Frozen ShoulderNCT07080060
Comparison of Niel-Asher and Spencer Techniques in Frozen Shoulder Patients
A study testing Niel-Asher Technique and Spencer Technique in people with Frozen Shoulder and Adhesive Capsulitis, run by Riphah International University at 1 site in Pakistan.
Trial summary
This study aims to compare the effectiveness of two manual therapy techniques-Niel-Asher Technique and Spencer Technique-when combined with conventional physiotherapy in treating patients with frozen shoulder (adhesive capsulitis). Read more about this study
- Who is it for?
- Ages 35 to 65 years
- Conditions the study is for
- Frozen Shoulder, Adhesive Capsulitis
- What is being tested?
- Niel-Asher Technique and Spencer Technique
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 44 participants
- Where
- 1 sitePakistan
- Study dates
- Jul 2025to 30 Nov 2025
- Phase
- Interventional
- Are there results?
- Not yet: the study is under way
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 35 to 65 years
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- Age group between 35-65 years diagnosed with primary Adhesive Capsulitis.
- Both gender male and female.
- Both Active and passive Range of Motion is limited.
- Stage II Frozen Shoulder patients (Freezing Stage,3-9 months).
- More than 50% of range of motion is limited in Flexion, Abduction and External rotation as compared to unaffected side.
- Pain reported on VAS score <7/10 in shoulder region.
- Patients agree to sign written consent form.
Who cannot join
- Patients with systemic illness:
- Diabetes Mellitus, Thyroid disorders.
- Rheumatoid Arthritis, Malignancy.
- Patients with mechanical injuries like:
- Rotator Cuff injury, Ligamentous Injuries.23
- Previous Surgery or Manipulation under Anesthesia.
- Patients with Stage I, III, IV of Frozen Shoulder.
- Patient reported with VAS score >7/10 in shoulder region.
Trial locations and contacts
1 site in 1 country. Contact the study team or a site near you to ask about taking part.
Pakistan1 site
Noor Thalassemia Foundation
Lahore, Punjab Province, 54000
Dr Bashir, 03034328759
About this study
Official title: Effects of Niel-Asher Technique Versus Spencer Technique Along With Conventional Therapy on Pain, Range of Motion, and Functional Status in Frozen Shoulder Patients
This study aims to compare the effectiveness of two manual therapy techniques-Niel-Asher Technique and Spencer Technique-when combined with conventional physiotherapy in treating patients with frozen shoulder (adhesive capsulitis). Frozen shoulder is a painful condition that limits movement and function of the shoulder joint. The study will include 44 adults aged 35 to 65 years who have been diagnosed with stage II frozen shoulder. Participants will be randomly assigned to one of two groups. Both groups will receive standard physiotherapy, including heat therapy, TENS, and stretching exercises. In addition, one group will receive the Niel-Asher Technique, while the other group will receive the Spencer Technique. Pain, range of motion, and shoulder function will be measured before and after a 4-week treatment period using validated tools such as the Visual Analogue Scale (VAS), a goniometer, and the Shoulder Pain and Disability Index (SPADI). The goal is to determine which manual therapy technique is more effective in improving symptoms and function in patients with frozen shoulder.
Read the detailed description
Frozen shoulder, also known as adhesive capsulitis, is a common musculoskeletal condition characterised by pain, stiffness, and reduced range of motion of the glenohumeral joint. It is often associated with idiopathic onset, and can significantly impair daily activities and quality of life. While conventional physiotherapy-including modalities such as heat, TENS, and therapeutic exercise-forms the basis of treatment, there is growing evidence supporting the use of manual therapy techniques for enhanced outcomes.
This randomised controlled trial investigates the comparative effects of the Niel-Asher Technique and the Spencer Technique, each provided alongside standard conventional physiotherapy. A total of 44 patients meeting inclusion criteria (age 35-65 years, diagnosed with stage II adhesive capsulitis, and VAS pain score <7/10) will be enrolled and randomly assigned to one of two groups using computer-generated numbers and sealed envelope allocation.
Group A will receive the Niel-Asher Technique, which targets trigger points and myofascial release to reduce muscle guarding and pain. Group B will receive the Spencer Technique, a structured sequence of mobilisation techniques often used in osteopathic manual therapy. Both groups will also receive conventional therapy including moist heat, TENS, Codman exercises, finger ladder exercises, and capsular stretching.
The intervention will be administered three times per week over a 4-week period. Primary outcome measures include shoulder pain assessed by the Visual Analogue Scale (VAS), range of motion measured by a universal goniometer, and functional status assessed by the Shoulder Pain and Disability Index (SPADI).
Data will be analysed using SPSS 25.0. Parametric or non-parametric tests will be applied based on data distribution. The findings of this study aim to provide evidence for clinical decision-making in the manual therapy treatment of frozen shoulder and may help establish more effective, hands-on techniques in physiotherapy practice.
- Conditions
- Frozen Shoulder, Adhesive Capsulitis
- Being tested
- Niel-Asher Technique, Spencer Technique
- Keywords
- Manual Therapy, Niel-Asher Technique, Spencer Technique, Pain, Range of motion
- Medical subject headings
- Bursitis, Pain
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Niel-Asher TechniqueOther
Participants in this group will receive the Niel-Asher Technique, a manual therapy approach focusing on trigger point release and myofascial decompression of the shoulder girdle. Treatment will involve structured pressure techniques applied to specific muscular trigger points including the infraspinatus, supraspinatus, subscapularis, and levator scapulae. The intervention will be delivered in side-lying and sitting positions.
Conventional physiotherapy, includes a 10-minute hot pack, 15-minute TENS, Codman exercises, finger ladder exercises (2-3 sets, 3-5 repetitions), and capsular stretching (20-30 sec hold, 2-4 repetitions). Sessions will be conducted 3 times per week for 4 weeks.
Spencer TechniqueOther
Participants in this group will receive the Spencer Technique, an osteopathic manual therapy consisting of eight mobilization steps: extension, flexion, circumduction with compression, circumduction with distraction, abduction, adduction with external rotation, internal rotation, and traction stretch. Each movement will be performed with patient participation using muscle energy techniques.
Conventional physiotherapy, includes a 10-minute hot pack, 15-minute TENS, Codman exercises, finger ladder exercises (2-3 sets, 3-5 repetitions), and capsular stretching (20-30 sec hold, 2-4 repetitions). Sessions will be conducted 3 times per week for 4 weeks.
| Study group | Role | What they receive |
|---|---|---|
| Niel-Asher Technique | Experimental | Participants in this group will receive the Niel-Asher Technique, a manual therapy approach focusing on trigger point release and myofascial decompression of the shoulder girdle. Treatment will involve structured pressure techniques applied to specific muscular trigger points including the infraspinatus, supraspinatus, subscapularis, and levator scapulae. The intervention will be delivered in side-lying and sitting positions. Receives: Other: Niel-Asher Technique |
| Spencer Technique | Experimental | Participants in this group will receive the Spencer Technique, an osteopathic manual therapy consisting of eight mobilization steps: extension, flexion, circumduction with compression, circumduction with distraction, abduction, adduction with external rotation, internal rotation, and traction stretch. Each movement will be performed with patient participation using muscle energy techniques. Receives: Other: Spencer Technique |
What is being measured
The primary outcome is the main question the study is designed to answer.
Numeric Pain Rating Scale
Pain intensity in the affected shoulder will be assessed using the Visual Analogue Scale (VAS), a validated 10-point scale where 0 indicates "no pain" and 10 indicates "worst imaginable pain." A decrease in score indicates pain reduction.
Measured: Baseline and 4 Weeks Post-Treatment
Shoulder Range of Motion (ROM)
Shoulder joint range of motion, including flexion, abduction, and external rotation, will be measured using a universal goniometer. ROM will be recorded in degrees. An increase in ROM values indicates functional improvement.
Measured: Baseline and 4 Weeks Post-Treatment
Shoulder Pain and Disability Index (SPADI)
Shoulder function will be evaluated using the Shoulder Pain and Disability Index (SPADI), a self-reported questionnaire assessing pain and disability. Scores range from 0 (no pain/disability) to 100 (maximum pain/disability). A reduction in score indicates functional improvement.
Measured: Baseline and 4 Weeks Post-Treatment
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted23 Jul 2025
- Study startJul 2025 (estimated)
- Primary completion15 Nov 2025 (estimated)
- Study completion30 Nov 2025 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (5)Papers the sponsor has linked to this study.
- Other trials for Frozen ShoulderStudies of the same condition, open and under way.
- More trials run by Riphah International UniversityThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Double blind
- Who is masked
- Participant, Outcomes assessor
- Enrolment
- 44 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Riphah International University
- Sponsor type
- University, hospital or other
- Responsible party
- Sponsor
- Investigators
- Amna Zia, Phd Scholar, Principal investigator, Riphah International University/ Mayo Hospital
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07080060
- Sponsor's protocol ID
- REC/RCR & AHS/24/0167- Minahil
- Status last verified
- Jul 2025
- First submitted
- 14 Jul 2025
- Last updated
- 23 Jul 2025
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Publications
Cavalleri E, Servadio A, Berardi A, Tofani M, Galeoto G. The effectiveness of physiotherapy in idiopathic or primary frozen shoulder. A systematic review and meta- analysis. MLTJ MUSCLES, LIGAMENTS AND TENDONS JOURNAL. 2020;10(1):24-39.
Tang CK, Shih YF, Lee CS. The effect of muscle-biased manual therapy on shoulder kinematics, muscle performance, functional impairment, and pain in patients with frozen shoulder. J Hand Ther. 2025 Jan-Mar;38(1):42-51. doi: 10.1016/j.jht.2024.02.010. Epub 2024 Jun 29.
PubMed 38944638Raghav 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 Apr 1;17(4):YC01-5.
Phansopkar P, Qureshi MI. A Research Protocol on Comparative evaluation of Efficacy of Spencer Technique, Kaltenborn, Mulligan, and Maitland mobilization on Pain, Range of Motion and Functional Disability in Frozen Shoulder.
Riaz H, Javed A, Ali H, Kazmi YA, Naz S, Javed Z. COMPARATIVE EFFECT OF SPENCER TECHNIQUE VS MULLIGAN MOBILIZATION ON ROM AND FUNCTIONAL DISABILITY AMONG ADHESIVE CAPSULITIS PATIENTS. Insights-Journal of Health and Rehabilitation. 2025 Jan 27;3(3 (Health & Rehab)):156-65.
Study at a glance
From the registry record, last updated by the sponsor on 23 Jul 2025. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Effects of Niel-Asher Technique Versus Spencer Technique Along With Conventional Therapy on Pain, Range of Motion, and Functional Status in Frozen Shoulder Patients
- ClinicalTrials.gov ID
- NCT07080060
- Acronym / sponsor ID
- REC/RCR & AHS/24/0167- Minahil
- Conditions
- Frozen Shoulder, Adhesive Capsulitis
- Keywords
- Manual Therapy, Niel-Asher Technique, Spencer Technique, Pain, Range of motion
- Study type
- Interventional
- Recruitment status
- Not yet recruiting
- Enrolment
- 44 participants (estimated)
- Lead sponsor
- Riphah International UniversityUniversity, hospital or other
- Study start
- Jul 2025 (estimated)
- Primary completion
- 15 Nov 2025 (estimated)
- Study completion
- 30 Nov 2025 (estimated)
- First posted
- 23 Jul 2025 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
This study aims to compare the effectiveness of two manual therapy techniques-Niel-Asher Technique and Spencer Technique-when combined with conventional physiotherapy in treating patients with frozen shoulder (adhesive capsulitis). Frozen shoulder is a painful condition that limits movement and function of the shoulder joint. The study will include 44 adults aged 35 to 65 years who have been diagnosed with stage II frozen shoulder. Participants will be randomly assigned to one of two groups. Both groups will receive standard physiotherapy, including heat therapy, TENS, and stretching exercises. In addition, one group will receive the Niel-Asher Technique, while the other group will receive the Spencer Technique. Pain, range of motion, and shoulder function will be measured before and after a 4-week treatment period using validated tools such as the Visual Analogue Scale (VAS), a goniometer, and the Shoulder Pain and Disability Index (SPADI). The goal is to determine which manual therapy technique is more effective in improving symptoms and function in patients with frozen shoulder.
Detailed description
Frozen shoulder, also known as adhesive capsulitis, is a common musculoskeletal condition characterised by pain, stiffness, and reduced range of motion of the glenohumeral joint. It is often associated with idiopathic onset, and can significantly impair daily activities and quality of life. While conventional physiotherapy-including modalities such as heat, TENS, and therapeutic exercise-forms the basis of treatment, there is growing evidence supporting the use of manual therapy techniques for enhanced outcomes.
This randomised controlled trial investigates the comparative effects of the Niel-Asher Technique and the Spencer Technique, each provided alongside standard conventional physiotherapy. A total of 44 patients meeting inclusion criteria (age 35-65 years, diagnosed with stage II adhesive capsulitis, and VAS pain score <7/10) will be enrolled and randomly assigned to one of two groups using computer-generated numbers and sealed envelope allocation.
Group A will receive the Niel-Asher Technique, which targets trigger points and myofascial release to reduce muscle guarding and pain. Group B will receive the Spencer Technique, a structured sequence of mobilisation techniques often used in osteopathic manual therapy. Both groups will also receive conventional therapy including moist heat, TENS, Codman exercises, finger ladder exercises, and capsular stretching.
The intervention will be administered three times per week over a 4-week period. Primary outcome measures include shoulder pain assessed by the Visual Analogue Scale (VAS), range of motion measured by a universal goniometer, and functional status assessed by the Shoulder Pain and Disability Index (SPADI).
Data will be analysed using SPSS 25.0. Parametric or non-parametric tests will be applied based on data distribution. The findings of this study aim to provide evidence for clinical decision-making in the manual therapy treatment of frozen shoulder and may help establish more effective, hands-on techniques in physiotherapy practice.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Double blind (participant, outcomes assessor)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Niel-Asher Technique | Experimental | Other: Niel-Asher TechniqueParticipants in this group will receive the Niel-Asher Technique, a manual therapy approach focusing on trigger point release and myofascial decompression of the shoulder girdle. Treatment will involve structured pressure techniques applied to specific muscular trigger points including the infraspinatus, supraspinatus, subscapularis, and levator scapulae. The intervention will be delivered in side-lying and sitting positions. |
| Spencer Technique | Experimental | Other: Spencer TechniqueParticipants in this group will receive the Spencer Technique, an osteopathic manual therapy consisting of eight mobilization steps: extension, flexion, circumduction with compression, circumduction with distraction, abduction, adduction with external rotation, internal rotation, and traction stretch. Each movement will be performed with patient participation using muscle energy techniques. |
Who may qualify
- Ages
- 35 to 65 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (7 listed)
- Age group between 35-65 years diagnosed with primary Adhesive Capsulitis.
- Both gender male and female.
- Both Active and passive Range of Motion is limited.
- Stage II Frozen Shoulder patients (Freezing Stage,3-9 months).
- More than 50% of range of motion is limited in Flexion, Abduction and External rotation as compared to unaffected side.
Key exclusion criteria (8 listed)
- Patients with systemic illness:
- Diabetes Mellitus, Thyroid disorders.
- Rheumatoid Arthritis, Malignancy.
- Patients with mechanical injuries like:
- Rotator Cuff injury, Ligamentous Injuries.23
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Niel-Asher TechniqueParticipants in this group will receive the Niel-Asher Technique, a manual therapy approach focusing on trigger point release and myofascial decompression of the shoulder girdle. Treatment will involve structured pressure techniques applied to specific muscular trigger points including the infraspinatus, supraspinatus, subscapularis, and levator scapulae. The intervention will be delivered in side-lying and sitting positions. Conventional physiotherapy, includes a 10-minute hot pack, 15-minute TENS, Codman exercises, finger ladder exercises (2-3 sets, 3-5 repetitions), and capsular stretching (20-30 sec hold, 2-4 repetitions). Sessions will be conducted 3 times per week for 4 weeks. | Other | Niel-Asher Technique |
| Spencer TechniqueParticipants in this group will receive the Spencer Technique, an osteopathic manual therapy consisting of eight mobilization steps: extension, flexion, circumduction with compression, circumduction with distraction, abduction, adduction with external rotation, internal rotation, and traction stretch. Each movement will be performed with patient participation using muscle energy techniques. Conventional physiotherapy, includes a 10-minute hot pack, 15-minute TENS, Codman exercises, finger ladder exercises (2-3 sets, 3-5 repetitions), and capsular stretching (20-30 sec hold, 2-4 repetitions). Sessions will be conducted 3 times per week for 4 weeks. | Other | Spencer Technique |
Primary outcome
Numeric Pain Rating Scale
Time frame: Baseline and 4 Weeks Post-Treatment
Pain intensity in the affected shoulder will be assessed using the Visual Analogue Scale (VAS), a validated 10-point scale where 0 indicates "no pain" and 10 indicates "worst imaginable pain." A decrease in score indicates pain reduction.
Shoulder Range of Motion (ROM)
Time frame: Baseline and 4 Weeks Post-Treatment
Shoulder joint range of motion, including flexion, abduction, and external rotation, will be measured using a universal goniometer. ROM will be recorded in degrees. An increase in ROM values indicates functional improvement.
Shoulder Pain and Disability Index (SPADI)
Time frame: Baseline and 4 Weeks Post-Treatment
Shoulder function will be evaluated using the Shoulder Pain and Disability Index (SPADI), a self-reported questionnaire assessing pain and disability. Scores range from 0 (no pain/disability) to 100 (maximum pain/disability). A reduction in score indicates functional improvement.
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 23 Jul 2025.
- BackgroundCavalleri E, Servadio A, Berardi A, Tofani M, Galeoto G. The effectiveness of physiotherapy in idiopathic or primary frozen shoulder. A systematic review and meta- analysis. MLTJ MUSCLES, LIGAMENTS AND TENDONS JOURNAL. 2020;10(1):24-39.
- Background: PubMed 38944638Tang CK, Shih YF, Lee CS. The effect of muscle-biased manual therapy on shoulder kinematics, muscle performance, functional impairment, and pain in patients with frozen shoulder. J Hand Ther. 2025 Jan-Mar;38(1):42-51. doi: 10.1016/j.jht.2024.02.010. Epub 2024 Jun 29.
- BackgroundRaghav 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 Apr 1;17(4):YC01-5.
- BackgroundPhansopkar P, Qureshi MI. A Research Protocol on Comparative evaluation of Efficacy of Spencer Technique, Kaltenborn, Mulligan, and Maitland mobilization on Pain, Range of Motion and Functional Disability in Frozen Shoulder.
- BackgroundRiaz H, Javed A, Ali H, Kazmi YA, Naz S, Javed Z. COMPARATIVE EFFECT OF SPENCER TECHNIQUE VS MULLIGAN MOBILIZATION ON ROM AND FUNCTIONAL DISABILITY AMONG ADHESIVE CAPSULITIS PATIENTS. Insights-Journal of Health and Rehabilitation. 2025 Jan 27;3(3 (Health & Rehab)):156-65.
- Individual participant dataSharing planned: No
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part.
Amna Zia, Phd Scholar principal investigator
Riphah International University/ Mayo Hospital
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Niel-Asher Technique and Spencer Technique in people with Frozen Shoulder and Adhesive Capsulitis, run by Riphah International University at 1 site in Pakistan.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 7 inclusion and 8 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: opening soon, as of the sponsor's last update on 23 Jul 2025. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Pakistan. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
Contact Samrood Akram, Phd Scholar (03324806143, samood.akram@riphah.edu.pk), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Numeric Pain Rating Scale (time frame: Baseline and 4 Weeks Post-Treatment). The study lists 3 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT07080060, which also lists 5 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 23 Jul 2025.