In adhesive capsulitis, stretching should be performed within tissue irritability limits because over-stretching can worsen outcomes.

• A. Stretching at least two times per day will maximize ROM gains.
• B. Stretching beyond limits of a patient's pain can lead to poor outcomes.
• C. Stretching for sixty seconds with two repetitions per stretch increases pain.
• D. Stretching should be avoided in high irritability patients only.

Answer: (B)

In adhesive capsulitis, the goal of stretching is to work tissues at a safe, tolerable level rather than pushing through pain. The joint capsule and surrounding structures are inflamed and fibrotic, so they have a limited tolerance for stretch. Going beyond the patient's pain limits can provoke increased pain, swelling, and protective muscle guarding, which can worsen inflammation, delay recovery, and even reduce ROM gains. By keeping stretches within tissue irritability limits, you promote gradual, safe remodeling of the capsule while avoiding temporary spikes in symptoms. If someone has higher irritability, you still stretch, but at gentler intensities, shorter holds, and closer symptom monitoring; as irritability lessens, progression can be made.