder pain (VAS with shoulder movement), shoulder function (UCLA), quality of life (SF-36) and were measured active - passive ROM with goniometer before and after treatment. When the both groups were compared after treatment, pain in the mirror group was found significantly less than the control group (p=0.007). Shoulder function scores were significantly higher than the control group (p = 0.003). Post-treatment measurements of active flexion (p=0.001), active abduction, passive flexion, passive abduction in the mirror group significantly were better than the control group (respectively p=0.02, p=0.002, p=0.02). Physical functioning, physical andemotional role functioning and pain parameters of SF-36 were found better in mirror therapy group than the control group after the treatment. When we compared before and after treatment for both groups, we found that statistically significant reduction in shoulder pain and statistically significant improvements in shoulder function, active-passive ROM measurements and quality of life after treatment. According to our results, we found that standard physical therapy and exercise programmewhich applied to frozen shoulder patients, is an effective treatment to reduce pain and to improve shoulder function, shoulder ROM and quality of life. However, if mirror therapy combines with physical therapy programme, results seem to be better than treatment alone which is a cheap, easy applicable and reliable method Key words: Adhesive capsulitis, frozen shoulder, mirror therapy