Adhesive Capsulitis (MUA, Capsular Release, Hydrodistention)

Updated Evidence-Based Insights (2023–2024)

  1. Early Motion Is Essential
    • Immediate post-op motion (within 24 hours) significantly improves long-term ROM outcomes.
    • Delay >3 days may lead to stiffness recurrence.
    • [Ref: Wang et al., 2023]
  2. Pain Control Is Priority
    • Effective analgesia is vital — pain is the main barrier to movement.
    • Capsular release patients often benefit from short-term regional blocks.
  3. No Range Restrictions Post-Release
    • Active and passive ROM encouraged in all planes from Day 1.
    • Progress exercises as tolerated, aiming to maintain intra-op gains.
  4. Intensive Physiotherapy in First 6 Weeks
    • Supervised PT 2–3x/week in first 6 weeks → better long-term outcomes.
    • [Ref: Sethi et al., 2024]
  5. Focus on Functional Use
    • Return to overhead and reaching tasks ASAP.
    • Delays >6–8 weeks without improvement may warrant re-referral.

Updated Adhesive Capsulitis Release Rehab Protocol (2024)

Phase Timeline Goals & Interventions Key Points
Phase 1: Immediate Mobilisation Day 0–2 weeks – Pain management (meds/block)
– Active/passive ROM in all planes
– AAROM: table/wall slides, pulleys, pendulums
– Functional tasks (dressing, hygiene)
– Daily home exercises		 – Emphasise early pain-free mobility
– No restrictions on range
– ROM > strength early
Phase 2: Movement Consolidation 2–6 weeks – ROM maintenance
– Add resistance-free strengthening (therabands, scapular control)
– Joint mobilisations (Grade II–IV)
– Address sleep positioning
– Begin proprioception drills		 – Reinforce daily home routine
– Progress ROM based on comfort
Phase 3: Functional Strengthening 6–12 weeks – Advance to strength (deltoid, RC, scapular stabilisers)
– Introduce closed chain & resistance work
– Emphasise overhead function
– Integrate functional goals		 – Watch for stiffness return or guarding
– Escalate only if ROM is maintained
Phase 4: Return to Full Function 12+ weeks – Return to sport/work/overhead demands
– Continue strengthening
– Self-management strategies for long term mobility		 – Refer back if ROM deteriorates or plateaus

Red Flags / Consultant Re-referral

  • Failure to maintain intra-op ROM gains
  • Significant pain despite analgesia
  • Stiffness returning after week 6
  • Psychological fear-avoidance patterns interfering with rehab
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Testimonials

“Kate used a technique called visceral release to work on my internal organs, the effect has been amazing. I have had several sessions with Kate and the pain in my hip has almost gone. I can move freely and walk more easily.”

Mary

”Kate has terrific skills and sensitivity – she treats the whole person, not just the symptoms”

Emma

“I have been seeing Kate on and off for several years now. She is incredible, no matter what my ailment and I have had various over the years, she has always managed to reduce my pain and increase my mobility. She is very professional but keeps a great balance of being personal too. I have been to many other physios but I will not see anyone else now.”

Kelly

“Kate is a superb therapist and has moved me quickly from despair to recovery.”

Alex

“I cannot sing enough praises for the treatment I received from Kate. Instead of treating the symptoms, she treated the cause of the problem.”

Tara (a professional triathlete)

”FIVE STAR EXPERIENCE.  Kate looks at the body as a whole (both physically and emotionally) and is able to identify and treat the root cause of the pain.  This type of Physiotherapy is much more logical and effective than traditional Physiotherapy.  The best physio I have come across – thank you Kate.”

Stacey

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