Combined Effects of Niel Asher Technique and Scapular Clock Exercises in Adhesive Capsulitis

NCT07484386 | Completed

• 1 other identifier: REC/RCR & AHS/24/0182
• Study Type: interventional
• Target: 34
• Locations: 1 country
• Sites: 1

Brief Summary

One of the most common shoulder condition in developed and developing countries is Adhesive Capsulitis, also known as Frozen Shoulder. Adhesive Capsulitis is a major cause of shoulder functional disability in patient as it is characterized by painful, restricted range of motion and capsular stiffness leading to difficulty in performing normal ADLs, causing an individual's activity limitations in dressing one's self, performing household chores and participation in the society. This study aims to determine the combined effects of Niel Asher Technique (NAT) and Scapular Clock Exercises on Pain, Range of Motion and Functional Disability in patients with Adhesive Capsulitis. This Randomized Controlled Trial will be conducted was conducted in RC medical Centre Lahore, over a 9-month period. A sample of 34 participants, aged 40-55 years were selected using non-probability convenient sampling. Informed Consent was obtained from all participants. Participants were divided into two groups: Group A received Niel Asher Technique and Scapular Clock Exercises along with conventional physical therapy, while Group B received only conventional physical therapy which included a moist hot pack, Therapeutic ultrasound, Shoulder Active Range of Motion Exercises and Maitland's Mobilization. Treatment duration will be 3 sessions/week for 4 weeks. Outcome measures including Numeric Pain Rating Scale (NPRS), Universal Goniometer and Shoulder Pain and Disability Index (SPADI) Urdu were assessed at baseline and after 4 weeks. Inclusion Criteria includes Stage II and III Adhesive Capsulitis, Positive Capsular pattern with limited both Active and Passive range of motion, shoulder pain with an NPRS score \>3 to ≤8. Exclusion Criteria includes patients with any systemic illness, metabolic disorder, prior history of shoulder surgery or shoulder dislocation. Data was analyzed using IBM SPSS version 27.0.

Conditions

Adhesive Capsulitis of Shoulder

Keywords

Adhesive Capsulitis, Diability, Pain, Range of Motion, SPADI

Outcome Measures

Primary Outcomes (3)

• Numeric Pain Rating Scale

  NPRS is a scale that has eleven points to rate the pain intensity in the individuals by assigning a numeric value from 0 (marked as "no pain") to 10 (marked as "worst possible pain") points. This outcome measure has been widely used in studies and has found to be effective and reliable in the assessment of shoulder pain.

  From the start upto 4 weeks

• Shoulder Pain and Disability Index

  SPADI is a self-report questionnaire that is widely used for assessment of intensity of shoulder pain and its influence on activity of daily living and functional restrictions. It consists of 13 items further sub-divided into pain scale and disability scale that assesses the degree of pain intensity and the problems experiences by the subject in performing everyday tasks such as lifting, reaching activities and sleeping. For each item, the person must assign a score ranging from 0 to 10 points, where a higher score indicates a greater level of pain or disability. The total score of the SPADI is calculated by averaging the results of the two subscales. SPADI has been shown to have good reliability and construct validity for assessing shoulder impairments majorly in patients presenting at the primary care level with shoulder pain

  From start of study upto 4 weeks

• Universal Goniometer

  Health care practitioners often use universal goniometer to assess objective measurements of joint mobility to find out the baseline mobility status and to evaluating efficacy of treatment

  From start of study upto 4 weeks

Study Arms (2)

Niel Asher Technique and Scapular clock exercises

EXPERIMENTAL

Other: Niel Asher Technique; Other: Scapular clock exercises; Other: Conventional Physical Therapy

Conventional Physical Therapy

ACTIVE COMPARATOR

Other: Conventional Physical Therapy

Interventions

Niel Asher Technique OTHER

For the management of these taut areas in the muscles, many techniques can be beneficial such as Niel Asher Technique, Ischemic pressure on these areas, Dry Needling, blocking the nerve supply of the muscle beneath the shoulder blade. NAT is a treatment that reinforces the natural healing process of the body for treating AC. This Novel technique consists of five-step treatment regimen involving Myofascial release technique + Deep stroking to manipulate the shoulder joint in a planned and precise order. Niel Asher technique is effective for two reasons, the tight structures surrounding shoulder joint are released first and then the stimulation of the neural pathway at the cortex level and spinal level.

Niel Asher Technique and Scapular clock exercises

Scapular clock exercises OTHER

Scapulothoracic hypomobility issues often occur due to adaptive shortening, due to long- protracted immobility caused by adhesive capsulitis. Scapular clock exercises are helpful in improving and restoring normal upward, downward, forward and backward movement of the shoulder blade. The SCE are responsible in maintaining the normal pattern of muscle mobility, ultimately enhancing the joint function. The musculature surrounding the shoulder blade includes SA, PM and TM, LS, and RM, dynamic multi-plane stability is provided by these muscles and helps in restoring shoulder blade mobility. Thus, during rest and movements, the proper functioning of these muscles is crucial to prevent any soft tissue injury \& developing any faulty posture.

Niel Asher Technique and Scapular clock exercises

Conventional Physical Therapy OTHER

The control group received conventional physical therapy: * Moist Hot Pack for 10 minutes. * Therapeutic Ultrasound for 10 minutes. * Maitland Mobilization glides passively 2 to 3 per second for 2 to 3 minutes. (Repeated 3 to 5 times) (for 4 weeks; 3 sessions/week). * Shoulder Active ROM exercises.

Conventional Physical Therapy; Niel Asher Technique and Scapular clock exercises

Eligibility Criteria

• Age: 40 Years - 55 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64)

You may qualify if:

• Age Group between 40-55 years
• Gender: Both Male and Female
• Pain Persisted for more than 3 months.
• Primary Adhesive Capsulitis Stage II and III
• Limited passive range of motion (PROM) with 40% reduction in atleast two of these shoulder movements (flexion, external rotation, internal rotation, and abduction) compared to unaffected side for more than 3 months atleast.
• Capsular Pattern +ve
• Impingement Tests (Neers Test, Hawkins Kennedy Test) -ve
• NPRS score of \>3 to ≤8 of having shoulder pain

You may not qualify if:

• Patient with systemic disease (Diabetes Mellitus, Thyroid Disorders, RA, Trauma, rotator cuff tears, malignancy, shoulder ligament injuries).
• Previous shoulder surgery or Manipulation under anesthesia (MUA)
• Prior history of shoulder dislocation

Sponsors & Collaborators

• Riphah International University: lead

Study Sites (1)

RC Medical Centre

Lahore, Punjab Province, 54792, Pakistan

Location

Related Publications (8)

• Gulwani AH. A study to find out the effect of scapular stabilization exercises on shoulder ROM and functional outcome in diabetic patients with stage 2 adhesive capsulitis of the shoulder joint: an interventional study. Int J Sci Healthc Res. 2020;5(2):320-33.

  BACKGROUND

• Malpani K, Mungikar S, Katage G. The effect of Shoulder Proprioceptive Neuromuscular Facilitation with Scapular Stability Exercises on pain, range of motion and function in Adhesive capsulitis-A case study. 2022

  BACKGROUND

• Saeed M, Hafeez S, Asad F, Haider W, Nawaz S, Kocub S. Comparison of scapular proprioceptive neuromuscular facilitation and myofascial release techniques on pain and function in scapular dyskinesia associated with adhesive capsulitis: Scapular dyskinesia associated with adhesive capsulitis. Pakistan BioMedical Journal. 2022:123-7.

  BACKGROUND

• Baheti MM, Jayswal P, Baheti B. The effect of scapular stabilization exercises on pain and function in patients with frozen shoulder. 2023.

  BACKGROUND

• Makwana A, Mishra N. The effect of cyriax soft tissue release and myofascial release on pain pressure threshold, flexibility and muscle length in idiopathic adhesive capsulitis-a comparative study. International Journal of Community Medicine and Public Health. 2023;10(11):4187

  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;17(4):YC01-YC5

  BACKGROUND

• Balakrishnan R, Sudhakar S. Effects of scapular clock exercises and scapular proprioceptive neuromuscular facilitation on pain and functional activities in subjects with adhesive capsulitis. 2024.

  BACKGROUND

• Ragapriyaa R, Kamalakannan M, Anitha A, Ramana K. Effect of Scapular Clock Exercise Versus Scapular PNF Exercise on Pain and ROM for Anterior Capsular Stiffness of Shoulder Joint. Indian Journal of Physiotherapy & Occupational Therapy. 2024;18.

  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

• Saba Rafique, Masters

  Riphah International University

  PRINCIPAL INVESTIGATOR

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: March 16, 2026
• First Posted: March 20, 2026
• Study Start: October 28, 2024
• Primary Completion: December 1, 2025
• Study Completion: February 1, 2026
• Last Updated: March 20, 2026

Record last verified: 2026-03

Data Sharing

• IPD Sharing: Will not share

Locations

PA (1)