Comparative Effects of Spencer Techniques and Movement With Mobilization in Improving Pain, Range of Motion, and Functional Disability in Rotator Cuff Syndrome.

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This study will be randomised clinical trial conducted at the University of Lahore Teaching Hospital, Lahore, Pakistan. A total of 60 participants will be selected and randomly allocated into two treatment groups (30 participants in each group) using the lottery method. All screened and willing participants who meet the eligibility criteria will be assigned to either Group A or Group B. Group A: Spencer Technique with Conventional Therapy Participants allocated to Group A will receive the Spencer Technique in combination with conventional physiotherapy. The intervention will follow a structured and progressive protocol for 6 weeks. Conventional Therapy (15 minutes per session) Conventional treatment will be administered prior to manual therapy and will include: Moist Hot Pack (5 minutes): A moist hot pack will be applied to the affected shoulder at a comfortable therapeutic temperature. A towel layer will be placed between the hot pack and the skin to prevent burns. Shoulder Stretching Exercises (10 minutes): Passive stretching will be performed to improve flexibility, reduce muscle tightness, and enhance shoulder range of motion. Each stretch will be held for 20-30 seconds and repeated 3-5 times. Stretching will include: Shoulder flexion and extension (supine position) Shoulder abduction Shoulder adduction (cross-body stretch) Internal and external rotation at 90° abduction Stretching will be performed five sessions per week. Spencer Technique (20 minutes per session) Following conventional therapy, the Spencer technique will be administered in seven sequential steps: Shoulder extension with elbow flexion to the point of restriction Shoulder flexion with elbow extension Circumduction with compression at 90° abduction Circumduction with distraction at 90° abduction Abduction with internal rotation (hand placed behind hip) Adduction with external rotation Stretching with fluid pumping maneuver (5-10 repetitions) Dosage and Progression: Frequency: 5 sessions per week Weeks 1-3: 2 sets of 10 repetitions per step (1-minute rest between sets) Weeks 4-6: 3 sets of 10 repetitions per step Total session duration: 35 minutes 5 minutes hot pack 10 minutes stretching 20 minutes Spencer technique Group B: Mobilization with Movement (MWM) with Conventional Therapy Participants allocated to Group B will receive Mobilization with Movement combined with conventional physiotherapy for 6 weeks. Conventional Therapy (15 minutes per session) The same conventional therapy protocol as Group A will be administered prior to mobilization: 5 minutes moist hot pack 10 minutes passive shoulder stretching Mobilization with Movement (20 minutes per session) MWM will be performed in the directions of: External rotation Internal rotation Abduction Flexion The participant will be positioned in sitting on a high chair. The therapist will stabilize the shoulder girdle with one hand while applying a sustained glide to the humeral head using the thenar eminence of the other hand. The glide will be maintained perpendicular to the plane of movement and adjusted according to the participant's pain-free direction. Participants will be instructed to actively move the shoulder through the available range while the glide is sustained. Movement will continue until the onset of pain or discomfort. Dosage: 3 sets of 10 repetitions 30-second rest between sets Frequency: 3 sessions per week Duration: 6 weeks Total session duration: 35 minutes 5 minutes hot pack 10 minutes stretching 20 minutes mobilization with movement

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