Rotator cuff syndrome is a common cause of shoulder pain and functional limitation, often associated with myofascial trigger points. Myofascial Trigger Point Release (MFTR) and the Neil Asher Technique (NAT) are manual therapies aimed at reducing pain and improving mobility. This study compares their effects on pain, range of motion, and disability in individuals with rotator cuff syndrome.
This will be a randomized Clinical trial conducted on 36 participants. Data will be collected from Jinnah hospital and The University of Lahore Teaching Hospital, Lahore by using non-probability convenience sampling technique. Adults aged 40 to 60 years with non-surgical rotator cuff-related shoulder pain, confirmed by positive Neer's or Hawkins-Kennedy tests and experiencing symptoms for more than four weeks, will be included in this study. Individuals with cardiac conditions, pregnancy, trauma-related shoulder injuries, or a history of shoulder surgery will be excluded. Group A will receive Myofascial Trigger Point Release (MFTR) along with conservative physiotherapy, while Group B will receive the Neil Asher Technique (NAT) combined with conservative physiotherapy. Each session will last 35 minutes-20 minutes for the primary intervention and 15 minutes for conventional therapy-administered four times per week for four weeks. Pre- and post-treatment evaluations will include the Numeric Pain Rating Scale (NPRS), range of motion (using a Universal Goniometer), and disability (measured via SPADI). Data will be analyzed using SPSS version 27.0.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
36
lateral border of the scapula, just below the infraspinatus. • Compression is followed by horizontal abduction and external rotation to stretch the muscle. Ischemic Compression: Each active trigger point is treated with 2 sets of deep pressure, applied using the therapist's fingers, thumb, or elbow. Duration: Each compression lasts 20-30 seconds, gradually increasing pressure to the patient's tolerance. Post-Compression Stretching: Gentle passive stretching of the treated muscle follows immediately after each compression set to restore muscle length. Each session will last 35 minutes (5 minutes hot pack, 10 minutes stretching, 20 minutes Myofascial Trigger Point Release)
The NAT is a non-invasive trigger point therapy that applies a specific sequence of ischemic compressions to deactivate active trigger points, stimulate reflex responses, and promote muscular balance. Apply several deep strokes over the fibrous band and then each trigger point is treated with sustained manual pressure for 20-30 seconds, repeated 2-3 times per session. Hot Pack Application: A moist hot pack will be applied over the affected shoulder for 5 minutes using a protective towel. Shoulder Stretching Routine: Includes flexion/extension, abduction/adduction, and internal/external rotation (each stretch held for 20-30 seconds and repeated 3-5 times).
University of Lahore Teaching Hospital, Lahore HOD Physio Department
Lahore, Punjab Province, Pakistan
Numeric Pain Rating Scale (NPRS) - Pain Assessment
The Numeric Pain Rating Scale (NPRS) is a unidimensional, patient-reported outcome measure used to assess pain intensity. Participants are asked to rate their current pain level, or average pain over a specified recall period (e.g., past 24 hours or past week), using an 11-point scale ranging from 0 to 10, where 0 indicates "no pain" and 10 indicates "worst imaginable pain."
Time frame: upto 4 weeks
Universal Goniometer (UG) - Range of Motion (ROM)
The Universal Goniometer (UG) is a standard clinical instrument used for measuring joint range of motion (ROM) in degrees. It consists of a fulcrum, stationary arm, and movable arm, allowing precise angular measurement of joint movement. For ROM assessment, the participant is positioned according to standardized protocols (supine, prone, or sitting depending on the joint being assessed). Anatomical landmarks are used for alignment to ensure accuracy and reliability. The stationary arm is aligned with the proximal segment of the joint, while the movable arm follows the distal segment.
Time frame: upto 4 weeks
Shoulder Pain and Disability Index (SPADI) - Disability Outcome
The Shoulder Pain and Disability Index (SPADI) is a validated, self-administered questionnaire designed to measure pain and functional disability in patients with shoulder conditions. It consists of 13 items divided into two subscales: Pain subscale (5 items) - assesses severity of shoulder pain during specific activities Disability subscale (8 items) - assesses difficulty in performing functional tasks such as dressing, reaching, lifting, and carrying objects Each item is scored on a Visual Analog Scale (0-10), where higher scores indicate greater pain and disability. The total SPADI score is calculated as a percentage, with 0% representing no disability and 100% representing maximum disability.
Time frame: upto 4 weeks
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