Effects of Nunchaku Exercise for Improving Frozen Shoulder

Effects of Nunchaku Exercise on Adhesive Capsulitis (Frozen Shoulder) in Middle-aged and Older Adults: A Randomized Controlled Trial

The goal of this clinical trial is to investigate if nunchaku exercise works to treat adhesive capsulitis, or frozen shoulder in middle-aged or older adults. It will also learn about the adherence of this exercise intervention. The main questions it aims to answer are:

• Does practicing nunchaku exercises help reduce shoulder pain and improve shoulder movement?
• Do people stick with nunchaku exercises better, and spend more time practicing on their own, compared with standard exercises for alleviating frozen-shoulder?

Researchers will compare nunchaku exercise to standard exercises for alleviating frozen-shoulder to see if nunchaku exercise works to alleviate frozen shoulder.

Participants will:

• Join small group exercise classes for 12 weeks, doing either nunchaku based exercises or standard exercises designed to help relieve frozen shoulder.

• Have their shoulder pain and movement checked three times:

  • before training
  • after 6 weeks of training,
  • after finishing the 12 week program, and
  • 12 weeks after the program ends.
• Keep a record of their home practice time.

Study Overview

• Status: Recruiting
• Conditions: Adhesive Capsulitis
• Intervention / Treatment: Behavioral: Shoulder Mobilization and Stretching Exercise (SMSE); Behavioral: Nunchaku Exercise

Detailed Description

Adhesive capsulitis, or frozen shoulder, is a progressive fibro-inflammatory condition characterized by synovitis, capsular thickening, and collagen remodeling, leading to substantial restrictions in active and passive shoulder motion. These movement limitations commonly result in impaired sleep, difficulties in self-care, and reduced capacity for work and leisure activities. Although conservative rehabilitation is the standard of care, real-world effectiveness is frequently constrained by poor adherence to home-based exercises, often due to discomfort and exercise monotony.

This randomized controlled trial investigates the effects of nunchaku exercise as a novel rehabilitative modality for individuals with adhesive capsulitis in the thawing phase. Nunchaku practice requires rhythmic, multiplanar arm motions, coordinated scapulohumeral control, and dynamic stabilization. These biomechanical characteristics align with therapeutic goals of end-range stretching, neuromuscular retraining, and rotator-cuff-based stabilization. The inherently rhythmic, skill-acquisition nature of nunchaku practice may also enhance intrinsic motivation and adherence relative to traditional exercise programs.

In this assessor-blinded, two-arm, parallel-group trial, 50 ethnic Chinese adults aged 45 years or older will be recruited and randomized 1:1 to either a standard shoulder mobilization and stretching exercise program (SMSE) or a nunchaku exercise program (NE). The nunchaku exercise program will adapt into a safe, soft-towel form suitable for older adults. Both interventions last 12 weeks and consist of twice-weekly, 60-minute, small-group sessions, supplemented by encouraged home practice. SMSE includes joint mobilization, end-range stretching, strengthening. NE follows the Level 1 nunchaku syllabus of the nunchaku system from the Hong Kong nunchaku association.

Outcomes will be assessed at baseline, week 6, week 12, and week 24. The primary outcome is the Shoulder Pain and Disability Index (SPADI). Secondary outcomes include the Visual Analog Scale for pain, Constant-Murley Score, pain-free range of motion, and intervention enjoyment (PACES-8). Adherence will be monitored through attendance, dropout rates, and weekly self-practice time.

This study aims to determine whether nunchaku exercise can improve adherence and produce superior clinical outcomes compared with standard rehabilitation in middle-aged and older adults with adhesive capsulitis.

• Study Type: Interventional
• Enrollment (Estimated): 50
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Angus Pak-Hung Yu, PhD; Phone Number: (852) 39435253; Email: phayu@cuhk.edu.hk

Study Locations

• Hong Kong
  • Hong Kong, Hong Kong
    • Recruiting
    • Department of Sports Science and Physical Education, The Chinese University of Hong Kong
    • Contact: Angus Pak-Hung Yu, PhD; Phone Number: (852) 39435253; Email: phayu@cuhk.edu.hk

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria:

• Ethnic Chinese;
• Age 45 years or above;
• Diagnosed with Adhesive Capsulitis (Frozen Shoulder) and currently in the thawing stage.

Exclusion Criteria:

• Presence of secondary causes of shoulder stiffness, including recent trauma, post-surgical stiffness, or structural lesions such as full-thickness rotator cuff tears or severe glenohumeral arthritis;
• Receipt of recent shoulder treatments known to influence short-term outcomes, including corticosteroid injections within the past three months, hydrodilatation, manipulation under anesthesia, arthroscopic capsular release within the past six months, or structured shoulder physiotherapy within the past three months;
• Presence of somatic conditions that limit their ability to participate safely in exercise (e.g., inability to walk without an assistive device).

Study Plan

How is the study designed?

Design Details

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

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Shoulder Mobilization and Stretching Exercise (SMSE)	Behavioral: Shoulder Mobilization and Stretching Exercise (SMSE); Participants in this group will be offered a 12-week rehabilitation program consisting of two 60-minute sessions per week. This program has been designed by a registered physiotherapist in accordance with the Hospital Authority of Hong Kong's self-care guidelines. Each session includes joint mobilization exercises, end-range stretching using a towel or stick, and muscle-strengthening and stabilizing exercises. The training will be conducted in small groups by trained exercise instructors, and you will be encouraged to continue practicing these exercises independently at home between sessions.
Experimental: Nunchaku Exercise	Behavioral: Nunchaku Exercise; Participants randomized to the Nunchaku Exercise group will participate in a 12-week training program consisting of two 60-minute sessions per week. To prioritize safety and minimize the risk of injury, you will use a soft towel with a knot at each end to simulate nunchaku movements (Figure 1). The training focuses on the level one syllabus of the standard nunchaku system, which involves rhythmic multi-angle movements, such as figure-eight trajectories and alternating hand transfers. Classes will be conducted in small groups by certified coaches from the Hong Kong Nunchaku Association, and you will be encouraged to perform these exercises independently at home between sessions.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Shoulder Pain and Disability Index (SPADI)	SPADI will be used to assess shoulder pain and functional limitations during daily living activities. SPADI, comprising 5 items to assess pain and 8 to assess disability, is widely used to evaluate the negative impact of frozen shoulder. Its Chinese version has been validated in China with good internal consistency and reliability	From enrollment to the end of follow-up period at 24 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Visual Analog Scale for Pain (VAS)	The perception of pain during resting, and ordinary daily activities will be assessed using VAS. Participants will be instructed to draw a mark on a 10-cm line, with one end indicating no pain and the other indicating worst pain imaginable, to indicate their pain level	From enrollment to the end of follow-up period at 24 weeks
Constant-Murley Score (CMS)	Overall shoulder function will be assessed using the CMS. CMS assesses 4 domains, including pain, how shoulder function affects daily activity, pain-free range of motion, and muscle strength. This instrument has been validated in China. This assessment will be conducted by a registered physiotherapist.	From enrollment to the end of follow-up period at 24 weeks
Pain-free Range of Motion (ROM)	The pain-free ROM of forward and lateral elevation during flexion and abduction will be measured using a goniometer. The assessment will be conducted by a registered physiotherapist.	From enrollment to the end of follow-up period at 24 weeks
Enjoyment of intervention	Enjoyment of intervention will be assessed using the Eight-Item Physical Activity Enjoyment Scale (PACES-8).	From mid-intervention at 6 weeks to to the end of follow-up period at 24 weeks

Collaborators and Investigators

• Sponsor: Chinese University of Hong Kong

Study record dates

Study Major Dates

• Study Start (Actual): April 14, 2026
• Primary Completion (Estimated): December 31, 2026
• Study Completion (Estimated): December 31, 2026

Study Registration Dates

• First Submitted: March 17, 2026
• First Submitted That Met QC Criteria: March 17, 2026
• First Posted (Actual): March 20, 2026

Study Record Updates

• Last Update Posted (Actual): April 17, 2026
• Last Update Submitted That Met QC Criteria: April 14, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Keywords: adhesive capsulitis; Frozen Shoulder; Nunchaku exercise
• Additional Relevant MeSH Terms: Musculoskeletal Diseases; Joint Diseases; Bursitis
• Other Study ID Numbers: FS_nun_1

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