Frozen ShoulderNCT07667556
The Combined Effect of Mulligan Mobilization, Pain Neuroscience-Based Training, and Core Stabilization Exercises in Frozen Shoulder Patients
A study testing Pain Neuroscience Education (PNE), Mulligan Mobilization With Movement (MWM) and Core Stabilization Exercises in people with Frozen Shoulder, run by Yeditepe University at 1 site in Turkey (Türkiye).
Trial summary
The purpose of this randomized controlled study is to investigate the effects of a combined rehabilitation program consisting of Mulligan Mobilization with Movement (MWM), Pain Neuroscience Education (PNE), and core stabilization exercises in individuals with adhesive capsulitis (frozen shoulder). Read more about this study
- Who is it for?
- Ages 18 to 65 years
- Conditions the study is for
- Frozen Shoulder
- What is being tested?
- Pain Neuroscience Education (PNE), Mulligan Mobilization With Movement (MWM) and Core Stabilization Exercises
- Type of treatment
- Surgery or procedure, Lifestyle or therapy programme
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 36 participants
- Where
- 1 siteTurkey (Türkiye)
- Study dates
- 21 Apr 2026to Jan 2027
- Phase
- Interventional
- Are there results?
- Not yet: the study is under way
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 to 65 years
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- Adults aged 18 to 65 years
- Diagnosis of adhesive capsulitis confirmed by an orthopedic surgeon or a physical medicine and rehabilitation physician
- Presence of shoulder pain and limitation of shoulder range of motion
- Ability to communicate verbally
- Ability to understand study procedures and educational content
- Willingness to participate and provide written informed consent
- Mini-Mental State Examination (MMSE) score of 24 or higher
- Ability to attend treatment and assessment sessions regularly
Who cannot join
- MMSE score below 24
- Severe cognitive impairment
- Severe psychiatric disorders
- Active infectious disease
- Active malignancy
- Uncontrolled cardiovascular disease
Show all 11Show fewer
- Presence of a cardiac pacemaker
- Contraindications to transcutaneous electrical nerve stimulation (TENS)
- Neurological disorders that may affect participation or outcomes
- Systemic diseases that may interfere with the safe implementation of the intervention
- Inability to comply with the study protocol or attend scheduled sessions
Trial locations and contacts
1 site in 1 country. Contact the study team or a site near you to ask about taking part.
Turkey (Türkiye)1 site, 1 recruiting
- Recruiting
Life Med Tıp Merkezi
Istanbul
Murat Gökhan Döner, +90 532 342 98 15, fztgokhandoner@gmail.com
About this study
The purpose of this randomized controlled study is to investigate the effects of a combined rehabilitation program consisting of Mulligan Mobilization with Movement (MWM), Pain Neuroscience Education (PNE), and core stabilization exercises in individuals with adhesive capsulitis (frozen shoulder).
The main questions this study aims to answer are:
Read more
Does the combination of Mulligan mobilization, Pain Neuroscience Education, and core stabilization exercises reduce pain in individuals with adhesive capsulitis? Does this combined intervention improve shoulder range of motion, shoulder function, quality of life, scapular dyskinesis, and pain catastrophizing compared with conventional physical therapy?
Participants diagnosed with adhesive capsulitis will be randomly assigned to one of two groups. The intervention group will receive Mulligan mobilization, Pain Neuroscience Education, and core stabilization exercises, while the control group will receive conventional physical therapy, including TENS, hot-pack application, passive joint mobilization, and stretching exercises. Both groups will participate in treatment sessions three times per week for six weeks. Outcome measures will be assessed at baseline and after completion of the 6-week intervention period.
Read the detailed description
Adhesive capsulitis, commonly known as frozen shoulder, is a musculoskeletal disorder characterized by shoulder pain, progressive restriction of active and passive range of motion, and functional disability. The condition negatively affects activities of daily living and quality of life and is most frequently observed in individuals between 40 and 65 years of age. Despite the widespread use of conventional physiotherapy interventions, optimal treatment strategies remain under investigation.
Mulligan Mobilization with Movement (MWM) is a manual therapy technique that combines sustained accessory joint glides with active pain-free movement. Previous studies have demonstrated beneficial effects of Mulligan mobilization on pain reduction and functional improvement in individuals with adhesive capsulitis. Pain Neuroscience Education (PNE) is an educational approach designed to improve patients' understanding of pain mechanisms and reduce maladaptive beliefs related to pain. Core stabilization exercises, particularly those based on Dynamic Neuromuscular Stabilization (DNS) principles, aim to improve postural control, neuromuscular coordination, and movement efficiency.
Although the effectiveness of Mulligan mobilization has been investigated in patients with adhesive capsulitis, there is limited evidence regarding the use of Pain Neuroscience Education in this population, and the effects of DNS-based core stabilization exercises have not been adequately studied. Furthermore, no previous study has examined the combined effects of Mulligan mobilization, Pain Neuroscience Education, and core stabilization exercises in individuals with adhesive capsulitis.
This randomized controlled trial aims to evaluate the short-term effects of a combined intervention consisting of Mulligan mobilization, Pain Neuroscience Education, and core stabilization exercises on pain intensity, shoulder range of motion, shoulder function, pain catastrophizing, scapular dyskinesis, core stability, and health-related quality of life in individuals with adhesive capsulitis.
Participants diagnosed with adhesive capsulitis will be randomly allocated to one of two groups. The experimental group will receive Mulligan mobilization, Pain Neuroscience Education, and DNS-based core stabilization exercises. The control group will receive conventional physical therapy consisting of transcutaneous electrical nerve stimulation (TENS), hot-pack application, passive joint mobilization, and stretching exercises. Both groups will participate in treatment sessions three times per week for six weeks. Assessments will be conducted at baseline and after completion of the intervention period.
The findings of this study may contribute to the development of a more comprehensive rehabilitation approach for individuals with adhesive capsulitis and provide evidence regarding the effectiveness of combining manual therapy, pain education, and core stabilization strategies in clinical practice.
- Conditions
- Frozen Shoulder
- Being tested
- Pain Neuroscience Education (PNE), Mulligan Mobilization With Movement (MWM), Core Stabilization Exercises, Conventional Physical Therapy
- Medical subject headings
- Bursitis
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Pain Neuroscience Education (PNE)Behavioural
Participants will receive Pain Neuroscience Education focused on the biopsychosocial nature of pain, central sensitization, the distinction between pain and tissue damage, and strategies to reduce fear of movement. The initial educational session will last approximately 15-20 minutes, followed by 5-10 minute reinforcement sessions throughout the intervention period. Education will be delivered through verbal explanations and interactive discussion.
Mulligan Mobilization With Movement (MWM)Procedure or surgery
Participants will receive Mulligan Mobilization with Movement techniques applied to the glenohumeral joint, including posterolateral glide with active abduction, inferior glide with shoulder flexion, and posterior glide with internal rotation. Mobilizations will be performed within a pain-free range of motion. Each technique will be administered in 3 sets of 10 repetitions with 30 seconds of rest between sets. Treatment will be provided three times per week for six weeks
Core Stabilization ExercisesBehavioural
Participants will perform Dynamic Neuromuscular Stabilization (DNS)-based core stabilization exercises. The program will include diaphragmatic breathing, supine 90/90 positioning, abdominal bracing, and progression to dead bug, bird-dog, and modified plank exercises as tolerated. Exercises will be performed in 2-3 sets of 8-12 repetitions with 10-20 second isometric holds. Progression will occur from stable to unstable surfaces and from static to dynamic activities
Conventional Physical TherapyOther
Participants in the control group will receive conventional physical therapy consisting of transcutaneous electrical nerve stimulation (TENS) applied at a sensory level for 20 minutes, hot-pack application for 20 minutes, passive shoulder joint mobilization exercises, pendulum exercises, and wand exercises. Treatment sessions will be conducted three times per week for six weeks.
| Study group | Role | What they receive |
|---|---|---|
| Experimental - Combined Treatment Group | Experimental | Mulligan Mobilization + Pain Neuroscience Education + Core Stabilization Exercises Receives: Behavioral: Pain Neuroscience Education (PNE); Procedure: Mulligan Mobilization With Movement (MWM); Behavioral: Core Stabilization Exercises |
| Active Comparator - Conventional Physical Therapy Group | Active comparator | Conventional Physical Therapy (TENS + hot-pack + ROM Exercises + Stretching Exercises) Receives: Other: Conventional Physical Therapy |
What is being measured
The primary outcome is the main question the study is designed to answer.
Pain Intensity
Pain intensity during movement will be assessed using the Visual Analog Scale (VAS). Higher scores indicate greater pain intensity.
Measured: Baseline and week 6
Shoulder Function
Shoulder pain, function, and patient satisfaction will be evaluated using the Penn Shoulder Score (PSS). Higher scores indicate better shoulder function.
Measured: Baseline and week 6
Shoulder Range of Motion
Active shoulder flexion, abduction, internal rotation, and external rotation range of motion will be measured using a goniometer.
Measured: Baseline and week 6
Secondary outcomes (4)
Pain Catastrophizing
Pain-related catastrophic thinking will be assessed using the Pain Catastrophizing Scale (PCS). Higher scores indicate greater pain catastrophizing.
Measured: Baseline and week 6
Core Stability
Core stability and neuromuscular control will be assessed using the Sahrmann Core Stability Test.
Measured: Baseline and week 6
Change in Scapular Dyskinesis
Scapular movement patterns and dyskinesis will be evaluated using the Scapular Dyskinesis Test.
Measured: Baseline and week 6
Change in Health-Related Quality of Life
Health-related quality of life will be assessed using the 12-Item Short Form Health Survey (SF-12).
Measured: Baseline and week 6
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted25 Jun 2026
- Study start21 Apr 2026
- Primary completionJan 2027 (estimated)
- Study completionJan 2027 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (4)Papers the sponsor has linked to this study.
- Other trials for Frozen ShoulderStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind
- Who is masked
- Outcomes assessor
- Enrolment
- 36 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Yeditepe University
- Sponsor type
- University, hospital or other
- Responsible party
- Sponsor
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07667556
- Sponsor's protocol ID
- Dilay Döner
- Status last verified
- Aug 2026
- First submitted
- 19 Jun 2026
- Last updated
- 4 Aug 2026
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Publications
Sullivan MJL, Bishop SR, Pivik J. The Pain Catastrophizing Scale: Development and validation. Psychological Assessment. 1995;7(4):524-532.
Leggin BG, Michener LA, Shaffer MA, Brenneman SK, Iannotti JP, Williams GR Jr. The Penn shoulder score: reliability and validity. J Orthop Sports Phys Ther. 2006 Mar;36(3):138-51. doi: 10.2519/jospt.2006.36.3.138.
PubMed 16596890Razzaq A, Nadeem RD, Akhtar M, Ghazanfar M, Aslam N, Nawaz S. Comparing the effects of muscle energy technique and mulligan mobilization with movements on pain, range of motion, and disability in adhesive capsulitis. J Pak Med Assoc. 2022 Jan;72(1):13-16. doi: 10.47391/JPMA.1360.
PubMed 35099430Doner G, Guven Z, Atalay A, Celiker R. Evalution of Mulligan's technique for adhesive capsulitis of the shoulder. J Rehabil Med. 2013 Jan;45(1):87-91. doi: 10.2340/16501977-1064.
PubMed 23037929
Study at a glance
From the registry record, last updated by the sponsor on 4 Aug 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- The Combined Effect of Mulligan Mobilization, Pain Neuroscience-Based Training, and Core Stabilization Exercises in Frozen Shoulder Patients
- ClinicalTrials.gov ID
- NCT07667556
- Acronym / sponsor ID
- Dilay Döner
- Conditions
- Frozen Shoulder
- Study type
- Interventional
- Recruitment status
- Recruiting
- Enrolment
- 36 participants (estimated)
- Lead sponsor
- Yeditepe UniversityUniversity, hospital or other
- Study start
- 21 Apr 2026 (actual)
- Primary completion
- Jan 2027 (estimated)
- Study completion
- Jan 2027 (estimated)
- First posted
- 25 Jun 2026 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
The purpose of this randomized controlled study is to investigate the effects of a combined rehabilitation program consisting of Mulligan Mobilization with Movement (MWM), Pain Neuroscience Education (PNE), and core stabilization exercises in individuals with adhesive capsulitis (frozen shoulder).
The main questions this study aims to answer are:
Does the combination of Mulligan mobilization, Pain Neuroscience Education, and core stabilization exercises reduce pain in individuals with adhesive capsulitis? Does this combined intervention improve shoulder range of motion, shoulder function, quality of life, scapular dyskinesis, and pain catastrophizing compared with conventional physical therapy?
Participants diagnosed with adhesive capsulitis will be randomly assigned to one of two groups. The intervention group will receive Mulligan mobilization, Pain Neuroscience Education, and core stabilization exercises, while the control group will receive conventional physical therapy, including TENS, hot-pack application, passive joint mobilization, and stretching exercises. Both groups will participate in treatment sessions three times per week for six weeks. Outcome measures will be assessed at baseline and after completion of the 6-week intervention period.
Detailed description
Adhesive capsulitis, commonly known as frozen shoulder, is a musculoskeletal disorder characterized by shoulder pain, progressive restriction of active and passive range of motion, and functional disability. The condition negatively affects activities of daily living and quality of life and is most frequently observed in individuals between 40 and 65 years of age. Despite the widespread use of conventional physiotherapy interventions, optimal treatment strategies remain under investigation.
Mulligan Mobilization with Movement (MWM) is a manual therapy technique that combines sustained accessory joint glides with active pain-free movement. Previous studies have demonstrated beneficial effects of Mulligan mobilization on pain reduction and functional improvement in individuals with adhesive capsulitis. Pain Neuroscience Education (PNE) is an educational approach designed to improve patients' understanding of pain mechanisms and reduce maladaptive beliefs related to pain. Core stabilization exercises, particularly those based on Dynamic Neuromuscular Stabilization (DNS) principles, aim to improve postural control, neuromuscular coordination, and movement efficiency.
Although the effectiveness of Mulligan mobilization has been investigated in patients with adhesive capsulitis, there is limited evidence regarding the use of Pain Neuroscience Education in this population, and the effects of DNS-based core stabilization exercises have not been adequately studied. Furthermore, no previous study has examined the combined effects of Mulligan mobilization, Pain Neuroscience Education, and core stabilization exercises in individuals with adhesive capsulitis.
This randomized controlled trial aims to evaluate the short-term effects of a combined intervention consisting of Mulligan mobilization, Pain Neuroscience Education, and core stabilization exercises on pain intensity, shoulder range of motion, shoulder function, pain catastrophizing, scapular dyskinesis, core stability, and health-related quality of life in individuals with adhesive capsulitis.
Participants diagnosed with adhesive capsulitis will be randomly allocated to one of two groups. The experimental group will receive Mulligan mobilization, Pain Neuroscience Education, and DNS-based core stabilization exercises. The control group will receive conventional physical therapy consisting of transcutaneous electrical nerve stimulation (TENS), hot-pack application, passive joint mobilization, and stretching exercises. Both groups will participate in treatment sessions three times per week for six weeks. Assessments will be conducted at baseline and after completion of the intervention period.
The findings of this study may contribute to the development of a more comprehensive rehabilitation approach for individuals with adhesive capsulitis and provide evidence regarding the effectiveness of combining manual therapy, pain education, and core stabilization strategies in clinical practice.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind (outcomes assessor)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Experimental - Combined Treatment Group | Experimental | Behavioral: Pain Neuroscience Education (PNE), Procedure: Mulligan Mobilization With Movement (MWM), Behavioral: Core Stabilization ExercisesMulligan Mobilization + Pain Neuroscience Education + Core Stabilization Exercises |
| Active Comparator - Conventional Physical Therapy Group | Active comparator | Other: Conventional Physical TherapyConventional Physical Therapy (TENS + hot-pack + ROM Exercises + Stretching Exercises) |
Who may qualify
- Ages
- 18 to 65 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (8 listed)
- Adults aged 18 to 65 years
- Diagnosis of adhesive capsulitis confirmed by an orthopedic surgeon or a physical medicine and rehabilitation physician
- Presence of shoulder pain and limitation of shoulder range of motion
- Ability to communicate verbally
- Ability to understand study procedures and educational content
Key exclusion criteria (11 listed)
- MMSE score below 24
- Severe cognitive impairment
- Severe psychiatric disorders
- Active infectious disease
- Active malignancy
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Pain Neuroscience Education (PNE)Participants will receive Pain Neuroscience Education focused on the biopsychosocial nature of pain, central sensitization, the distinction between pain and tissue damage, and strategies to reduce fear of movement. The initial educational session will last approximately 15-20 minutes, followed by 5-10 minute reinforcement sessions throughout the intervention period. Education will be delivered through verbal explanations and interactive discussion. | Behavioural | Experimental - Combined Treatment Group |
| Mulligan Mobilization With Movement (MWM)Participants will receive Mulligan Mobilization with Movement techniques applied to the glenohumeral joint, including posterolateral glide with active abduction, inferior glide with shoulder flexion, and posterior glide with internal rotation. Mobilizations will be performed within a pain-free range of motion. Each technique will be administered in 3 sets of 10 repetitions with 30 seconds of rest between sets. Treatment will be provided three times per week for six weeks | Procedure or surgery | Experimental - Combined Treatment Group |
| Core Stabilization ExercisesParticipants will perform Dynamic Neuromuscular Stabilization (DNS)-based core stabilization exercises. The program will include diaphragmatic breathing, supine 90/90 positioning, abdominal bracing, and progression to dead bug, bird-dog, and modified plank exercises as tolerated. Exercises will be performed in 2-3 sets of 8-12 repetitions with 10-20 second isometric holds. Progression will occur from stable to unstable surfaces and from static to dynamic activities | Behavioural | Experimental - Combined Treatment Group |
| Conventional Physical TherapyParticipants in the control group will receive conventional physical therapy consisting of transcutaneous electrical nerve stimulation (TENS) applied at a sensory level for 20 minutes, hot-pack application for 20 minutes, passive shoulder joint mobilization exercises, pendulum exercises, and wand exercises. Treatment sessions will be conducted three times per week for six weeks. | Other | Active Comparator - Conventional Physical Therapy Group |
Primary outcome
Pain Intensity
Time frame: Baseline and week 6
Pain intensity during movement will be assessed using the Visual Analog Scale (VAS). Higher scores indicate greater pain intensity.
Shoulder Function
Time frame: Baseline and week 6
Shoulder pain, function, and patient satisfaction will be evaluated using the Penn Shoulder Score (PSS). Higher scores indicate better shoulder function.
Shoulder Range of Motion
Time frame: Baseline and week 6
Active shoulder flexion, abduction, internal rotation, and external rotation range of motion will be measured using a goniometer.
4 secondary outcomes
Pain Catastrophizing
Time frame: Baseline and week 6
Core Stability
Time frame: Baseline and week 6
Change in Scapular Dyskinesis
Time frame: Baseline and week 6
Change in Health-Related Quality of Life
Time frame: Baseline and week 6
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 4 Aug 2026.
- BackgroundSullivan MJL, Bishop SR, Pivik J. The Pain Catastrophizing Scale: Development and validation. Psychological Assessment. 1995;7(4):524-532.
- Background: PubMed 16596890Leggin BG, Michener LA, Shaffer MA, Brenneman SK, Iannotti JP, Williams GR Jr. The Penn shoulder score: reliability and validity. J Orthop Sports Phys Ther. 2006 Mar;36(3):138-51. doi: 10.2519/jospt.2006.36.3.138.
- Background: PubMed 35099430Razzaq A, Nadeem RD, Akhtar M, Ghazanfar M, Aslam N, Nawaz S. Comparing the effects of muscle energy technique and mulligan mobilization with movements on pain, range of motion, and disability in adhesive capsulitis. J Pak Med Assoc. 2022 Jan;72(1):13-16. doi: 10.47391/JPMA.1360.
- Background: PubMed 23037929Doner G, Guven Z, Atalay A, Celiker R. Evalution of Mulligan's technique for adhesive capsulitis of the shoulder. J Rehabil Med. 2013 Jan;45(1):87-91. doi: 10.2340/16501977-1064.
- Individual participant dataSharing planned: No
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part.
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Pain Neuroscience Education (PNE), Mulligan Mobilization With Movement (MWM) and Core Stabilization Exercises in people with Frozen Shoulder, run by Yeditepe University at 1 site in Turkey (Türkiye).
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 8 inclusion and 11 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: looking for participants now, as of the sponsor's last update on 4 Aug 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Turkey (Türkiye). Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
Contact Dilay Döner (+90 0535 019 58 83, dilay.doner@std.yeditepe.edu.tr), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Pain Intensity (time frame: Baseline and week 6). The study lists 3 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT07667556, which also lists 4 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 4 Aug 2026.