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NCT Number: NCT07484386

Combined Effects of Niel Asher Technique and Scapular Clock Exercises in 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.

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Key information

Conditions

Adhesive Capsulitis of Shoulder Bursitis Joint Diseases Musculoskeletal Diseases Neurologic Manifestations Pain Pathological Conditions, Signs and Symptoms Signs and Symptoms

Age range

40 year–55 year

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

RC Medical Centre

Lahore, Punjab Province, 54792, Pakistan

About this study

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.

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

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

Treatment and study plan

Niel Asher Technique

Other

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.

Scapular clock exercises

Other

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.

Conventional physical therapy

Other

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.

Primary outcomes

  1. Numeric Pain Rating Scale

    Time frame: From the start upto 4 weeks

    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.

  2. Shoulder Pain and Disability Index

    Time frame: From start of study upto 4 weeks

    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

  3. Universal Goniometer

    Time frame: From start of study upto 4 weeks

    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

Sponsors and collaborators

Lead sponsor

Riphah International University

Other

Registry information

Official study title

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

Important dates

Study start
2024
Primary completion
2025
Study completion
2026
First posted
Mar 20, 2026
Registry last updated
Mar 20, 2026

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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