COMPARATIVE EFFICACY OF SPENCER’S TECHNIQUE VERSUS MULLIGAN’S TECHNIQUE ON PAIN, RANGE OF MOTION, AND QUALITY OF LIFE IN PATIENTS WITH STAGE II FROZEN SHOULDER

Abstract

Background: Adhesive capsulitis, commonly known as frozen shoulder, is a painful musculoskeletal condition characterized by progressive shoulder pain, stiffness, and restriction of range of motion (ROM), which may adversely affect functional performance and health-related quality of life. Stage II adhesive capsulitis is associated with persistent pain and considerable restriction of shoulder mobility. Although various manual therapy techniques are used in clinical rehabilitation, comparative evidence regarding Spencer’s Technique and Mulligan’s Mobilization with Movement (MWM) remains limited. Therefore, this study compared the effects of Spencer’s Technique and Mulligan’s MWM on pain intensity, shoulder ROM, and health-related quality of life in patients with Stage II idiopathic adhesive capsulitis.

Objective: To compare the effects of Spencer’s Technique and Mulligan’s MWM on pain intensity, shoulder ROM, and health-related quality of life in patients with Stage II idiopathic adhesive capsulitis.

Methods: This randomized controlled trial included 72 participants with Stage II idiopathic adhesive capsulitis who were recruited from Ibn-e-Sina Hospital and Research Institute and City Hospital, Multan, using a non-probability convenience sampling technique. Participants were randomly allocated into two equal groups (n = 36 per group). Group A received Spencer’s Technique with conventional physiotherapy, while Group B received Mulligan’s MWM with conventional physiotherapy. Both groups received five treatment sessions per week for four weeks. Pain intensity was assessed using the Numeric Pain Rating Scale (NPRS), shoulder ROM was measured using a goniometer, and health-related quality of life was assessed using the 36-Item Short Form Health Survey (SF-36). Assessments were conducted before and after the intervention. Normality was assessed using the Kolmogorov–Smirnov test. Within-group comparisons were performed using paired-samples t tests for normally distributed ROM data and Wilcoxon signed-rank tests for non-normally distributed outcomes. Between-group comparisons were performed using the Mann–Whitney U test. Statistical analysis was conducted using IBM SPSS Statistics version 26.0, with p ≤ .05 considered statistically significant.

Results: Both groups demonstrated statistically significant within-group improvements in all eight shoulder ROM measures, including flexion, extension, abduction, adduction, internal rotation, external rotation, horizontal abduction, and horizontal adduction (all p < .001). Pain intensity also decreased significantly in both the Spencer’s Technique group (Z = −5.44, p < .001) and the Mulligan’s MWM group (Z = −5.40, p < .001). Similarly, all eight SF-36 domains demonstrated statistically significant within-group improvements in both groups (all p < .001). Between-group analysis revealed no statistically significant difference in pain intensity (p = .184) or most SF-36 domains. However, statistically significant between-group differences were observed in shoulder horizontal adduction (p = .003) and the General Health domain of the SF-36 (p = .015).

Conclusion: Both Spencer’s Technique and Mulligan’s MWM, when combined with conventional physiotherapy, were associated with significant improvements in pain intensity, shoulder ROM, and health-related quality of life in patients with Stage II idiopathic adhesive capsulitis. Between-group differences were observed specifically for shoulder horizontal adduction and the General Health domain, whereas no significant differences were found for pain intensity or the remaining assessed outcomes.