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Effect of Spencer Muscle Energy Technique and Proprioceptive Neuromuscular Facilitation in Adhesive Capsulitis
Effect of Spencer Muscle Energy Technique and Proprioceptive Neuromuscular Facilitation in Adhesive Capsulitis
How to cite this article: Deepika B, Jagatheesan Alagesan, Buvanesh A et. al. Effect of Spencer Muscle Energy
Technique and Proprioceptive Neuromuscular Facilitation in Adhesive Capsulitis. Indian Journal of Physiotherapy
and Occupational Therapy / Volume 18, Year 2024.
Abstract
Background: Adhesive Capsulitis in the shoulder characterized as a self-limiting situation that lasts only while it
has also been described as a 24 week long-term impairment caused by a chronic condition. SMET is a widely used
method to restore normal ROM and reduce pain. PNF aims to improve joint synchronization, movement control,
and mobility.
Purpose: This study focuses on the effect of Spencer Muscle Energy Technique and Proprioceptive Neuromuscular
Facilitation for reducing pain and disability in Adhesive Capsulitis.
Materials and Methods: A total of 40 participants were selected based on inclusion and exclusion criteria from
Eyan Healthcare Foundation during the period of November 2022 to July 2023. They were split into two groups,
with 20 Participants receiving Spencer Muscle Energy Technique and 20 Participants receiving Proprioceptive
Neuromuscular Facilitation. Subjects with age of 40-70 years, with or without diabetes and pain or stiffness on
shoulder were included and Subjects with recent trauma, injury around the shoulder were excluded in the study.
All the subjects underwent pre-test measurement with Shoulder Pain and Disability Index (SPADI) and the same
repeated for post-test measurement at the end of 4 weeks.
Results: By statistical analysis there is a significant difference between the two groups. The Spencer group displays
a greater difference than the PNF group when comparing mean differences of the two groups using SPADI.
Conclusion: The study concluded that subjects who underwent Spencer Muscle Energy Technique are found to
be more effective in reducing pain and disability than Proprioceptive Neuromuscular Facilitation in Adhesive
Capsulitis.
Corresponding Author: Jagatheesan Alagesan, Professor and Principal, Saveetha College of Physiotherapy, Saveetha
Institute of Medical and Technical Sciences, Chennai, Tamil Nadu, India.
E-Mail: jagatheesanphd@gmailcom
448 Indian Journal of Physiotherapy and Occupational Therapy / Volume 18 Special Issue 2024
Technique, the following movement patterns with elbow on extended position. Participant distal
were performed, and the treatment duration was forearm was used as pivot to rotate the humerus
30 minutes6. clockwise and anticlockwise direction with slight
compression on shoulder joint for 15 times each.
Spencer Techniques
Shoulder Abduction and Shoulder Abduction with
Shoulder Extension
External Rotation
Participants positioned in side lying with
Participants positioned in side lying with affected
affected shoulder uppermost and physiotherapist
shoulder uppermost and physiotherapist standing
stand in front of participant with one hand stabilize
in front of participant with one hand stabilizing the
the acromioclavicular joint and other hand extend
acromioclavicular joint while participant grabbed
the participant shoulder in horizontal plane with
elbow flexed position until end range barrier was on physiotherapist same forearm and other hand
felt. Resistance was provided on the elbow joint provided resistance on elbow joint for abduction
and participants were instructed to push at a force. Participant has to extend upward pressure
resistance barrier against resistance and maintained on the elbow to increase abduction till end range
in contraction for 8-10 sec. The same procedure is was felt. Participants were instructed to push at a
repeated on the new restricted barrier position. resistance barrier against resistance and maintained
in contraction for 8-10 sec. The same procedure is
Shoulder Flexion
repeated on the new restricted barrier position.
Participants positioned in side lying with affected
Shoulder Internal Rotation
shoulder uppermost and physiotherapist standing
in front of participant with one hand stabilizing Participant positioned in side lying with affected
the acromioclavicular joint and other hand flexing shoulder uppermost with elbow flexed and hand
the participant shoulder in horizontal plane with positioned on the back within the available range
elbow extended position until end range barrier and physiotherapist standing in front of participant
was felt. Resistance was provided on the elbow with one hand stabilize the acromioclavicular
joint and participants were instructed to push at a joint while the other hand applied resistance on
resistance barrier against resistance and maintained elbow joint where the arm was internally rotated
in contraction for 8-10 sec. The same procedure is position. Participant has to exert forward pressure
repeated on the new restricted barrier position. to the elbow to internally rotate until the end range
Shoulder Circumduction is felt. Participants were instructed to push at a
resistance barrier against resistance and maintained
Participants positioned in side lying with affected in contraction for 8-10 sec. The same procedure is
shoulder uppermost and physiotherapist standing
repeated on the new restricted barrier position.
in front of participant with one hand stabilizing the
acromioclavicular joint and other hand abducted the Shoulder Adduction with Distraction
participant shoulder in horizontal plane with elbow
Participant positioned in side lying with
in flexed position. Participant elbow joint was used
affected shoulder uppermost with shoulder and
to rotate the humerus clockwise and anticlockwise
elbow extended and rested on therapist shoulder
direction with slight compression on shoulder joint
and physiotherapist standing in front of participant
for 15 times each.
with clasped his hand around participant shoulder
Shoulder Circumduction with Traction and provide downward and upward motion on
Participants positioned in side lying with the the deltoid muscle to increase soft tissue motion of
affected shoulder uppermost and physiotherapist deltoid as well as ligament on shoulder joints. It was
standing in front of participant with one hand continued for 30 sec and repeated.
stabilizing the acromioclavicular joint and other hand Proprioceptive Neuromuscular Facilitation group
abducted the participant shoulder in horizontal plane
450 Indian Journal of Physiotherapy and Occupational Therapy / Volume 18 Special Issue 2024
Participants treated with Proprioceptive Flexed and Ulnar Deviated, Fingers Flexed and
Neuromuscular Facilitation, the following movement Adducted. Participants positioned in supine lying
patterns were performed and the treatment duration and Physiotherapist in walk stand on the affected
was 20 minutes7. shoulder and place one hand over the elbow joint
and other over the palmar surface of the hand. The
PNF Techniques
resistance is applied by the physiotherapist.
Diagonal 1(D1) Flexion Pattern of Proprioceptive
Data Analysis
Neuromuscular Facilitation
For this study, 40 participants with adhesive
Shoulder Flexion, Adduction and External
capsulitis of male 18 and female 22 between the ages
Rotation, Elbow Flexed, Forearm Supinated,
of 40 to 70 years were selected. The participants with
Wrist Flexed and Radial Deviated with Fingers
pain and disability measured by SPADI before and
Flexed. Participants positioned in supine lying
after the treatment to provide pre-test and post-test
and Physiotherapist in Walk stand on the affected
values respectively.
shoulder and place one hand over the arm and other
over the hand. As the participant starts moving the
extremity, the physiotherapist applies resistance.
Shoulder Extension, Adduction and Internal Fig - 2: Analysis of pre-test and post-test values of
Rotation, Elbow Flexed, Forearm Pronated, Wrist PNF group.
Indian Journal of Physiotherapy and Occupational Therapy / Volume 18 Special Issue 2024 451
treatment some participant’s active participation at Journal of musculoskeletal & neuronal interactions.
the initial stage has been challenging. Further study 2019;19(4):482.
on PNF needed to investigate long term effects and 5. Ravichandran H, Balamurugan J. Effect of
to improve the quality of research, randomized and proprioceptive neuromuscular facilitation stretch
standardized blinding approaches are recommended. and muscle energy technique in the management of
adhesive capsulitis of the shoulder. Saudi journal of
Conclusion sports medicine. 2015 May 1;15(2):170.
6. Logabalan T, CV SN, Rajalaxmi V, Ramachandran S,
This study found that both the strategies utilized
Sudhakar S. A comparative study on the effectiveness
in the current Spencer Muscle Energy Technique
of muscle energy techniques and mobilization coupled
and Proprioceptive Neuromuscular Facilitation are
with ultrasound in patients with periarthritis of the
helpful in lowering pain and disability in adhesive shoulder joint. International Journal of Physiotherapy.
capsulitis. However, Spencer Muscle Energy 2016 Oct 8:619-24.
Technique is more effective than Proprioceptive
7. Saeed M, Hafeez S, Asad F, Haider W, Nawaz S,
Neuromuscular Facilitation.
Kocub S. Comparison Of Scapular Proprioceptive
Ethical clearance: Taken from the institutional Neuromuscular Facilitation and Myofascial Release
ethical committee. ISRB number - 03 /017/ 2022/ Techniques on Pain and Function in Scapular
Dyskinesia Associated with Adhesive Capsulitis:
ISRB/ SR/ SCPT
Scapular Dyskinesia Associated with Adhesive
Funding: Self. Capsulitis. Pakistan BioMedical Journal. 2022 Apr
30:123-7.
Conflict of Interest: Nil.
8. Contractor ES, Agnihotri DS, Patel RM. Effect of
spencer muscle energy technique on pain and
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