Effects of Muscle Energy Techniques With and Without Manual Axial Distraction in Post-Mastectomy Patients With Axillary Web Syndrome

NCT07266623 | Not Yet Recruiting DMC

• 1 other identifier: UBAS/ERB/FoRS/25/031
• Study Type: interventional
• Target: 58
• Locations: 0 countries
• Sites: N/A

Brief Summary

This randomized controlled trial aims to evaluate the effects of muscle energy techniques with and without manual axial distraction among post-mastectomy patients with axillary web syndrome. Fifty-eight participants will be randomly allocated into two groups and will receive the interventions for six weeks. It is hypothesized that the group that will receive both the muscle energy technique and manual axial distraction will produce greater improvements compared to the other group that will receive only MET.

Conditions

Axillary Web Syndrome; Post-mastectomy

Keywords

Axillary web syndrome; Muscle energy techniques; Manual axial distraction; Functional outcomes; Range of motion

Outcome Measures

Primary Outcomes (2)

• Pain Intensity

  Participants will be asked to rate the pain by using an outcome measure tool, NPRS, a numeric pain rating scale that ranges from 0 to 10. O means no pain, 1-3 means mild pain, 4-6 means moderate pain, 7-10 means severe pain.

  Baseline: Before intervention 6 weeks post-intervention

• Shoulder Range of Motion

  Shoulder range of motion of the affected side will be measured by using an outcome measure tool, goniometry. Shoulder flexion and abduction ranges will be assessed in the sitting position. Each movement will be performed thrice, and the average values will be analyzed accordingly.

  Baseline: Before intervention 6 weeks post-intervention

Secondary Outcomes (1)

• Functional Outcomes

  Baseline: Before intervention 6 weeks post-intervention

Study Arms (2)

Group A (Muscle energy technique + Manual axial distraction)

EXPERIMENTAL

Other: Muscle energy technique + Manual axial distraction

Group B (Muscle energy technique only)

EXPERIMENTAL

Other: Muscle energy technique

Interventions

Muscle energy technique + Manual axial distraction OTHER

In the MET+ MAD group, a combination of muscle energy techniques and manual axial distraction will be applied on the affected side. The use of MET will target the pectoralis major, supraspinatus, subscapularis, and latissimus dorsi muscles. The participant will contract the targeted muscle for 10 seconds and then relax it. After that, the therapist will stretch that muscle for 10 to 30 seconds, along with manual axial distraction applied to the affected shoulder. The technique of manual axial distraction will employ firm digital pressure combined with distraction at various points over the fibrous band. The intervention will be given 3 times a week for 6 weeks, intensity will be according to the participants' tolerance. Each session will continue for 30 to 40 minutes

Group A (Muscle energy technique + Manual axial distraction)

Muscle energy technique OTHER

Group B will receive only the muscle energy techniques targeting the pectoralis major, supraspinatus, subscapularis, and lattisimus dorsi muscles on the affected side. The participants will contract the target muscle for 10 seconds and then relax it. After that, the therapist will stretch that muscle for 10 to 30 seconds. The intervention will be given three times a week for six weeks, and each session will continue for 30 to 40 minutes.

Group B (Muscle energy technique only)

Eligibility Criteria

• Age: 30 Years - 60 Years
• Gender Eligibility Details: Females
• Healthy Volunteers: No
• Age Groups: Adult (18-64)

You may qualify if:

• Patients diagnosed with AWS following breast cancer surgery
• Females aged 30 to 60 years old
• Participants must be within 1 month to 2 years post-surgery
• Participants having limited shoulder ROM
• Participants must have completed their post-surgery radiation therapy and chemotherapy minimum of 2-3 weeks

You may not qualify if:

• Any previous history of shoulder pathology
• Patients with a cervical problem that radiates pain down the shoulder
• Pregnant females
• Bilateral mastectomy
• Ongoing cancer stage
• Participants with ongoing chemotherapy
• Frozen shoulder

Sponsors & Collaborators

• Lahore University of Biological and Applied Sciences: lead

Related Publications (5)

• Koehler LA, Blaes AH, Haddad TC, Hunter DW, Hirsch AT, Ludewig PM. Movement, Function, Pain, and Postoperative Edema in Axillary Web Syndrome. Phys Ther. 2015 Oct;95(10):1345-53. doi: 10.2522/ptj.20140377. Epub 2015 May 14.

  PMID: 25977305 BACKGROUND

• Meer TA, Noor R, Bashir MS, Ikram M. Comparative effects of lymphatic drainage and soft tissue mobilization on pain threshold, shoulder mobility and quality of life in patients with axillary web syndrome after mastectomy. BMC Womens Health. 2023 Nov 10;23(1):588. doi: 10.1186/s12905-023-02762-w.

  PMID: 37950230 BACKGROUND

• Gonzalez-Rubino JB, Vinolo-Gil MJ, Martin-Valero R. Effectiveness of physical therapy in axillary web syndrome after breast cancer: a systematic review and meta-analysis. Support Care Cancer. 2023 Apr 12;31(5):257. doi: 10.1007/s00520-023-07666-x.

  PMID: 37043039 BACKGROUND

• Gonzalez-Rubino JB, Martin-Valero R, Vinolo-Gil MJ. Physiotherapy protocol to reduce the evolution time of axillary web syndrome in women post-breast cancer surgery: a randomized clinical trial. Support Care Cancer. 2025 Mar 28;33(4):326. doi: 10.1007/s00520-025-09373-1.

  PMID: 40153020 BACKGROUND

• Sandrin F, Nevola Teixeira LF, Garavaglia M, Gandini S, Simoncini MC, Luini A. The efficacy in shoulder range of motion of a snapping manual maneuver added to a standardized exercise protocol in axillary web syndrome: a randomized controlled trial. Acta Oncol. 2023 Aug;62(8):969-976. doi: 10.1080/0284186X.2023.2241995. Epub 2023 Sep 26.

  PMID: 37750301 BACKGROUND

Study Officials

• Muhammad Tariq Shafi

  Lahore University of Biological and Applied Sciences

  STUDY CHAIR

Central Study Contacts

Tayyba Majeed

CONTACT

+923019491681; tayybamajeed501@gmail.com

Muhammad Tariq Shafi

CONTACT

+92345190056; muhammadtariq@ubas.edu.pk

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Masking Details: Due to the nature of the intervention, the blinding of participants and therapists was not feasible. To overcome the assessment bias, the outcome assessor remained blinded to group allocations, maintaining single blinded study design
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: November 24, 2025
• First Posted: December 5, 2025
• Study Start: December 13, 2025
• Primary Completion (Estimated): May 25, 2026
• Study Completion (Estimated): May 30, 2026
• Last Updated: December 22, 2025

Record last verified: 2025-12

Data Sharing

• IPD Sharing: Will not share