Spencer's Muscle Energy Technique Along With Strain Counter Strain in Adhesive Capsulitis.
Condition: Adhesive Capsulitis
MeSH terms: Bursitis; Sprains and Strains
Study type: Interventional

Summary: 
      Numerous Physiotherapy techniques have been found to be beneficial but there is no consensus
      on the best treatment approach for speeding up rehabilitation process and rejuvenating
      functional capacity in patients suffering from Adhesive capsulitis. Spencer Muscle energy
      technique is found to be effective in treatment of shoulder pathologies. It increases pain
      free range of motion through stretching the tissues, enhancing lymphatic flow and increasing
      the joint circulation where as Strain Counter Strain is a technique derived from positional
      release therapy which uses a pain monitor (trigger points) to find the position of the pain
      when it is no longer felt at the monitoring point. The purpose of this study is to determine
      the effects of Spencer Muscle energy technique with and without the employment of Strain
      Counter Strain on pain, Range of motion and disability in Adhesive capsulitis.
    

Detailed description: 
      Adhesive shoulder capsulitis or arthrofibrosis commonly known as frozen shoulder, depicts a
      pathological process in which the body forms excessive scar tissue or adhesions in the
      capsule around the glenohumeral joint, leading to stiffness, pain and dysfunction. The
      incidence of adhesive capsulitis in general population is approximately three to five percent
      and up to twenty percent in patients with diabetes. It is more common in women aged between
      forty and sixty years and in about twenty-thirty percent of cases it occurs bilaterally. In
      Pakistan, its precise prevalence is unknown, but in general it ranges from two-five percent.
      Adhesive capsulitis is classified into two categories: primary which is idiopathic in origin
      and occur spontaneously without any specific trauma or inciting event and is characterized by
      painful restriction of all shoulder movements, both active and passive, or Secondary which
      occurs as a result of some identifiable disorder, such as diabetes mellitus, or due to any
      inciting event such as cardiac surgery or trauma. There are four stages of frozen shoulder.
      Stage-one is painful shoulder. Stage - two is "Freezing Stage" with chronic pain and
      limitation in range of motion. Stage-three is "Frozen Stage" with considerable decreased
      Range Of Motion and rigid "end feel". Stage-four is "Thawing Phase" with progressive
      improvement in Range Of Motion. Physiotherapy methods such as active and active assisted
      exercises, pendular ex's, wand ex's, wall and ladder ex's, capsular stretching ex's and
      shoulder joint mobilization are often standard exercises in treating frozen shoulder.
      Electrotherapy modalities such as application of ultrasound, Interferential therapy,
      short-wave diathermy and LASER are used to relieve pain and promote hyperthermal effect to
      the tissues.

      The Spencer technique is a standardized series of shoulder treatments with broad application
      in diagnosis, treatment and prognosis. It was developed by Spencer in 1961. This approach is
      a well-known osteopathic manipulative technique that focuses on mobilization of the
      glenohumeral and scapulothoracic joints. It is an articulatory technique with seven different
      procedures, in this technique passive, smooth, rhythmic motion of the shoulder joint is done
      by the therapist to stretch contracted muscles, ligaments and capsule. Most of the force is
      applied at the end range of motion. This technique increases pain free range of motion
      through stretching the tissues, enhancing lymphatic flow and stimulating increased joint
      circulation.

      Positional release technique ( PRT), originally termed strain-counterstain, is a therapeutic
      technique that uses tender points (TPs) and a position of comfort (POC) to resolve the
      associated dysfunction. Essentially, Positional release technique is the opposite of
      stretching. For example, if a patient had a tight, tender area on the calf, if the clinician
      dorsiflex the foot to stretch the calf in an effort to reduce the tightness and pain. This
      might lead to muscle guarding and increased pain. Using the same example, a clinician who
      employs Positional release technique would place the tender point in the position of greatest
      comfort (plantar flexion), shortening the muscle in an effort to relax the tissues and
      decrease the tender points. Dr. Lawrence H. Jones, an osteopathic physician, was the first to
      publish a map of tender point locations and their associated treatment positions. Jones1964
      proposed that when a muscle is strained by a sudden unexpected force, its antagonist attempts
      to stabilize the joint, resulting in a counterstain of the muscle in a resting or shortened
      position. Before the antagonist is counter strained, gamma neural activity is heightened as a
      result of its shortened position, making the spindle more sensitive propagating development
      of restriction, sustained contraction, and tender point development. The application of
      Positional release technique relaxes the muscle-spindle mechanism, decreasing aberrant gamma
      and alpha neuronal activity, thereby breaking the sustained contraction. The prevailing
      theory underlying Positional release technique involve spacing tissues in a relaxed shortened
      state, or position of comfort , for a period of time (ninety sec) to decrease gamma gain in
      order to facilitate restoration of normal tissue length and tension.
    

Intervention name(s): Spencer Muscle energy technique with conventional Physiotherapy; Strain counter strain along with conventional Physiotherapy and Spencer Muscle energy technique
Intervention type(s): Other; Other
Intervention description(s): shoulder extension with elbow flexion. shoulder flexion with elbow extension. circumduction with compression circumduction with distraction shoulder abduction and internal rotation with elbow flexion. shoulder adduction and external rotation with elbow flexion stretching tissue and pumping fluids with the arm extended: therapist interlocks his fingertips over the deltoid muscle, patient's hand was placed over the therapist shoulder, and the therapist slowly moved the arm away from the shoulder and released.
During all the movements patient is asked to use their muscle energy against the slight resistance offered by the therapist for 6-8 sec.
conventional therapy Joint mobilization
Exercise therapy:
Self stretching and strengthening exercises; Palpate surrounding and opposing tissues to locate tender point for both shoulder abduction and external rotation.
Use one or two finger pads to monitor fasciculation and TP. Fine-tune position with rotation. Hold the POC (position of comfort) until fasciculation decreases significantly or ceases.
Average positions hold time while pressure is 90 s to 3 min. Transient periods of brief tingling, numbness, and temperature changes might occur. Release tissue or joint slowly and reassess.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Investigator)
Primary purpose: Treatment
Keywords: adhesive capsulitis; spencer muscle energy; strain counterstrain