Guzmán-García Rafael, Pérez-Montalbán María, Pruimboom Leo, Navarro-Ledesma Santiago
Medicine and Public Health PhD Program, Faculty of Health Sciences, University of Granada, Av. de la Ilustración, 60, 18071 Granada, Spain.
Department of Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, University of Sevilla, C. Avenzoar, 6, 41009 Sevilla, Spain.
J Clin Med. 2025 Jun 26;14(13):4539. doi: 10.3390/jcm14134539.
Frozen shoulder (FS) is a common musculoskeletal condition with significant socioeconomic impact. Despite its prevalence, the condition lacks a definitive understanding and universally effective treatment approach. To evaluate the effects of an intervention combining manual therapy, conventional exercises, and strategies to improve sleep quality and circadian rhythm on recovery and biomarkers in patients with FS. A single-blind, randomized, controlled trial was conducted with 34 participants divided into control and experimental groups (n = 17 each). Both groups received manual therapy and conventional exercises, while the experimental group (EG) also received sleep and circadian rhythm optimization instructions. Biomarkers (fasting glucose, insulin, Homeostasis Model Assessment of Insulin Resistance (HOMA) index, leptin, triglycerides, total cholesterol, HDL cholesterol, uric acid, CRP, IL-1β, IL-6, IL-17, IL-10, IL-33, HMGB1, and TNF-α) and functional outcomes (SPADI, ROM, and PSQI) were assessed pre- and post-intervention. After six weeks, the EG showed significant improvements in IL-10 levels (mean change: 2.5 pg/mL vs. 0.5 pg/mL in the control group (CG), = 0.03), IL-6 reduction (-1.8 pg/mL vs. -0.4 pg/mL, = 0.02), and HOMA index (-0.8 vs. -0.2, = 0.04). ROM improved by 20 degrees in the EG versus 10 degrees in the CG ( = 0.01), SPADI scores decreased by 25 points versus 15 points ( = 0.03), and PSQI improved by 4 points compared to 2 points ( = 0.05). The integration of sleep quality and circadian rhythm optimization into conventional rehabilitation significantly enhances recovery, particularly IL-10 modulation, but these did not translate into superior clinical improvements within the study period. Further long-term studies are needed to confirm whether early biological effects lead to sustained functional recovery in FS patients.
肩周炎（FS）是一种常见的肌肉骨骼疾病，具有重大的社会经济影响。尽管其发病率较高，但对该疾病的认识尚不明确，也缺乏普遍有效的治疗方法。为了评估一种结合手法治疗、传统运动以及改善睡眠质量和昼夜节律策略的干预措施对FS患者恢复情况和生物标志物的影响。进行了一项单盲、随机、对照试验，34名参与者被分为对照组和实验组（每组n = 17）。两组均接受手法治疗和传统运动，而实验组（EG）还接受了睡眠和昼夜节律优化指导。在干预前后评估生物标志物（空腹血糖、胰岛素、胰岛素抵抗稳态模型评估（HOMA）指数、瘦素、甘油三酯、总胆固醇、高密度脂蛋白胆固醇、尿酸、CRP、IL-1β、IL-6、IL-17、IL-10、IL-33、HMGB1和TNF-α）和功能结局（SPADI、ROM和PSQI）。六周后，实验组的IL-10水平有显著改善（平均变化：2.5 pg/mL，对照组（CG）为0.5 pg/mL，P = 0.03），IL-6降低（-1.8 pg/mL对-0.4 pg/mL，P = 0.02），HOMA指数降低（-0.8对-0.2，P = 0.04）。实验组的ROM改善了20度，而对照组改善了10度（P = 0.01），SPADI评分降低了25分，而对照组降低了15分（P = 0.03），PSQI改善了4分，对照组改善了2分（P = 0.05）。将睡眠质量和昼夜节律优化纳入传统康复治疗可显著促进恢复，尤其是对IL-10的调节，但在研究期间这些并未转化为更优的临床改善效果。需要进一步的长期研究来证实早期生物学效应是否会导致FS患者持续的功能恢复。
