Effectiveness of 1st Rib Mobilization and Scalene Muscles Muscle Energy Technique Among Patients With Asthma

This randomized controlled trial aims to evaluate the effectiveness of first rib mobilization and scalene muscle energy technique (MET) in improving respiratory function and reducing symptoms in patients with asthma. Asthma is a chronic inflammatory condition of the airways characterized by bronchoconstriction, airway hyperresponsiveness, and mucus overproduction, often leading to respiratory difficulty and increased use of accessory muscles such as the scalene.

Study Overview

• Status: Active, not recruiting
• Conditions: Asthma
• Intervention / Treatment: Diagnostic test: First Rib Mobilization + Respiratory Physiotherapy; Combination product: Scalene Muscle Energy Technique (MET) + Respiratory Physiotherapy

Detailed Description

Manual therapy techniques like first rib mobilization and scalene MET are believed to restore upper thoracic mobility, reduce muscle tightness, and optimize breathing mechanics. In this study, 47 asthmatic patients will be randomly assigned into two groups: Group A will receive first rib mobilization combined with respiratory physiotherapy, while Group B will receive scalene MET along with the same physiotherapy protocol. Treatment will be administered three times a week for four weeks.

• Study Type: Interventional
• Enrollment (Actual): 47
• Phase: Early Phase 1

Contacts and Locations

Study Locations

• Pakistan
  • Punjab
    • Lahore, Punjab, Pakistan
      • Chaudary Muhammad Akram Teaching Hospital, Azra Naheed Medical College, Superior University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Both male and female age range: 18-65 years.
• Diagnosed with asthma according to the Global Initiative for Asthma criteria.
• Presence of musculoskeletal symptoms; Complaints of chest tightness, neck stiffness, or restricted upper thoracic mobility, often associated with dysfunctional breathing patterns.
• Ability to provide informed consent and comply with the treatment protocol.

Exclusion Criteria:

• clinically unstable or had a neuromuscular disease, unstable cardiovascular disease, or musculoskeletal disease that may interfere with exercise
• History of thoracic or cervical spine surgery, trauma, or fractures
• Pregnancy or postpartum status
• Rheumatologic diseases, a history of musculoskeletal trauma, or musculoskeletal malformations.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: First Rib Mobilization + Respiratory Physiotherapy	Diagnostic test: First Rib Mobilization + Respiratory Physiotherapy; Patients were given post isometric relaxation for restricted first rib in sitting position and therefore the affected elevated first rib, opposite foot of therapist was placed on the table and patient non affected arm is 'dropped' on the therapist flexed knee. The practitioner's conjointly flexes the elbow on the non-affected side placed anterior to shoulder with the hand supporting the patient facet of head. Then therapist makes contact with the tubercle of the first rib with fingers or thumb of affected side (patient) disposing of available soft tissue. slack as steady force is applied in inferior direction. The therapist eases his flexed leg and uses his supported hand to encourage patient's neck into a side flexion and rotation to affected side thus unloading the scalene tension thereon side and encourage the first rib to move anteriorly and inferiorly
Active Comparator: Scalene Muscle Energy Technique (MET) + Respiratory Physiotherapy	Combination product: Scalene Muscle Energy Technique (MET) + Respiratory Physiotherapy; MET for the scalene muscle, the participants were made to lie supine with a cushion or towel under the upper thoracic area. The PT placed his hand on the side of the participant's face/forehead to resist the isometric contraction and the other hand on the sternum. The participants were asked to perform the action of the anterior scalene muscle against PT resistance and hold it for 7-8 seconds followed by relaxation. (42) Along with the same respiratory physiotherapy protocol used in Group A. The treatment protocol was given for three sessions per week for four weeks

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
St. George's Respiratory Questionnaire (SGRQ)	The total score has a maximum of 100 points, with values ranging from 0 to 100. The higher the number, the more impact the disease has.	6 Month

Collaborators and Investigators

• Sponsor: Superior University

Study record dates

Study Major Dates

• Study Start (Actual): March 4, 2025
• Primary Completion (Actual): June 1, 2025
• Study Completion (Estimated): September 30, 2025

Study Registration Dates

• First Submitted: June 17, 2025
• First Submitted That Met QC Criteria: June 17, 2025
• First Posted (Estimated): June 25, 2025

Study Record Updates

• Last Update Posted (Estimated): June 25, 2025
• Last Update Submitted That Met QC Criteria: June 17, 2025
• Last Verified: June 1, 2025

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Immune System Diseases; Respiratory Tract Diseases; Lung Diseases; Bronchial Diseases; Lung Diseases, Obstructive; Respiratory Hypersensitivity; Hypersensitivity, Immediate; Hypersensitivity; Asthma
• Other Study ID Numbers: DPT/Batch-Fall20/1001

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No