Francesca Galiano
13/09/2022 - Last update 29/12/2022

Mushyyaida Iqbal, Huma Riaz, Misbah Ghous, Kanza Masood | Year 2020

Comparison of Spencer muscle energy technique and Passive stretching in adhesive capsulitis, A single blind randomized control trial


Adhesive capsulitis and/or frozen shoulder

Type of study:

Randomized controlled trial

Date of publication of the study’:



Purpose of the study

  • Objective: to compare the effects of Spencer muscle energy technique and passive stretching in adhesive capsulitis
  • Measured outcomes:
    • Primary: pain, range of motion (ROM), shoulder functionality and disability using numerical scales, goniometer and validated questionnaires


  • Number: 60 people (39 female and 21 male)
  • Criteria of inclusion: age 30-55 years, with idiopathic frozen shoulder stage 1 or 2 or stiff painful shoulder joints for at least 3 months
  • Criteria of exclusion: rotator cuff injuries, rheumatoid or gouty arthritis, shoulder cancers, reflex sympathetic dystrophy of the shoulder, thoracic inlet syndrome, peripheral nerve damage, fractures of the shoulder girdle, dislocations, no use of analgesics
  • Groups of study: two groups obtained by randomization
    • Group 1: Spencer muscle energy technique, 37 people (mean age 45.1 years)
    • Group 2: passive stretching, 35 people (mean age 46.6 years)

Interventions and evaluations

  • An assessment before the first session, after two weeks and then after 4 weeks (that is, after the last intervention)
    • pain evaluation through numeric pain scale rating (NPSR) from 0 to 10
    • shoulder ROM assessment by goniometer
    • shoulder function assessment by the quick version of the disabilities of arm, shoulder and hand questionnaire (Quick-DASH)
    • evaluation of the pain and disability specifically connected to the shoulder using the shoulder pain and disability index (SPADI)
  • 3 intervention sessions per week, every other day, for 4 weeks
  • Spencer technique: Spencer technique to assess and treat 7 different shoulder movements
  • Passive stretching: passive stretching of flexion, internal rotation, external rotation and abduction
  • Before each operation, warming up of the shoulder for 7-10 minutes using a heating patch


Primary outcomes: primary outcomes: in all cases, Spencer technique, compared to passive stretching, favored a statistically significant greater reduction of pain and disability measured by NSPR (-5 vs -3), Quick-DASH (-27 vs -14) and SPADI (-30 vs -19), both after 2 weeks and at the end of the study.

with regard to the shoulder ROM, Spencer technique statistically significantly induced a greater improvement in extension (+20° vs +13°), flexion (+61° vs +29°), internal rotation (+39° vs +18°), external rotation (+58° vs +24°) and abduction (+70° vs +32°) compared to passive stretching.


Compared to passive stretching treatment, the use of an osteopathic muscle energy technique, Spencer technique, induced decidedly better results in treating pain and disability related to a frozen shoulder situation. The ROM was also positively affected by the osteopathic technique, and far more than by passive stretching.

Probably, the efficacy of Spencer technique resides in having acted on the biochemical markers connected to pain, as well as on the activation of cerebral paths and areas (eg, periaqueductal gray) inhibiting pain thanks to the stimulation of several mechanoreceptors.
Given the severity of the condition – high levels of pain and disability – having effective conservative strategies is of paramount importance.

The authors hope for larger, longer-lasting future studies (follow-up) that stratify the results for the stage of pathology, as each stage has its own peculiarities and may need different interventions, as shown by the literature.

The review of Osteopedia

By Marco Chiera

Strengths: sample size (number of people to be included in the study) calculated on the basis of past cases of adhesive capsulitis in which the effect of the Spencer technique on pain and disability was assessed; use of specific validated tests, described in a concise but effective manner.

Interesting results because clinically significant (eg, for the SPADI, the clinical condition can be said to have changed if the score varies by at least 13 points. Spencer technique induced a change of 30 points).

Limits: there is no discussion of the distinction between adhesive capsulitis (properly physical alteration with fibrosis) and frozen shoulder (a disorder potentially even only functional), which generates confusion in the interpretation of the study.
Lack of a specific primary outcome (although it could have been the level of pain or disability, given that it looks like the sample size was calculated on them).

Not very clear results tables (not explained to the reader the meaning of the data in two of the columns); intragroup statistical tests not reported although carried out; given the peculiarity of the pathology, lack of a long-term evaluation (eg, 1 month after the end of the study).

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