Comparative Effects of Sequential Versus Non-Sequential Spencer Techniques on Pain, Range of Motion and Functional Outcomes in Patients with Frozen Shoulder

Abstract

Background: Adhesive capsulitis is a painful and disabling shoulder disorder marked by progressive stiffness and functional decline, frequently requiring prolonged rehabilitation. The Spencer muscle energy technique is widely used, yet whether structured sequencing of its steps improves outcomes remains uncertain. Objective: To compare Sequential versus Non-Sequential application of the Spencer technique for improving pain, range of motion (ROM), and functional outcomes in patients with adhesive capsulitis. Methods: In this single-blind randomized controlled trial, 40 participants with idiopathic adhesive capsulitis were allocated to Sequential Spencer Technique (SST; n=20) or Non-Sequential Spencer Technique (NSST; n=20). Both groups received identical standardized physiotherapy (TENS, hot pack, ultrasound) and exercises. Outcomes included Numeric Pain Rating Scale (NPRS), Shoulder Pain and Disability Index (SPADI), and shoulder ROM in six planes measured pre- and post-intervention after three weeks. Between-group comparisons were performed using independent tests, with within-group analyses using paired tests. Results: Both groups showed significant improvements in NPRS, SPADI, and ROM (all p<0.001). SST produced greater post-treatment pain reduction than NSST (NPRS 1.45 ± 0.88 vs 2.40 ± 0.94; p=0.002) and superior functional recovery (SPADI 32.85 ± 7.60 vs 40.25 ± 8.05; p=0.007). ROM gains were significantly larger in SST across flexion, extension, abduction, adduction, internal rotation, and external rotation (all p<0.05). Conclusion: Sequencing within the Spencer technique enhances pain relief, ROM restoration, and functional recovery in adhesive capsulitis, supporting structured progression as a preferred clinical approach.