Comparative Effects of Spencer Techniques and Movement With Mobilization in Improving Pain, Range of Motion, and Functional Disability in Rotator Cuff Syndrome.

University of Lahore60 enrolled

Overview

This study will be randomised clinical trial conducted at the University of Lahore Teaching Hospital, Lahore, Pakistan. A total of 60 participants will be selected and randomly allocated into two treatment groups (30 participants in each group) using the lottery method. All screened and willing participants who meet the eligibility criteria will be assigned to either Group A or Group B. Group A: Spencer Technique with Conventional Therapy Participants allocated to Group A will receive the Spencer Technique in combination with conventional physiotherapy. The intervention will follow a structured and progressive protocol for 6 weeks. Conventional Therapy (15 minutes per session) Conventional treatment will be administered prior to manual therapy and will include: Moist Hot Pack (5 minutes): A moist hot pack will be applied to the affected shoulder at a comfortable therapeutic temperature. A towel layer will be placed between the hot pack and the skin to prevent burns. Shoulder Stretching Exercises (10 minutes): Passive stretching will be performed to improve flexibility, reduce muscle tightness, and enhance shoulder range of motion. Each stretch will be held for 20-30 seconds and repeated 3-5 times. Stretching will include: Shoulder flexion and extension (supine position) Shoulder abduction Shoulder adduction (cross-body stretch) Internal and external rotation at 90° abduction Stretching will be performed five sessions per week. Spencer Technique (20 minutes per session) Following conventional therapy, the Spencer technique will be administered in seven sequential steps: Shoulder extension with elbow flexion to the point of restriction Shoulder flexion with elbow extension Circumduction with compression at 90° abduction Circumduction with distraction at 90° abduction Abduction with internal rotation (hand placed behind hip) Adduction with external rotation Stretching with fluid pumping maneuver (5-10 repetitions) Dosage and Progression: Frequency: 5 sessions per week Weeks 1-3: 2 sets of 10 repetitions per step (1-minute rest between sets) Weeks 4-6: 3 sets of 10 repetitions per step Total session duration: 35 minutes 5 minutes hot pack 10 minutes stretching 20 minutes Spencer technique Group B: Mobilization with Movement (MWM) with Conventional Therapy Participants allocated to Group B will receive Mobilization with Movement combined with conventional physiotherapy for 6 weeks. Conventional Therapy (15 minutes per session) The same conventional therapy protocol as Group A will be administered prior to mobilization: 5 minutes moist hot pack 10 minutes passive shoulder stretching Mobilization with Movement (20 minutes per session) MWM will be performed in the directions of: External rotation Internal rotation Abduction Flexion The participant will be positioned in sitting on a high chair. The therapist will stabilize the shoulder girdle with one hand while applying a sustained glide to the humeral head using the thenar eminence of the other hand. The glide will be maintained perpendicular to the plane of movement and adjusted according to the participant's pain-free direction. Participants will be instructed to actively move the shoulder through the available range while the glide is sustained. Movement will continue until the onset of pain or discomfort. Dosage: 3 sets of 10 repetitions 30-second rest between sets Frequency: 3 sessions per week Duration: 6 weeks Total session duration: 35 minutes 5 minutes hot pack 10 minutes stretching 20 minutes mobilization with movement

Study Design and Procedures This study is a single-blinded, randomized controlled trial designed to compare the effectiveness of the Spencer Technique combined with conventional therapy versus Mobilization with Movement combined with conventional therapy in individuals with shoulder dysfunction. Screening and Recruitment Participants who meet the predefined inclusion criteria will be recruited using a purposive sampling technique. Individuals who are readily available and willing to participate will be screened for eligibility. Eligible participants will be informed about the study objectives, procedures, potential risks, and benefits. Written informed consent will be obtained prior to enrollment. Sample Size and Allocation A total sample of 52 participants will be included in the study. After baseline assessment, participants will be randomly allocated into two groups (Group A and Group B) using the lottery method. Randomization Randomization will be performed using a simple lottery method to ensure equal allocation into the two intervention groups. Blinding This study will follow a single-blinded design. Participants will be blinded to group allocation. Intervention Duration and Assessment Both groups will receive treatment for 6 weeks. Sessions will be conducted 3 times per week. Outcome assessments will be performed at baseline and at the end of the 6th week. Each treatment session for both groups will have a total duration of 35 minutes. Data will be analyzed using Statistical Package for the Social Sciences (SPSS) version 27.0. Interventions Group A: Spencer Technique with Conventional Therapy Participants allocated to Group A will receive the Spencer Technique in combination with conventional physiotherapy. Conventional Therapy (15 minutes per session) Moist Hot Pack (5 minutes): A moist hot pack will be applied to the affected shoulder at a therapeutic temperature, with a towel placed between the pack and the skin. Shoulder Stretching (10 minutes): Passive stretching exercises will be performed to improve flexibility and range of motion. Each stretch will be held for 20-30 seconds and repeated 3-5 times. Stretching will include: Shoulder flexion and extension Shoulder abduction Shoulder adduction Internal and external rotation at 90° abduction Spencer Technique (20 minutes per session) The technique will be administered in seven sequential steps: Shoulder extension with elbow flexion to restriction Shoulder flexion with elbow extension Circumduction with compression at 90° abduction Circumduction with distraction at 90° abduction Abduction with internal rotation Adduction with external rotation Stretching with fluid pumping maneuver (5-10 repetitions) Dosage progression: Weeks 1-3: 2 sets of 10 repetitions per step (1-minute rest between sets) Weeks 4-6: 3 sets of 10 repetitions per step Total session duration: 35 minutes (5 minutes hot pack, 10 minutes stretching, 20 minutes Spencer technique). Group B: Mobilization with Movement with Conventional Therapy Participants allocated to Group B will receive Mobilization with Movement (MWM) combined with conventional physiotherapy. Conventional Therapy (15 minutes per session) 5 minutes moist hot pack 10 minutes passive shoulder stretching Mobilization with Movement (20 minutes per session) Participants will be positioned in sitting. The therapist will stabilize the shoulder girdle with one hand and apply a sustained glide to the humeral head using the thenar eminence of the other hand. The glide will be maintained perpendicular to the plane of movement and adjusted to remain pain-free. Mobilization will be performed in: External rotation Internal rotation Abduction Flexion Participants will actively move the shoulder during sustained glide until the onset of pain or discomfort. Dosage: 3 sets of 10 repetitions 30-second rest between sets 3 sessions per week for 6 weeks Total session duration: 35 minutes (5 minutes hot pack, 10 minutes stretching, 20 minutes mobilization).

Interventions

Spencer techniqueOTHER

Spencer Technique (20 minutes per session) The technique will be administered in seven sequential steps: Shoulder extension with elbow flexion to restriction Shoulder flexion with elbow extension Circumduction with compression at 90° abduction Circumduction with distraction at 90° abduction Abduction with internal rotation Adduction with external rotation Stretching with fluid pumping maneuver (5-10 repetitions) Weeks 1-3: 2 sets of 10 repetitions per step (1-minute rest between sets) Weeks 4-6: 3 sets of 10 repetitions per step

Movement with mobilizationOTHER

Mobilization will be performed in: External rotation Internal rotation Abduction Flexion Participants will actively move the shoulder during sustained glide until the onset of pain or discomfort. Dosage: 3 sets of 10 repetitions 30-second rest between sets 3 sessions per week for 6 weeks Conventional Therapy (15 minutes per session) Moist Hot Pack (5 minutes): A moist hot pack will be applied to the affected shoulder at a therapeutic temperature, with a towel placed between the pack and the skin. Shoulder Stretching (10 minutes): Passive stretching exercises will be performed to improve flexibility and range of motion. Each stretch will be held for 20-30 seconds and repeated 3-5 times. Stretching will include: Shoulder flexion and extension Shoulder abduction Shoulder adduction Internal and external rotation at 90° abduction Total session duration: 35 minutes (5 minutes hot pack, 10 minutes stretching, 20 minutes mobilization).

conventional physical therapyOTHER

Conventional Therapy (15 minutes per session) Moist Hot Pack (5 minutes): A moist hot pack will be applied to the affected shoulder at a therapeutic temperature, with a towel placed between the pack and the skin. Shoulder Stretching (10 minutes): Passive stretching exercises will be performed to improve flexibility and range of motion. Each stretch will be held for 20-30 seconds and repeated 3-5 times. Stretching will include: Shoulder flexion and extension Shoulder abduction Shoulder adduction Internal and external rotation at 90° abduction

Eligibility

Sex: ALLMin age: 30 YearsMax age: 60 Years

Medical Language ↔ Plain English

Inclusion Criteria: * • Patient from the age of 30 to 60. * Patient suffering from rotator cuff syndrome. Patient with a history of pain in shoulder for more than 3 month. * Patient with grade 1 and grade 2 of rotator cuff syndrome which doesn't require surgery. * Patient with 2 positive Neers and Hawkins Kennedy test. * Patient who haven't gone under any physical therapy treatment in the past 6 months. Exclusion Criteria: * • Patient with any cardiac problem like myocardial infarction. * Patient with diagnosis of fibromyalgia. * Patient with ongoing pregnancy. * Patient with pain related to shoulder trauma. * Patient with history of shoulder injury or shoulder surgery. * Patient with associated symptoms like numbness and tingling. * Patient who have taken corticosteroids injections of shoulder within a year.

Outcomes

Primary Outcomes

Pain Intensity (Visual Analogue Scale)

Visual Analogue Scale The Visual Analogue Scale (VAS) is a subjective measure in which individuals rate their pain on an eleven-point numerical scale. The scale is composed of 0 (no pain at all) to 10 (worst imaginable pain). According to researches VAS shows excellent reliability (0.97 and 0.99, respectively) for the measurement of musculoskeletal pain.

Time frame: baseline, 3rd week , 6th week

Secondary Outcomes

range of motion

Goniometer Range of motion is measured using a goniometer at baseline and end point measurements. Range of motion of joints are usually assessed by a device known as universal goniometer. goniometer has two arms stationary as well as movable arm. The centre of the goniometer is known as fulcrum. Through goniometer in each plane joint ranges are measured. Goniometer Positioning for Shoulder Joint Assessment For Goniometer assessment fulcrum with be place on the shoulder joint. On the other hand it was in aligned with frontal axis in terms of assessing flexion and extension and add sagittal axis in terms of assessing abduction and abduction and in longitudinal axis for internal and external rotation.

Time frame: baseline, 3rd week, 6th week

for function (DASH)

Disability of Arm, Shoulder, and Hand (DASH) questionnaire The Disability of Arm, Shoulder, and Hand (DASH) questionnaire consists of 30 items designed to evaluate self-reported disability. It measures both symptoms and physical abilities related to upper musculoskeletal conditions. Additionally, it assesses upper limb impairment by tracking changes in symptoms and functionality over time. The questionnaire demonstrates strong reliability (0.96) and solid validity (0.70).

Time frame: Baseline, 3rd week, 6th week