Comparative efficacy of different joint mobilization techniques in shoulder adhesive capsulitis: a systematic review and meta-analysis of randomized controlled trials

OBJECTIVES: Conservative management of shoulder adhesive capsulitis primarily relies on physical therapy, with non-thrust joint mobilization representing a fundamental component. This systematic review compared the clinical effects of different non-thrust joint mobilization approaches on objective and subjective outcomes among individuals with shoulder adhesive capsulitis. METHODS: English-language randomized controlled trials published between January 1, 2000, and November 30, 2025, were identified by systematically searching PubMed, the Cochrane Central Register of Controlled Trials, Web of Science, Scopus, and ScienceDirect. Eligible trials evaluated the clinical effects of different non-thrust joint mobilization approaches, delivered alone or in combination with other interventions, on objective and subjective outcomes in individuals with shoulder adhesive capsulitis. RESULTS: The Mulligan mobilization approach, compared with the Maitland mobilization approach, was more effective in restoring ranges of shoulder abduction and external rotation and decreasing shoulder pain and disability, with mean differences of 1.49 (95% CI: 0.91 to 2.07), 1.26 (95% CI: 0.85 to 1.67), and -1.23 (95% CI: -2.39 to -0.07), respectively. In addition, the random-effects model exhibited a statistically significant difference between posterior and anterior Kaltenborn mobilization techniques in the range of shoulder external rotation, with a mean difference of 2.56 (95% CI: 1.92 to 3.19). CONCLUSIONS: The comparative effects of non-thrust joint mobilization techniques in adhesive capsulitis appear to be technique-specific and outcome-dependent. Although Mulligan and posterior Kaltenborn mobilization showed favorable effects for selected outcomes, the certainty of evidence was very low. Therefore, no single mobilization technique can currently be recommended as universally superior.