Scapular Repeated Contractions Facilitation Versus Hold-relax Techniques in Patients With Adhesive Capsulitis

Effects of Scapular Repeated Contractions Facilitation Versus Hold-relax Techniques on Pain, Range of Motion and Functional Disability in Patients With Adhesive Capsulitis

The study was conducted to determine the effects of scapular repeated contractions facilitation versus hold-relax techniques on pain, range of motion and functional disability in patients with adhesive capsulitis

Study Overview

• Status: Completed
• Conditions: Adhesive Capsulitis of the Shoulder
• Intervention / Treatment: Other: Repeated Contraction Facilitation Technique; Other: Conventional Physical therapy Treatment for Adhesive Capsulitis; Other: Hold-Relax Technique

• Study Type: Interventional
• Enrollment (Actual): 66
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Pakistan
  • Punjab Province
    • Dhok Gujra, Punjab Province, Pakistan, 50700
      • Rasool Medical Complex Gujrat

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria:

• Diagnosed stage 2 of Adhesive Capsulitis (>4-12 months)
• Difficulties in 2 or more movements: external rotation, abduction, flexion or internal rotation presenting limitation of more than 30 degrees
• Patients having diagnosed Diabetes Mellitus type 2
• Capsular pattern of restriction
• Unilateral involvement of the shoulder
• Patients who are not taking any pain killer

Exclusion Criteria:

• Surgical history of affected shoulder
• History of trauma or fracture in affected shoulder
• Cervical neuropathy or any other disorders of cervical spine, elbow and wrist
• Any Neurological disorders such as stroke or parkinsonism
• Any systemic disease such as rheumatoid arthritis, osteoporosis and malignancies in shoulder region
• Intra-articular injection
• Open wound or skin infection
• Manipulation under anesthesia
• Recurrent dislocation or subluxation
• Shoulder injuries such as rotator cuff tear, or tendon calcification

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: Scapular Repeated Contraction Facilitation Technique	Other: Repeated Contraction Facilitation Technique; Repeated contraction facilitation on scapula in two diagonal patterns (D1&D2) were performed .D1 consisted of anterior elevation and posterior depression and D2 consisted of posterior elevation and anterior depression. Isotonic contraction of muscles against the resistance throughout the active ROM was performed.3 sets of 10 repetitions were performed with 20 seconds of rest interval.; Other: Conventional Physical therapy Treatment for Adhesive Capsulitis; Moist heat pack for 15-20 mins Therapeutic Ultrasound at 1MHz for 8-10 mins in continuous mode with the intensity of 1.5W/cm2 Active Assisted Shoulder for abduction, flexion, internal rotation and external rotation with 3 sets of 15 repetitions 4days/week for 4 weeks Wall slides, Finger ladder exercises, Wand exercises and home exercises were performed.3x15 repetitions with 2 min rest interval for 4 sessions per week for four weeks for each exercise Maitland Glenohumeral Joint Mobilization with 2-3 oscillations per second for 30 seconds for 5 sets 4 times a week in caudal and posteroanterior direction was applied for 4 weeks.
Active Comparator: Scapular Hold-Relax Technique	Other: Conventional Physical therapy Treatment for Adhesive Capsulitis; Moist heat pack for 15-20 mins Therapeutic Ultrasound at 1MHz for 8-10 mins in continuous mode with the intensity of 1.5W/cm2 Active Assisted Shoulder for abduction, flexion, internal rotation and external rotation with 3 sets of 15 repetitions 4days/week for 4 weeks Wall slides, Finger ladder exercises, Wand exercises and home exercises were performed.3x15 repetitions with 2 min rest interval for 4 sessions per week for four weeks for each exercise Maitland Glenohumeral Joint Mobilization with 2-3 oscillations per second for 30 seconds for 5 sets 4 times a week in caudal and posteroanterior direction was applied for 4 weeks.; Other: Hold-Relax Technique; Hold -Relax on scapula in two diagonal patterns (D1&D2) were performed .D1 consisted of anterior elevation and posterior depression and D2 consisted of posterior elevation and anterior depression in which restricted muscles were contracted isometrically with 5 sec hold followed by relaxation into new range .3 sets of 10 repetitions were performed with 20 seconds of rest interval.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Numeric Pain Rating Scale	Patient level of pain was assessed using this scale. This scale ranges from 0 to 10. 0 indicates "no pain" ,1- 3 indicates mild pain ,4-6 indicates moderate pain and 7-10 indicates "worst pain". NPRS have shown high test-retest reliability (r = 0.96 and 0.95, respectively) MCID value of NPRS is 2-3	At base line and end of 4 weeks
Shoulder Pain And Disability Index	SPADI was used to assess functional disability. It has 13 items, with 5 items for pain and 8 items for disability	from baseline to end of 4 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
ROM shoulder flexion	changes from baseline ROM of shoulder flexion was taken	4th week
ROM shoulder abduction	changes from baseline ROM of shoulder was taken	4th week
ROM shoulder external rotation	changes from baseline ROM of shoulder external rotation was taken	4th week
ROM shoulder internal rotation	changes from baseline ROM of shoulder internal rotation was taken	4th week

Collaborators and Investigators

• Sponsor: Riphah International University
• Investigators: Principal Investigator: Ameena Amjad, Ph.D, Riphah International University

Publications and helpful links

General Publications

• Joshi D, Chitra J. Effect of scapular proprioceptive neuromuscular facilitation on shoulder pain, range of motion, and upper extremity function in hemiplegic patients: A randomized controlled trial. Indian Journal of Health Sciences and Biomedical Research KLEU. 2017;10(3):276-82.
• Chitra J, Joshi D. Effect of scapular hold-relax technique on shoulder pain in hemiplegic subjects: A randomized controlled trial. Physiotherapy-The Journal of Indian Association of Physiotherapists. 2017;11(2):49-52.
• Mishra N, Mishra A, Charaniya P. Effect of scapular proprioceptive neuromuscular facilitation on pain and disability in patients with adhesive capsulitis. Int J Yogic Hum Mov Sports Sciences. 2019;4(1):995-1000.
• 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.
• Bhavika PG, Vinosh Kumar P. Effect of Scapular Proprioceptive Neuromuscular Facilitation versus Scapular Mobilization on Pain and function in adhesive capsulitis-A Pragmatic Randomized Clinical Trial. INTI JOURNAL. 2023;2023(64):1-6.
• Akgüller T, Akbaba YA, Taşkıran H. The effect of scapular proprioceptive neuromuscular facilitation techniques on pain and functionality in patients with subacromial impingement syndrome: a randomized controlled trial. Physikalische Medizin, Rehabilitationsmedizin, Kurortmedizin. 2023;33(03):149-61.
• Shaikh SB, Ganvir SS. Effect of 4 Weeks of Scapular Proprioceptive Neuromuscular Facilitation on Scapular Alignment and Upper Extremity Motor Performance in Patients with Stroke: A Repeated Measure Design. Medical Journal of Dr DY Patil Vidyapeeth. 2023;16(Suppl 2):S228-S34.
• 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.
• Cellatoğlu H, Kaygısız BB. Effect of proprioceptive neuromuscular facilitation (PNF) technique on posture, balance and gait characteristics of older adults with scapular dyskinesis: a randomized controlled trial. PeerJ. 2025;13:e19718.
• Butt MS, Tanveer F. Effects of scapular proprioceptive neuromuscular facilitation techniques in addition to routine physical therapy on clinical outcomes in patients with adhesive capsulitis: A randomized controlled trial. The Healer Journal of Physiotherapy and Rehabilitation Sciences. 2022;2(1):78-87.
• Ghias S, Saeed H, Ahmed M, Faisal M, Solangi TA, Asim HAB, et al. Effectiveness of PNF Pattern in Regular Physical Therapy Sessions on Functional Mobility in Frozen Shoulder: PNF Pattern in Frozen Shoulder Therapy. THE THERAPIST (Journal of Therapies & Rehabilitation Sciences). 2024:46-50.
• Lin P, Yang M, Huang D, Lin H, Wang J, Zhong C, et al. Effect of proprioceptive neuromuscular facilitation technique on the treatment of frozen shoulder: a pilot randomized controlled trial. BMC musculoskeletal disorders. 2022;23(1):367
• Zhang EJX, Lam YX, Lim WSR, Lie DTT. Effect of proprioceptive neuromuscular facilitation on efficacy and pain relief for symptomatic shoulder conditions: a meta-analysis. Journal of Orthopaedic Reports. 2025;4(1):100541.

Study record dates

Study Major Dates

• Study Start (Actual): January 18, 2025
• Primary Completion (Actual): May 31, 2025
• Study Completion (Actual): October 30, 2025

Study Registration Dates

• First Submitted: February 4, 2026
• First Submitted That Met QC Criteria: February 4, 2026
• First Posted (Actual): February 11, 2026

Study Record Updates

• Last Update Posted (Actual): February 11, 2026
• Last Update Submitted That Met QC Criteria: February 4, 2026
• Last Verified: February 1, 2026

More Information

Terms related to this study

• Keywords: Adhesive Capsulitis; Proprioceptive Neuromuscular Facilitation; Scapula Repeated Contraction Facilitation Technique; scapular Hold-Relax Technique
• Additional Relevant MeSH Terms: Musculoskeletal Diseases; Joint Diseases; Bursitis
• Other Study ID Numbers: REC/RCR & AHS/24/0196

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