Mulligan and Proprioceptive Neuromuscular Facilitation Techniques in Individuals With Rotator Cuff Lesions

NCT07294729 | Active Not Recruiting

• 1 other identifier: E-10840098-202.3.02-7892
• Study Type: interventional
• Target: 45
• Locations: 1 country
• Sites: 1

Brief Summary

This study aims to compare the effects of Mulligan mobilization with movement (MWM) and Proprioceptive Neuromuscular Facilitation (PNF) techniques on pain, functionality, proprioception, and quality of life in individuals diagnosed with rotator cuff lesions. A total of 45 participants aged 30-70 years with partial supraspinatus tears confirmed by clinical and radiological assessment will be randomly assigned to three groups: conventional physiotherapy, Mulligan + conventional physiotherapy, and PNF + conventional physiotherapy. All groups will receive a standardized three-week physiotherapy program, while the Mulligan and PNF groups will additionally undergo their respective manual therapy interventions. Outcome measures will include pain intensity (VAS), shoulder range of motion, functional disability (DASH), joint position sense, and rotator cuff-specific quality of life (RC-QoL). The study seeks to determine which manual therapy approach (Mulligan or PNF) provides superior improvements in clinical outcomes compared with conventional treatment alone.

Conditions

Rotator Cuff Syndrome; Rotator Cuff Injuries

Keywords

Rotator Cuff Syndrome; Mulligan Mobilization; Manual Therapy; Proprioceptive Neuromuscular Facilitation; Physiotherapy; Shoulder Rehabilitation

Outcome Measures

Primary Outcomes (1)

• Joint Position Sense

  Joint position sense will be assessed using the Becure Extremity ROM system. Joint position sense will be assessed at 60 degrees of shoulder flexion and shoulder abduction. While standing, the participant will first be asked to lift the arm with eyes open and memorize the position at 60 degrees. Then, with eyes closed, the participant will be instructed to raise the arm to the same position reached when the eyes were open. The shoulder angle obtained with eyes closed will be recorded. The difference between the angles measured with eyes open and eyes closed will be considered the joint position sense error. This method will be performed at 60 degrees of both flexion and abduction.

  3 weeks

Secondary Outcomes (4)

• Pain (VAS Score)

  3 weeks

• Range of Motion (Shoulder Flexion, Abduction, Internal and External Rotation Measured in Degrees)

  3 weeks

• Disability (DASH Questionnaire Score)

  3 weeks

• Quality of Life (RC-QoL Score)

  3 weeks

Study Arms (3)

Control Group (Conventional Physiotherapy)

ACTIVE COMPARATOR

All participants will receive a conventional physiotherapy program for 3 weeks, 4 days per week. The program includes wand exercises in all directions (10 repetitions with a 2-second end-range hold), Codman pendulum exercises in flexion, abduction, and circular motions (10 repetitions), stretching exercises held for 20 seconds for 5 repetitions in all directions, and finger-ladder exercises for flexion and abduction (10 repetitions). Strengthening exercises will be performed using elastic bands selected according to each participant's physical capacity (3 sets of 10 repetitions). All sessions will be supervised by a physiotherapist. Additionally, TENS will be applied to the painful area at 100 Hz for 20 minutes in each session.

Other: Control Group (Conventional Physiotherapy)

Mulligan Group

EXPERIMENTAL

In the Mulligan group, the MWM (Movement With Mobilization) technique will be applied in addition to the conventional exercise program. MWM will be performed twice a week for 3 weeks in flexion, abduction, internal rotation, and external rotation. The technique will be applied before exercises. A mobilization belt will be used to provide an effective glide, and participants will first demonstrate the painful or restricted movement. The belt will be placed around the shoulder, and the joint positioned pain-free. A glide force will be applied while the participant performs the movement actively, followed by a 3-second hold at the end range. The first two sessions will include 10 repetitions; subsequent sessions will include 3 sets of 10 repetitions. Participants will be positioned supine for rotation techniques and seated for flexion and abduction.

Other: Control Group (Conventional Physiotherapy); Other: Mulligan Mobilization

Proprioceptive Neuromuscular Facilitation Group

EXPERIMENTAL

Before the standard physiotherapy and exercise program, the "hold-relax active movement" technique will be applied to increase circulation around the joint and enhance muscle activation. This technique is based on repeated isotonic contractions that do not require continuous effort. The physiotherapist will first ask the participant to perform an isometric contraction in the shortened position of the agonist pattern. Then the participant will be instructed to relax, and the segment will be moved quickly and passively into the lengthened position of the antagonist pattern. The participant will then be asked to perform an isotonic contraction of the agonist pattern again. This sequence will be repeated several times until contraction is adequately felt in the weak muscles or until fatigue occurs. Care will be taken to ensure that the passive movement into the antagonist direction is performed smoothly and quickly.

Other: Control Group (Conventional Physiotherapy); Other: Proprioceptive Neuromuscular Facilitation

Interventions

Control Group (Conventional Physiotherapy) OTHER

Participants in the control group will receive a supervised conventional physiotherapy program consisting of wand, pendulum, stretching, and finger-ladder exercises, strengthening with elastic bands, and TENS applied to the painful area at 100 Hz for 20 minutes per session.

Control Group (Conventional Physiotherapy); Mulligan Group; Proprioceptive Neuromuscular Facilitation Group

Mulligan Mobilization OTHER

Participants in the Mulligan group will receive the conventional physiotherapy program plus Mulligan Movement With Mobilization (MWM) techniques applied twice weekly before exercises. The physiotherapist will use a mobilization belt to provide joint glide while participants perform pain-free active movements in flexion, abduction, and rotation.

Mulligan Group

Proprioceptive Neuromuscular Facilitation OTHER

Participants in the PNF group will receive the conventional physiotherapy program plus PNF "hold-relax active movement" techniques applied before exercises. The physiotherapist will guide participants through repeated isometric, passive, and isotonic contractions to enhance proprioceptive input, muscle activation, and joint mobility.

Proprioceptive Neuromuscular Facilitation Group

Eligibility Criteria

• Age: 30 Years - 70 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Male and female participants between 30 and 70 years of age.
• A diagnosis of partial supraspinatus tear made by a physical medicine and rehabilitation s-specialist.
• Confirmation of the diagnosis through radiological imaging methods.
• No history of any shoulder surgery.
• Shoulder symptoms persisting for more than 4 weeks.

You may not qualify if:

• Individuals who are unable to cooperate or who have mental health problems.
• Individuals who have participated in any shoulder-related physiotherapy program within the last 3 months.
• Individuals with other musculoskeletal conditions that may affect the shoulder region.

Sponsors & Collaborators

• Medipol University: lead

Study Sites (1)

Emre Dansuk

Istanbul, Beykoz, 34815, Turkey (Türkiye)

Location

MeSH Terms

Conditions

Rotator Cuff Injuries

Interventions

Control Groups; Muscle Stretching Exercises

Condition Hierarchy (Ancestors)

Rupture; Wounds and Injuries; Shoulder Injuries; Tendon Injuries

Intervention Hierarchy (Ancestors)

Epidemiologic Research Design; Epidemiologic Methods; Investigative Techniques; Research Design; Methods; Exercise Therapy; Rehabilitation; Aftercare; Continuity of Patient Care; Patient Care; Therapeutics; Physical Therapy Modalities; Exercise; Motor Activity; Movement; Musculoskeletal Physiological Phenomena; Musculoskeletal and Neural Physiological Phenomena

Study Officials

• Emre Dansuk, PhD

  Medipol University

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: DOUBLE
• Who Masked: PARTICIPANT, OUTCOMES ASSESSOR
• Masking Details: Participants and outcomes assessors will be blinded to group allocation. The care providers administering the interventions will not be blinded due to the nature of the manual therapy techniques. Group assignments will be concealed using coded identifiers, and outcome assessments will be performed by an assessor who is unaware of the participants' treatment groups.
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Principal Investigator

Model Details: This study uses a parallel-group randomized controlled trial design in which participants with rotator cuff lesions are assigned to one of three groups: (1) Conventional Physiotherapy, (2) Mulligan Mobilization With Movement plus Conventional Physiotherapy, or (3) Proprioceptive Neuromuscular Facilitation plus Conventional Physiotherapy.

Study Record Dates

• First Submitted: December 8, 2025
• First Posted: December 19, 2025
• Study Start: December 25, 2025
• Primary Completion: April 20, 2026
• Study Completion: April 25, 2026
• Last Updated: March 19, 2026

Record last verified: 2026-03

Locations

TU (1)