Comparison of Niel-Asher and Spencer Techniques in Frozen Shoulder Patients

NCT07080060 | Not Yet Recruiting

• 1 other identifier: REC/RCR & AHS/24/0167- Minahil
• Study Type: interventional
• Target: 44
• Locations: 1 country
• Sites: 1

Brief Summary

This study aims to compare the effectiveness of two manual therapy techniques-Niel-Asher Technique and Spencer Technique-when combined with conventional physiotherapy in treating patients with frozen shoulder (adhesive capsulitis). Frozen shoulder is a painful condition that limits movement and function of the shoulder joint. The study will include 44 adults aged 35 to 65 years who have been diagnosed with stage II frozen shoulder. Participants will be randomly assigned to one of two groups. Both groups will receive standard physiotherapy, including heat therapy, TENS, and stretching exercises. In addition, one group will receive the Niel-Asher Technique, while the other group will receive the Spencer Technique. Pain, range of motion, and shoulder function will be measured before and after a 4-week treatment period using validated tools such as the Visual Analogue Scale (VAS), a goniometer, and the Shoulder Pain and Disability Index (SPADI). The goal is to determine which manual therapy technique is more effective in improving symptoms and function in patients with frozen shoulder.

Conditions

Frozen Shoulder; Adhesive Capsulitis

Keywords

Manual Therapy; Niel-Asher Technique; Spencer Technique; Pain; Range of motion

Outcome Measures

Primary Outcomes (3)

• Numeric Pain Rating Scale

  Pain intensity in the affected shoulder will be assessed using the Visual Analogue Scale (VAS), a validated 10-point scale where 0 indicates "no pain" and 10 indicates "worst imaginable pain." A decrease in score indicates pain reduction.

  Baseline and 4 Weeks Post-Treatment

• Shoulder Range of Motion (ROM)

  Shoulder joint range of motion, including flexion, abduction, and external rotation, will be measured using a universal goniometer. ROM will be recorded in degrees. An increase in ROM values indicates functional improvement.

  Baseline and 4 Weeks Post-Treatment

• Shoulder Pain and Disability Index (SPADI)

  Shoulder function will be evaluated using the Shoulder Pain and Disability Index (SPADI), a self-reported questionnaire assessing pain and disability. Scores range from 0 (no pain/disability) to 100 (maximum pain/disability). A reduction in score indicates functional improvement.

  Baseline and 4 Weeks Post-Treatment

Study Arms (2)

Niel-Asher Technique

EXPERIMENTAL

Participants in this group will receive the Niel-Asher Technique, a manual therapy approach focusing on trigger point release and myofascial decompression of the shoulder girdle. Treatment will involve structured pressure techniques applied to specific muscular trigger points including the infraspinatus, supraspinatus, subscapularis, and levator scapulae. The intervention will be delivered in side-lying and sitting positions.

Other: Niel-Asher Technique

Spencer Technique

EXPERIMENTAL

Participants in this group will receive the Spencer Technique, an osteopathic manual therapy consisting of eight mobilization steps: extension, flexion, circumduction with compression, circumduction with distraction, abduction, adduction with external rotation, internal rotation, and traction stretch. Each movement will be performed with patient participation using muscle energy techniques.

Other: Spencer Technique

Interventions

Niel-Asher Technique OTHER

Participants in this group will receive the Niel-Asher Technique, a manual therapy approach focusing on trigger point release and myofascial decompression of the shoulder girdle. Treatment will involve structured pressure techniques applied to specific muscular trigger points including the infraspinatus, supraspinatus, subscapularis, and levator scapulae. The intervention will be delivered in side-lying and sitting positions. Conventional physiotherapy, includes a 10-minute hot pack, 15-minute TENS, Codman exercises, finger ladder exercises (2-3 sets, 3-5 repetitions), and capsular stretching (20-30 sec hold, 2-4 repetitions). Sessions will be conducted 3 times per week for 4 weeks.

Niel-Asher Technique

Spencer Technique OTHER

Participants in this group will receive the Spencer Technique, an osteopathic manual therapy consisting of eight mobilization steps: extension, flexion, circumduction with compression, circumduction with distraction, abduction, adduction with external rotation, internal rotation, and traction stretch. Each movement will be performed with patient participation using muscle energy techniques. Conventional physiotherapy, includes a 10-minute hot pack, 15-minute TENS, Codman exercises, finger ladder exercises (2-3 sets, 3-5 repetitions), and capsular stretching (20-30 sec hold, 2-4 repetitions). Sessions will be conducted 3 times per week for 4 weeks.

Spencer Technique

Eligibility Criteria

• Age: 35 Years - 65 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Age group between 35-65 years diagnosed with primary Adhesive Capsulitis.
• Both gender male and female.
• Both Active and passive Range of Motion is limited.
• Stage II Frozen Shoulder patients (Freezing Stage,3-9 months).
• More than 50% of range of motion is limited in Flexion, Abduction and External rotation as compared to unaffected side.
• Pain reported on VAS score \<7/10 in shoulder region.
• Patients agree to sign written consent form.

You may not qualify if:

• Patients with systemic illness:
• Diabetes Mellitus, Thyroid disorders.
• Rheumatoid Arthritis, Malignancy.
• Patients with mechanical injuries like:
• Rotator Cuff injury, Ligamentous Injuries.23
• Previous Surgery or Manipulation under Anesthesia.
• Patients with Stage I, III, IV of Frozen Shoulder.
• Patient reported with VAS score \>7/10 in shoulder region.

Sponsors & Collaborators

• Riphah International University: lead

Study Sites (1)

Noor Thalassemia Foundation

Lahore, Punjab Province, 54000, Pakistan

Location

Related Publications (5)

• Cavalleri E, Servadio A, Berardi A, Tofani M, Galeoto G. The effectiveness of physiotherapy in idiopathic or primary frozen shoulder. A systematic review and meta- analysis. MLTJ MUSCLES, LIGAMENTS AND TENDONS JOURNAL. 2020;10(1):24-39.

  BACKGROUND

• Tang CK, Shih YF, Lee CS. The effect of muscle-biased manual therapy on shoulder kinematics, muscle performance, functional impairment, and pain in patients with frozen shoulder. J Hand Ther. 2025 Jan-Mar;38(1):42-51. doi: 10.1016/j.jht.2024.02.010. Epub 2024 Jun 29.

  PMID: 38944638 BACKGROUND

• Raghav D, Krishnapandian PR, Dwivedi A. Comparative Effect of Niel-Asher Technique and Positional Release Technique on Pain, Active ROM and Functional Disability in Adhesive Capsulitis: An Experimental Study. JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH. 2023 Apr 1;17(4):YC01-5.

  BACKGROUND

• Phansopkar P, Qureshi MI. A Research Protocol on Comparative evaluation of Efficacy of Spencer Technique, Kaltenborn, Mulligan, and Maitland mobilization on Pain, Range of Motion and Functional Disability in Frozen Shoulder.

  BACKGROUND

• Riaz H, Javed A, Ali H, Kazmi YA, Naz S, Javed Z. COMPARATIVE EFFECT OF SPENCER TECHNIQUE VS MULLIGAN MOBILIZATION ON ROM AND FUNCTIONAL DISABILITY AMONG ADHESIVE CAPSULITIS PATIENTS. Insights-Journal of Health and Rehabilitation. 2025 Jan 27;3(3 (Health & Rehab)):156-65.

  BACKGROUND

MeSH Terms

Conditions

Bursitis; Pain

Condition Hierarchy (Ancestors)

Joint Diseases; Musculoskeletal Diseases; Neurologic Manifestations; Signs and Symptoms; Pathological Conditions, Signs and Symptoms

Study Officials

• Amna Zia, Phd Scholar

  Riphah International University/ Mayo Hospital

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Samrood Akram, Phd Scholar

CONTACT

03324806143; samood.akram@riphah.edu.pk

Amna Zia, Phd Scholar

CONTACT

03244686993; amna_zia_17@live.com

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: DOUBLE
• Who Masked: PARTICIPANT, OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: July 14, 2025
• First Posted: July 23, 2025
• Study Start: July 1, 2025
• Primary Completion: November 15, 2025
• Study Completion: November 30, 2025
• Last Updated: July 23, 2025

Record last verified: 2025-07

Data Sharing

• IPD Sharing: Will not share

Locations

PA (1)