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

Summary

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.

Conditions

• Adhesive Capsulitis of Shoulder

Interventions

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.

Sponsors & Collaborators

• Riphah International University

  lead OTHER

Principal Investigators

• Saba Rafique, Masters · Riphah International University

Study Design

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

DOUBLE

Model

PARALLEL

Eligibility

Min Age

40 Years

Max Age

55 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2024-10-28

Primary Completion

2025-12-01

Completion

2026-02-01

Countries

• Pakistan

Study Locations