Comparative Effects of Spencer Techniques and Movement With Mobilization in Improving Pain, Range of Motion, and Functional Disability in Rotator Cuff Syndrome.
Spencer Technique and Movement With Mobilization in Rotator Cuff Syndrome
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 Overview
Status
Conditions
Intervention / Treatment
Detailed Description
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).
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
-
Punjab Province
-
Lahore, Punjab Province, Pakistan, 55150
- University of Lahore Teaching Hospital
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
- Adult
Accepts Healthy Volunteers
Description
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.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Single
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
|---|---|
|
Experimental: Spencer technique + conventional physical therapy
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). |
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 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 |
|
Experimental: movement with mobilization + conventional physical therapy
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). |
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 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). |
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Pain Intensity (Visual Analogue Scale)
Time Frame: baseline, 3rd week , 6th week
|
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.
|
baseline, 3rd week , 6th week
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
range of motion
Time Frame: baseline, 3rd week, 6th week
|
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. |
baseline, 3rd week, 6th week
|
|
for function (DASH)
Time Frame: Baseline, 3rd week, 6th week
|
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).
|
Baseline, 3rd week, 6th week
|
Collaborators and Investigators
Sponsor
Collaborators
Investigators
- Principal Investigator: Asim Arif, Phd scholar, University of Lahore
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- UOL/IREB/25/12/0014
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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