This research synopsis, titled "Comparative Effects of Niel-Asher Technique and Bowen Technique on Pain, Range of Motion, and Functional Disability in Adhesive Capsulitis," aims to compare the effectiveness of two manual therapy techniques in managing adhesive capsulitis (frozen shoulder). Adhesive capsulitis is a painful musculoskeletal condition characterized by progressive stiffness, reduced shoulder range of motion (ROM), and functional limitations that significantly affect daily activities and quality of life. Although several conservative treatment approaches exist, there is still no consensus regarding the most effective intervention. The study will be conducted as a single-blind randomized clinical trial at the Rehabilitation Department of Fauji Foundation Hospital, Rawalpindi, over one year. A total of 54 participants aged 40-60 years with stage II (frozen stage) adhesive capsulitis will be recruited using purposive sampling and randomly allocated into two groups through a coin toss method. Group A will receive the Niel-Asher Technique (NAT) combined with conventional physical therapy, while Group B will receive the Bowen Technique along with the same conventional treatment. Both groups will undergo treatment three times per week for four weeks.
Diagnosed case of unilateral primary or idiopathic Adhesive Capsulitis.
Age ranging from 40-60 years.
Frozen stage (Stage II).
Having pain and restricted active and passive range of motion >6 months.
Local corticosteroid injection to the affected shoulder within the last three months or who were on current corticosteroid therapy.
Any recent shoulder surgery.
Patients with neurological disorders, such as stroke, as well as those with uncontrolled diabetes, rheumatic disease in the shoulder, malignant tumors.
A history of the fracture or subluxation in the affected shoulder, history of surgery to the injured shoulder.
Parallel
Niel asher technique
Procedure/SurgeryThe Niel-Asher Technique (NAT) is a standardized five-step manual therapy protocol designed to treat adhesive capsulitis by targeting myofascial trigger points around the shoulder. It begins with a brief soft tissue massage to relax the neck and shoulder muscles. Step 1 involves deep stroking massage along the lateral arm. Step 2 applies sustained ischemic compression to trigger points in the posterior rotator cuff region. Step 3 consists of gentle passive circumduction of the glenohumeral joint. Step 4 combines deep stroking and trigger-point compression over the long head of the biceps tendon. Step 5 applies compression to the infraspinatus trigger point with assisted external rotation, followed by shoulder rolls to conclude treatment.
Bowen Technique
Procedure/SurgeryThe Bowen Technique is a gentle, non-invasive manual therapy that involves a series of precise rolling movements applied over specific muscles, tendons, fascia, and connective tissues. The technique is delivered in a standardized treatment protocol with short pauses between sets of moves to allow the body's neuromuscular and autonomic responses to occur. In patients with adhesive capsulitis, the intervention targets the shoulder girdle and associated regions, including the upper trapezius, levator scapulae, deltoid, rotator cuff muscles, pectoral muscles, and thoracic region, with the aim of reducing pain, improving shoulder range of motion, decreasing muscle tension, and enhancing functional mobility. Each treatment session lasts approximately 40 minutes, with three sessions per week for four weeks (12 sessions total).
Shoulder Range of Motion
A greater increase in shoulder range of motion of shoulder in goniometry
Functional Disability.
Functional disability in patients with adhesive capsulitis will be assessed as a secondary outcome using the Shoulder Pain and Disability Index (SPADI). SPADI is a patient-reported outcome measure specifically designed to assess shoulder pain and functional disability. It consists of 13 items, divided into two subscales: 5 items assessing pain and 8 items assessing disability. Each item is scored on a 0-10 numerical scale, where 0 represents no pain/no difficulty and 10 represents the worst pain or inability to perform the activity. The scores are converted to a 0-100 scale, with higher scores indicating greater pain and functional disability. SPADI will be assessed at baseline (pre-intervention) and again after completion of the intervention (post-intervention). The change in SPADI score from pre- to post-intervention will be used to determine improvement in shoulder-related functional disability and will be analyzed as a secondary outcome of the study.
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