Outcomes of Early vs. Delayed Physiotherapy Intervention in Adhesive Capsulitis

Abstract

Background: Controversy persists regarding optimal timing of physiotherapy in adhesive capsulitis, with traditional approaches favouring delayed intervention while emerging evidence supports early treatment. Objective: To compare the effectiveness of early (within 4 weeks) versus delayed (after 12 weeks) structured physiotherapy on pain, disability, and range of motion in adhesive capsulitis. Methods: Eighty patients with unilateral idiopathic adhesive capsulitis were randomised to early (n=40) or delayed (n=40) physiotherapy groups. Both received identical 12-week structured mobilisation, stretching, and home exercise protocols three times weekly. Primary outcome was Disabilities of the Arm, Shoulder and Hand (DASH) score; secondary outcomes included pain (VAS), active range of motion, sleep quality, global rating of change, and analgesic use at 12 weeks. Analyses used ANCOVA adjusted for baseline values and multiple regression. Results: Early physiotherapy yielded significantly greater improvements: pain reduction (−4.6 vs −2.8 VAS points), DASH (−38.4 vs −25.8 points), flexion (+66° vs +50°), abduction (+64° vs +50°), and external rotation (+30° vs +22°); all between-group differences p ≤ 0.002. Early intervention independently predicted 11.8-point lower post-treatment DASH (95% CI −16.3 to −7.4, p < 0.001). Conclusion: Early physiotherapy within 4 weeks of symptom onset produces superior short-term clinical and functional outcomes compared with delayed intervention and should be the preferred management strategy.