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

Study Design and Procedures

This study is a single-blinded, randomized controlled trial designed to compare the effectiveness of the Spencer Technique combined with conventional therapy versus Mobilization with Movement combined with conventional therapy in individuals with shoulder dysfunction.

Screening and Recruitment

Participants who meet the predefined inclusion criteria will be recruited using a purposive sampling technique. Individuals who are readily available and willing to participate will be screened for eligibility.

Eligible participants will be informed about the study objectives, procedures, potential risks, and benefits. Written informed consent will be obtained prior to enrollment.

Sample Size and Allocation

A total sample of 52 participants will be included in the study. After baseline assessment, participants will be randomly allocated into two groups (Group A and Group B) using the lottery method.

Randomization

Randomization will be performed using a simple lottery method to ensure equal allocation into the two intervention groups.

Blinding

This study will follow a single-blinded design. Participants will be blinded to group allocation.

Intervention Duration and Assessment

Both groups will receive treatment for 6 weeks. Sessions will be conducted 3 times per week. Outcome assessments will be performed at baseline and at the end of the 6th week.

Each treatment session for both groups will have a total duration of 35 minutes.

Data will be analyzed using Statistical Package for the Social Sciences (SPSS) version 27.0.

Interventions Group A: Spencer Technique with Conventional Therapy

Participants allocated to Group A will receive the Spencer Technique in combination with conventional physiotherapy.

Conventional Therapy (15 minutes per session)

Moist Hot Pack (5 minutes):

A moist hot pack will be applied to the affected shoulder at a therapeutic temperature, with a towel placed between the pack and the skin.

Shoulder Stretching (10 minutes):

Passive stretching exercises will be performed to improve flexibility and range of motion. Each stretch will be held for 20-30 seconds and repeated 3-5 times. Stretching will include:

Shoulder flexion and extension

Shoulder abduction

Shoulder adduction

Internal and external rotation at 90° abduction

Spencer Technique (20 minutes per session)

The technique will be administered in seven sequential steps:

Shoulder extension with elbow flexion to restriction

Shoulder flexion with elbow extension

Circumduction with compression at 90° abduction

Circumduction with distraction at 90° abduction

Abduction with internal rotation

Adduction with external rotation

Stretching with fluid pumping maneuver (5-10 repetitions)

Dosage progression:

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 with Conventional Therapy

Participants allocated to Group B will receive Mobilization with Movement (MWM) combined with conventional physiotherapy.

Conventional Therapy (15 minutes per session)

5 minutes moist hot pack

10 minutes passive shoulder stretching

Mobilization with Movement (20 minutes per session)

Participants will be positioned in sitting. The therapist will stabilize the shoulder girdle with one hand and apply 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 to remain pain-free.

Mobilization will be performed in:

External rotation

Internal rotation

Abduction

Flexion

Participants will actively move the shoulder during sustained glide until the onset of pain or discomfort.

Dosage:

3 sets of 10 repetitions

30-second rest between sets

3 sessions per week for 6 weeks

Total session duration: 35 minutes (5 minutes hot pack, 10 minutes stretching, 20 minutes mobilization).

Inclusion Criteria:

• • Patient from the age of 30 to 60.

  • Patient suffering from rotator cuff syndrome. Patient with a history of pain in shoulder for more than 3 month.
  • Patient with grade 1 and grade 2 of rotator cuff syndrome which doesn't require surgery.
  • Patient with 2 positive Neers and Hawkins Kennedy test.
  • Patient who haven't gone under any physical therapy treatment in the past 6 months.

Exclusion Criteria:

• • Patient with any cardiac problem like myocardial infarction.

  • Patient with diagnosis of fibromyalgia.
  • Patient with ongoing pregnancy.
  • Patient with pain related to shoulder trauma.
  • Patient with history of shoulder injury or shoulder surgery.
  • Patient with associated symptoms like numbness and tingling.
  • Patient who have taken corticosteroids injections of shoulder within a year.

This study used a single-blind approach. This means that while the researchers knew which treatment each person was getting, the patients did not know if they were in the group A or group B. They were not told which exercise protocol was the main focus of the study or which one was expected to be more effective. This helps ensure that the patients' expectations did not influence the results or their reporting of pain levels.