For a moderately irritable adhesive capsulitis patient, which manual therapy approach is appropriate?

• A. End-range techniques into tissue resistance with low amplitude
• B. Only low-intensity techniques with no movement into tissue resistance
• C. Techniques that progress into tissue resistance can be used if there is no post-intervention pain
• D. Very little joint mobilization should be used until low irritability is achieved; passive ROM only

Answer: (C)

For moderately irritable adhesive capsulitis, you can use mobilizations that reach and move into tissue resistance, as long as the patient does not have increased pain after the session. The key idea is to challenge the joint gradually to lengthen and remodel the tight capsule, but you must monitor the patient’s pain response. If there’s no post-treatment pain, progressing into the end feel helps restore ROM without provoking inflammation. If pain flares after treatment, back off the dosage and avoid moving into resistance for now. This approach balances mobility gains with symptom safety, which is appropriate for a moderate level of irritability.