The effect of breathing exercises on pain, range of motion and quality of life in frozen shoulder rehabilitation: A randomized controlled study

Objective This randomized controlled trial evaluated the effects of breathing exercises as an adjunct to conventional physiotherapy on pain, range of motion (ROM), and quality of life (QoL) in patients with frozen shoulders. Methods Forty participants (mean age 48.2 ± 9.6 years) with adhesive capsulitis were randomly allocated to either: (1) an intervention group receiving 15 sessions of conventional physiotherapy plus diaphragmatic/costal breathing exercises (n = 20), or (2) a control group receiving conventional physiotherapy alone (n = 20). Conventional therapy included ultrasound, TENS, Codman exercises, and stretching. Primary outcomes included visual analog scale (VAS) for pain, digital goniometer-measured shoulder ROM, and SF-36 QoL questionnaire, assessed at baseline and post-intervention. Results Both groups showed a significant within-group reduction in post-treatment VAS scores compared with baseline (p < 0.001); the between-group difference in pain was not significant, although a significant Group × Time interaction (p = 0.007) and a lower mean post-treatment pain score in the intervention group were observed. The intervention group demonstrated significantly greater improvements in shoulder abduction (p = 0.03) and external rotation (p = 0.04) compared to controls. SF-36 results revealed between-group differences favoring the intervention group in physical role (p = 0.02) and social functioning (p = 0.03) domains, with significant group-time interactions for physical functioning, emotional role, pain, and general health (all p < 0.05). Conclusion Breathing exercises combined with conventional physiotherapy provided additional benefits for improving shoulder mobility (particularly abduction/external rotation) and quality of life domains in frozen shoulder patients, though pain reduction was equivalent between groups. These findings support the integration of respiratory exercises as a complementary approach in frozen shoulder rehabilitation.