Effect of Joint Mobilization and Movement Control Exercises on Shoulder Pain and Function in Fast Bowlers (RCT) (RCT)

Combined Effects of Mulligan Mobilization With Movement and Kinetic Medial Rotation Control for Shoulder on Pain, Range of Motion, and Function Among Fast Bowlers

The goal of this clinical trial is to determine combined effects of the Kinetic control for shoulder on pain, range, and function among fast bowlers. The main question it aims to answer is:

Does mulligan mobilization with movement along with kinetic medial rotation control work in decreasing pain, improving shoulder internal range of motion and shoulder function in fast bowlers with glenohumeral internal rotation deficit? Is the combination of Mulligan mobilization with movement along with kinetic control therapy effective in fast bowlers with glenohumeral internal rotation deficit? Treatment arm will receive movement retraining exercises to develop kinetic control with mulligan mobilization and comparison arm will receive standard physical therapy exercises with mulligan mobilization.

Treatment group will receive shoulder warm up exercises, movement retraining exercises and mulligan mobilization with movement.

Comparison group will receive shoulder warm up exercises, modified sleeper stretch, shoulder isometrics and mulligan mobilization with movement.

Study Overview

• Status: Enrolling by invitation
• Conditions: Glenohumeral Internal Rotation Deficit (GIRD)
• Intervention / Treatment: Other: Kinetic control for shoulder internal rotation with mobilization with movement; Other: stretches, strengthening and mobilization with movement

• Study Type: Interventional
• Enrollment (Estimated): 42
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Pakistan
  • Punjab Province
    • Lahore, Punjab Province, Pakistan, 54000
      • Sehat Medical Complex
    • Lahore, Punjab Province, Pakistan, 54850
      • Bata Sports Club

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria:

• Male cricketers aged 18-45 years.
• Participants experiencing persistent mild to moderate shoulder pain during overhead movements for more than 3 months.
• Fast bowlers actively participating in regular cricket training sessions.
• Presence of Glenohumeral Internal Rotation Deficit (GIRD) greater than 10 degrees, measured with a goniometer by comparing internal rotation of the dominant and non-dominant shoulders.

Exclusion Criteria

• Cricketers who have undergone shoulder (e.g., rotator cuff repair, arthroscopic labrum repair) or elbow surgery within the past 3 months.
• Participants presenting with numbness or tingling sensations in the upper extremity.
• Individuals with comorbidities such as a history of cardiac or pulmonary diseases.
• Subjects with a history of recurrent shoulder dislocations or shoulder instability.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Movement control exercises with the concept of kinetic control and mobilization with movement; Each person will follow this program three times a week. The session starts with a shoulder movement test to check how well the shoulder rotates-60 degrees inward and 45 degrees outward-without the shoulder blade or upper arm moving incorrectly. Next, movement retraining exercises are used to fix any incorrect shoulder movements. This includes helping the shoulder and shoulder blade move properly using hands-on support, along with exercises that may be supported or unsupported. Visual cues (like mirrors), touch, and manual guidance are used to teach correct movement. Lastly, Mobilization with Movement (MWM) is performed. This involves gently pushing the shoulder joint backward	Other: Kinetic control for shoulder internal rotation with mobilization with movement; stretches and strengthening along with mobilization with movement is given to participants. stretches include sleeper stretch and isometrics in strengthening
Active Comparator: Stretches, strengthening and mobilization with movement; Each person in the control group will do these exercises three times a week. The session starts with shoulder warm-up exercises like arm circles, shoulder rolls, and reaching overhead. These are done in 2 sets of 10 reps. Next is the modified sleeper stretch. This is repeated 3 times, with a 30-second rest between each stretch. Then, isometric shoulder exercises are done in standing. The person pushes their arm inward against resistance without actually moving it. Finally, Mobilization with Movement (MWM) is used.	Other: stretches, strengthening and mobilization with movement; Each person in the control group will do these exercises three times a week. The session starts with shoulder warm-up exercises like arm circles, shoulder rolls, and reaching overhead. These are done in 2 sets of 10 reps. Next is the modified sleeper stretch. This is repeated 3 times, with a 30-second rest between each stretch. Then, isometric shoulder exercises are done in standing. The person pushes their arm inward against resistance without actually moving it. Finally, Mobilization with Movement (MWM) is used.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Pain intensity	Pain intensity will be evaluated using the Numeric Pain Rating Scale (NPRS) ranging from 0 to 10, where 0 indicates no pain, 1-3 represents mild pain, 4-6 indicates moderate pain, and 7-10 reflects severe pain.	baseline, 3 weeks and 6 weeks
Shoulder Range of Motion	Shoulder range of motion will be measured in all planes of movement using a universal goniometer. The movements will include: Flexion (0-180°) Extension (0-60°) Abduction (0-180°) Adduction (0-40°) Internal Rotation (0-70°) External Rotation (0-90°) All measurements will be recorded in degrees to assess improvement in joint mobility across these planes.	All outcomes will be recorded at baseline, after 3 weeks, and after 6 weeks of intervention.
Functional disability	Functional disability will be assessed using the Shoulder Pain and Disability Index (SPADI), which provides a percentage score ranging from 0 to 100%. A low score (0-29%) represents minimal disability, a moderate score (30-59%) indicates moderate disability, and a high score (60-100%) signifies severe functional limitation.	All outcomes will be recorded at baseline, after 3 weeks, and after 6 weeks of intervention.

Collaborators and Investigators

• Sponsor: Lahore University of Biological and Applied Sciences
• Investigators: Principal Investigator: Hammad Haider, MS-MSK PT, Lahore University of Biological and Applied Sciences

Study record dates

Study Major Dates

• Study Start (Actual): October 1, 2025
• Primary Completion (Estimated): January 15, 2026
• Study Completion (Estimated): February 25, 2026

Study Registration Dates

• First Submitted: October 2, 2025
• First Submitted That Met QC Criteria: November 13, 2025
• First Posted (Estimated): November 14, 2025

Study Record Updates

• Last Update Posted (Estimated): November 14, 2025
• Last Update Submitted That Met QC Criteria: November 13, 2025
• Last Verified: November 1, 2025

More Information

Terms related to this study

• Keywords: Musculoskeletal Disorder; Sports Injury; Internal Rotation; Overhead Athletes; Kinetic Control
• Additional Relevant MeSH Terms: Wounds and Injuries; Musculoskeletal Diseases; Athletic Injuries; Musculoskeletal Physiological Phenomena; Musculoskeletal and Neural Physiological Phenomena; Physiological Phenomena; Movement
• Other Study ID Numbers: UBAS/ERB/FoRS/25/022

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

Drug and device information, study documents

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