Spencer's Muscle Energy Technique and Cyriax Deep Friction Massage on Adhesive Capsulitis
Condition: Adhesive Capsulitis
MeSH terms: Bursitis
Study type: Interventional

Summary: 
      To compare the effects of Spencer technique and Cyriax deep friction massage on pain, range
      of motion (ROM) and functional disability of the shoulder in Adhesive capsulitis
    

Detailed description: 
      Adhesive capsulitis is a common condition of the shoulder characterized by severe pain,
      stiffness and gradual loss of both active and passive range of motion (ROM) due to
      progressive fibrosis and contracture of the glenohumeral joint capsule.As a result, capsule
      gets tighten and shoulder movement restriction happens in a capsular pattern Shoulder
      external rotation ROM is restricted first followed by shoulder abduction and internal
      rotation.

      The stiffness of the shoulder capsule develops muscle spasm. On assessment one will find
      tenderness on anterior and lateral gleno-humeral joint line followed by muscle spasm and
      trigger points in pectoral muscles, scapular muscles and deltoid causing pain over the
      shoulder girdle.According to Travell and Simons study which is also taken as a reference by
      M.V.Arjun (2021) stated that AC is a muscular dysfunction model.

      It is usually classified into two types. One is primary and other is secondary. The
      idiopathic cause in which no finding in history or examination explains the reason for onset
      is known as "Primary Adhesive capsulitis". The disorder develops from a known cause called
      "Secondary Adhesive capsulitis" According to a study of 2020 by Akshay Date and Luthfur
      Rahman there are four stages of Adhesive capsulitis. Stage 1 (less than 3 months) is a
      "painful stage" with moderate pain and reduced movement due to hypertrophic synovitis with
      hyper vascularity. Stage 2 (3-9 months) is the "Freezing stage" with severe pain and limited
      shoulder movement due to perivascular synovitis and disorganized collagen deposition and
      scarring. Stage 3 (10-14 months) is the "Frozen stage" with marked stiffness due to dense and
      hyper cellular collagenous tissue of the capsule. The last stage 4 (14-24 months) is the
      "Thawing stage" with minimal pain and gradual improvement in movement.

      Although pain and decreased range of motion cause functional limitation of the shoulder but
      with appropriate treatment and rehabilitation intervention, the severity of disability due to
      FS is markedly reduced in patients. Physical therapy is often considered the 1st line of
      treatment option for FS as various exercise and physical therapy modalities help to relieve
      pain, maintain ROM and restore functions. Out of different manual techniques we will work on
      Spencer technique and Cyriax deep friction massage and compare their effects.

      Spencer muscle energy technique (SMET) is an osteopathic manipulative treatment which is
      widely used in western practice to treat shoulder problems. It consists of different
      articulation techniques especially designed to enhance mobility of glenohumeral and
      scapulothoracic joints by stretching of soft tissue and mobilization of fluid in Adhesive
      capsulitis patients.To stretch the contracted muscles, ligaments and joint capsules, smooth,
      rhythmical, passive motion couple with active muscular contraction is required as it includes
      both active and passive approaches. This procedure required slow stretching of the shoulder
      joint within the available ROM and maintaining it into the restrictive barrier by a
      physiotherapist (passive) and creating isometric contraction of muscles against resistance by
      the patient ( active) followed by a relaxation phase succeeding to the new restrictive
      barrier. This voluntary isometric contraction of targeted antagonist muscle produces
      relaxation to agonist muscle and helps reduce the spasms which in turn increase range of
      which was decreased due to muscle spasm.It also increases blood circulation to the shoulder
      joint, enhances lymphatic flow and stretches the muscle, ligaments and capsule of the
      shoulder joint in order to enhance pain-free range of motion.

      Different studies such as Anil Rimal (2021), Raksha R et.al (2021) and Mushyyaida (2020)
      suggested that SMET is effective for reducing pain, increasing ROM and improving
      functionality in AC.

      Another technique used for Adhesive Capsulitis was by James Cyriax, cross-fiber friction
      massage which is also known as "Deep transverse friction". It is an influential type of soft
      tissue massage applied transversely to the tissue involved such as ligaments, tendons, muscle
      bellies, musculotendinous junction and joint capsules.It enhances remodeling and hence
      reorientation of the collagen fibers in a longitudinal manner. It is a passive technique. The
      method of applying Deep friction massage on the shoulder is to place the thumb or finger on
      the shoulder joint line, supraspinatus, subscapularis, Deltoid and pectoralis major and
      compress. Then move the patient's skin back and forth over the treated fibers perpendicular
      to the tissue fibers.This will produce transverse movement of collagen fibers that helps in
      preventing adhesion formation and relaxing muscles. This technique also provides analgesic
      effects via gate control theory.

      There are few studies in literature which prove the effectiveness of Spencer MET and Cyriax
      DFM on Adhesive Capsulitis. However, there have been no studies which have compared the
      effectiveness of both the techniques. The rationale behind our study is to determine the most
      effective technique among Spencer MET and Cyriax DFM. To find out whether Spencer is more
      effective for the Adhesive Capsulitis patients regarding pain, range of motion and functional
      disability,as it contains both active and passive approaches as compared to Cyriax DFM or
      vice versa.
    

Intervention name(s): Cyriax Deep Friction Massage; Spencer Muscle energy technique
Intervention type(s): Other; Other
Intervention description(s): Hotpack : 10 min TENS : 20 min, High frequency(100 Hz pulse ), 3 days/week Kaltenborn mobilization: End range - Anterior, posterior and caudal glides :10 repetitions with 10 sec hold x 3 sets, 3 days/week Cyriax DFM on targeted muscles (Supraspinatus, Infraspinatus, subscapularis, Deltoid and Pectoralis) 3 minutes each muscle (15 mins in total ) x 1 set , 3 days / week; Hotpack : 10 min TENS : 20 min, High frequency(100 Hz pulse ), 3 days/week Kaltenborn mobilization: End range - Anterior, posterior and caudal glides :10 repetitions with 10 sec hold x 3 sets, 3 days/week The Spencer technique will be applied in Abduction, External rotation and Internal rotation for targeting muscles Supraspinatus, Infraspinatus, subscapularis, Deltoid and Pectoralis.
10 repetitions x 3set , 3 days/week.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Spencer muscle technique; Cyriax deep friction massage; SHOULDER PAIN