Combined Effects of Niel Asher Technique and Scapular Clock Exercises in Adhesive Capsulitis

Combined Effects of Niel Asher Technique and Scapular Clock Exercises on Pain, Range of Motion and Functional Disability in Patients With Adhesive Capsulitis

One of the most common shoulder condition in developed and developing countries is Adhesive Capsulitis, also known as Frozen Shoulder. Adhesive Capsulitis is a major cause of shoulder functional disability in patient as it is characterized by painful, restricted range of motion and capsular stiffness leading to difficulty in performing normal ADLs, causing an individual's activity limitations in dressing one's self, performing household chores and participation in the society. This study aims to determine the combined effects of Niel Asher Technique (NAT) and Scapular Clock Exercises on Pain, Range of Motion and Functional Disability in patients with Adhesive Capsulitis.

This Randomized Controlled Trial will be conducted was conducted in RC medical Centre Lahore, over a 9-month period. A sample of 34 participants, aged 40-55 years were selected using non-probability convenient sampling. Informed

Consent was obtained from all participants. Participants were divided into two groups:

Group A received Niel Asher Technique and Scapular Clock Exercises along with conventional physical therapy, while Group B received only conventional physical therapy which included a moist hot pack, Therapeutic ultrasound, Shoulder Active Range of Motion Exercises and Maitland's Mobilization. Treatment duration will be 3 sessions/week for 4 weeks. Outcome measures including Numeric Pain Rating Scale (NPRS), Universal Goniometer and Shoulder Pain and Disability Index (SPADI) Urdu were assessed at baseline and after 4 weeks. Inclusion Criteria includes Stage II and III Adhesive Capsulitis, Positive Capsular pattern with limited both Active and Passive range of motion, shoulder pain with an NPRS score >3 to ≤8. Exclusion Criteria includes patients with any systemic illness, metabolic disorder, prior history of shoulder surgery or shoulder dislocation. Data was analyzed using IBM SPSS version 27.0.

Study Overview

• Status: Completed
• Conditions: Adhesive Capsulitis of Shoulder
• Intervention / Treatment: Other: Niel Asher Technique; Other: Scapular clock exercises; Other: Conventional Physical Therapy

Detailed Description

One of the most common shoulder condition in developed and developing countries is Adhesive Capsulitis, also known as Frozen Shoulder. Adhesive Capsulitis is a major cause of shoulder functional disability in patient as it is characterized by painful, restricted range of motion and capsular stiffness leading to difficulty in performing normal ADLs, causing an individual's activity limitations in dressing one's self, performing household chores and participation in the society. This study aims to determine the combined effects of Niel Asher Technique (NAT) and Scapular Clock Exercises on Pain, Range of Motion and Functional Disability in patients with Adhesive Capsulitis.

This Randomized Controlled Trial will be conducted was conducted in RC medical Centre Lahore, over a 9-month period. A sample of 34 participants, aged 40-55 years were selected using non-probability convenient sampling. Informed

Consent was obtained from all participants. Participants were divided into two groups:

Group A received Niel Asher Technique and Scapular Clock Exercises along with conventional physical therapy, while Group B received only conventional physical therapy which included a moist hot pack, Therapeutic ultrasound, Shoulder Active Range of Motion Exercises and Maitland's Mobilization. Treatment duration will be 3 sessions/week for 4 weeks. Outcome measures including Numeric Pain Rating Scale (NPRS), Universal Goniometer and Shoulder Pain and Disability Index (SPADI) Urdu were assessed at baseline and after 4 weeks. Inclusion Criteria includes Stage II and III Adhesive Capsulitis, Positive Capsular pattern with limited both Active and Passive range of motion, shoulder pain with an NPRS score >3 to ≤8. Exclusion Criteria includes patients with any systemic illness, metabolic disorder, prior history of shoulder surgery or shoulder dislocation. Data was analyzed using IBM SPSS version 27.0.

• Study Type: Interventional
• Enrollment (Actual): 34
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Pakistan
  • Punjab Province
    • Lahore, Punjab Province, Pakistan, 54792
      • RC Medical Centre

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria:

• • Age Group between 40-55 years

  • Gender: Both Male and Female
  • Pain Persisted for more than 3 months.
  • Primary Adhesive Capsulitis Stage II and III
  • Limited passive range of motion (PROM) with 40% reduction in atleast two of these shoulder movements (flexion, external rotation, internal rotation, and abduction) compared to unaffected side for more than 3 months atleast.
  • Capsular Pattern +ve
  • Impingement Tests (Neers Test, Hawkins Kennedy Test) -ve
  • NPRS score of >3 to ≤8 of having shoulder pain

Exclusion Criteria:

• • Patient with systemic disease (Diabetes Mellitus, Thyroid Disorders, RA, Trauma, rotator cuff tears, malignancy, shoulder ligament injuries).

  • Previous shoulder surgery or Manipulation under anesthesia (MUA)
  • Prior history of shoulder dislocation

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
Active Comparator: Conventional Physical Therapy	Other: Conventional Physical Therapy; The control group received conventional physical therapy: Moist Hot Pack for 10 minutes.; Therapeutic Ultrasound for 10 minutes.; Maitland Mobilization glides passively 2 to 3 per second for 2 to 3 minutes. (Repeated 3 to 5 times) (for 4 weeks; 3 sessions/week).; Shoulder Active ROM exercises.
Experimental: Niel Asher Technique and Scapular clock exercises	Other: Niel Asher Technique; For the management of these taut areas in the muscles, many techniques can be beneficial such as Niel Asher Technique, Ischemic pressure on these areas, Dry Needling, blocking the nerve supply of the muscle beneath the shoulder blade. NAT is a treatment that reinforces the natural healing process of the body for treating AC. This Novel technique consists of five-step treatment regimen involving Myofascial release technique + Deep stroking to manipulate the shoulder joint in a planned and precise order. Niel Asher technique is effective for two reasons, the tight structures surrounding shoulder joint are released first and then the stimulation of the neural pathway at the cortex level and spinal level.; Other: Scapular clock exercises; Scapulothoracic hypomobility issues often occur due to adaptive shortening, due to long- protracted immobility caused by adhesive capsulitis. Scapular clock exercises are helpful in improving and restoring normal upward, downward, forward and backward movement of the shoulder blade. The SCE are responsible in maintaining the normal pattern of muscle mobility, ultimately enhancing the joint function. The musculature surrounding the shoulder blade includes SA, PM and TM, LS, and RM, dynamic multi-plane stability is provided by these muscles and helps in restoring shoulder blade mobility. Thus, during rest and movements, the proper functioning of these muscles is crucial to prevent any soft tissue injury & developing any faulty posture.; Other: Conventional Physical Therapy; The control group received conventional physical therapy: Moist Hot Pack for 10 minutes.; Therapeutic Ultrasound for 10 minutes.; Maitland Mobilization glides passively 2 to 3 per second for 2 to 3 minutes. (Repeated 3 to 5 times) (for 4 weeks; 3 sessions/week).; Shoulder Active ROM exercises.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Numeric Pain Rating Scale	NPRS is a scale that has eleven points to rate the pain intensity in the individuals by assigning a numeric value from 0 (marked as "no pain") to 10 (marked as "worst possible pain") points. This outcome measure has been widely used in studies and has found to be effective and reliable in the assessment of shoulder pain.	From the start upto 4 weeks
Shoulder Pain and Disability Index	SPADI is a self-report questionnaire that is widely used for assessment of intensity of shoulder pain and its influence on activity of daily living and functional restrictions. It consists of 13 items further sub-divided into pain scale and disability scale that assesses the degree of pain intensity and the problems experiences by the subject in performing everyday tasks such as lifting, reaching activities and sleeping. For each item, the person must assign a score ranging from 0 to 10 points, where a higher score indicates a greater level of pain or disability. The total score of the SPADI is calculated by averaging the results of the two subscales. SPADI has been shown to have good reliability and construct validity for assessing shoulder impairments majorly in patients presenting at the primary care level with shoulder pain	From start of study upto 4 weeks
Universal Goniometer	Health care practitioners often use universal goniometer to assess objective measurements of joint mobility to find out the baseline mobility status and to evaluating efficacy of treatment	From start of study upto 4 weeks

Collaborators and Investigators

• Sponsor: Riphah International University
• Investigators: Principal Investigator: Saba Rafique, Masters, Riphah International University

Publications and helpful links

General Publications

• 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.
• 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.
• Gulwani AH. A study to find out the effect of scapular stabilization exercises on shoulder ROM and functional outcome in diabetic patients with stage 2 adhesive capsulitis of the shoulder joint: an interventional study. Int J Sci Healthc Res. 2020;5(2):320-33.
• Malpani K, Mungikar S, Katage G. The effect of Shoulder Proprioceptive Neuromuscular Facilitation with Scapular Stability Exercises on pain, range of motion and function in Adhesive capsulitis-A case study. 2022
• Baheti MM, Jayswal P, Baheti B. The effect of scapular stabilization exercises on pain and function in patients with frozen shoulder. 2023.
• Makwana A, Mishra N. The effect of cyriax soft tissue release and myofascial release on pain pressure threshold, flexibility and muscle length in idiopathic adhesive capsulitis-a comparative study. International Journal of Community Medicine and Public Health. 2023;10(11):4187
• Raghav D, Krishnapandian PR, Dwivedi A. Comparative Effect of Niel-Asher Technique and Positional Release Technique on Pain, Active ROM and Functional Disability in Adhesive Capsulitis: An Experimental Study. JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH. 2023;17(4):YC01-YC5
• Balakrishnan R, Sudhakar S. Effects of scapular clock exercises and scapular proprioceptive neuromuscular facilitation on pain and functional activities in subjects with adhesive capsulitis. 2024.

Study record dates

Study Major Dates

• Study Start (Actual): October 28, 2024
• Primary Completion (Actual): December 1, 2025
• Study Completion (Actual): February 1, 2026

Study Registration Dates

• First Submitted: March 16, 2026
• First Submitted That Met QC Criteria: March 16, 2026
• First Posted (Actual): March 20, 2026

Study Record Updates

• Last Update Posted (Actual): March 20, 2026
• Last Update Submitted That Met QC Criteria: March 16, 2026
• Last Verified: March 1, 2026

More Information

Terms related to this study

• Keywords: Adhesive Capsulitis, Diability, Pain, Range of Motion, SPADI
• Additional Relevant MeSH Terms: Neurologic Manifestations; Musculoskeletal Diseases; Joint Diseases; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Pain; Bursitis
• Other Study ID Numbers: REC/RCR & AHS/24/0182

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