Comparison of Spencer's Muscle Energy Technique and Post-facilitation Stretch in Patients With Adhesive Capsulitis
Condition: Frozen Shoulder
MeSH terms: Bursitis
Study type: Interventional

Summary: 
      Adhesive capsulitis is one of the most common problems of the upper limb. Adhesive capsulitis
      (AC) and frozen shoulder syndrome (FSS) are two terms that have been used to describe a
      painful and stiff shoulder.

      Conservative treatment includes transcutaneous electrical nerve stimulation (TENS),
      Ultrasound, LASER, Range of Motion, stretching and strengthening exercises, patient
      education, and home exercises. Manual therapy includes mobilization, Spencer's Muscle Energy
      Technique and Mobilization With Movement.
    

Detailed description: 
      The American Academy of Orthopedic Surgeons defines this condition as: "A condition of
      varying severity characterized by the gradual development of global limitation of active and
      passive shoulder motion where radiographic findings other than osteopenia are absent."
      Patients with frozen shoulder typically experience insidious shoulder stiffness, severe pain
      that usually worsens at night, and near-complete loss of passive and active external rotation
      of the shoulder.

      Although spencer's Muscle Energy Technique is a very effective technique, still it was rarely
      used. It is a standardized series of steps of shoulder treatments with broad application in
      diagnosis, treatment, and prognosis developed by Spencer in 1961 and is a well-known
      osteopathic manipulative technique that focuses on mobilization of the glenohumeral and
      scapulothoracic joints. It is an articulatory technique in which 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 by stretching the tissues, enhancing lymphatic
      flow, and stimulating increased joint circulation.

      On the other hand, "post-facilitation stretch (PFS)" is a muscle energy technique developed
      by Dr.Vladimir Janda to lengthen chronically shortened muscles that involves a maximal
      contraction of the muscle at mid-range with a rapid movement to maximal length followed by a
      20-second static stretch. This technique is more aggressive than Post Isometric Relaxation
      and based on the concept of autogenic inhibition
    

Intervention name(s): Spencer's MET with conventional therapy; Post-Facilitation Stretch with conventional therapy
Intervention type(s): Other; Other
Intervention description(s): Patients will be asked to lie in a side lying position with the affected shoulder above. The therapist will stabilize the shoulder girdle with the proximal hand and the distal hand provided force into the restrictive barrier of shoulder in 7 different movements. During all the movements, patients will ask to use their muscle energy 20% against the slight resistance offered by the therapist for 3-5 seconds. The patient then asks to relax and exhale after that shoulder joint will move beyond the barrier to achieve the next barrier. After 20 sec of rest, this technique will be repeated 3-5 times; Muscle Energy Technique [Post Facilitation Stretch)] for the shoulder joint will be applied with 3 repetitions per set, 1 session per day. Patient will be instructed to perform a full strength contraction of the muscle to be stretch for 10 seconds. The muscle is then allow to fully relax, whereupon a rapid stretch of the affected muscle will be performed and will held in position by the physician for 15 sec. Patient will be asked to relax and whole cycle will be repeated
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: spencer Muscle energy technique; post facilitation; pain; range of motion