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Rotator cuff syndrome is a common cause of shoulder pain and functional limitation, often associated with myofascial trigger points. Myofascial Trigger Point Release (MFTR) and the Neil Asher Technique (NAT) are manual therapies aimed at reducing pain and improving mobility. This study compares their effects on pain, range of motion, and disability in individuals with rotator cuff syndrome.
This will be a randomized Clinical trial conducted on 36 participants. Data will be collected from Jinnah hospital and The University of Lahore Teaching Hospital, Lahore by using non-probability convenience sampling technique. Adults aged 40 to 60 years with non-surgical rotator cuff-related shoulder pain, confirmed by positive Neer's or Hawkins-Kennedy tests and experiencing symptoms for more than four weeks, will be included in this study. Individuals with cardiac conditions, pregnancy, trauma-related shoulder injuries, or a history of shoulder surgery will be excluded. Group A will receive Myofascial Trigger Point Release (MFTR) along with conservative physiotherapy, while Group B will receive the Neil Asher Technique (NAT) combined with conservative physiotherapy. Each session will last 35 minutes-20 minutes for the primary intervention and 15 minutes for conventional therapy-administered four times per week for four weeks. Pre- and post-treatment evaluations will include the Numeric Pain Rating Scale (NPRS), range of motion (using a Universal Goniometer), and disability (measured via SPADI). Data will be analyzed using SPSS version 27.0.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Myofascial Trigger Point Release (MFTR)+ conservative physiotherapy Group) | Experimental | This group will be given Myofascial Trigger Point Release (MFTR) with basic physiotherapy care. |
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| Neil Asher Technique (NAT) + conservative physiotherapy Group | Active Comparator | This group will be given Neil Asher Technique (NAT) along with basic physiotherapy care. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Myofascial Trigger Point Release (MFTR)+ conservative physiotherapy Group | Other | lateral border of the scapula, just below the infraspinatus. • Compression is followed by horizontal abduction and external rotation to stretch the muscle. Ischemic Compression: Each active trigger point is treated with 2 sets of deep pressure, applied using the therapist's fingers, thumb, or elbow. Duration: Each compression lasts 20-30 seconds, gradually increasing pressure to the patient's tolerance. Post-Compression Stretching: Gentle passive stretching of the treated muscle follows immediately after each compression set to restore muscle length. Each session will last 35 minutes (5 minutes hot pack, 10 minutes stretching, 20 minutes Myofascial Trigger Point Release) |
| Measure | Description | Time Frame |
|---|---|---|
| Numeric Pain Rating Scale (NPRS) - Pain Assessment | The Numeric Pain Rating Scale (NPRS) is a unidimensional, patient-reported outcome measure used to assess pain intensity. Participants are asked to rate their current pain level, or average pain over a specified recall period (e.g., past 24 hours or past week), using an 11-point scale ranging from 0 to 10, where 0 indicates "no pain" and 10 indicates "worst imaginable pain." | upto 4 weeks |
| Universal Goniometer (UG) - Range of Motion (ROM) | The Universal Goniometer (UG) is a standard clinical instrument used for measuring joint range of motion (ROM) in degrees. It consists of a fulcrum, stationary arm, and movable arm, allowing precise angular measurement of joint movement. For ROM assessment, the participant is positioned according to standardized protocols (supine, prone, or sitting depending on the joint being assessed). Anatomical landmarks are used for alignment to ensure accuracy and reliability. The stationary arm is aligned with the proximal segment of the joint, while the movable arm follows the distal segment. | upto 4 weeks |
| Shoulder Pain and Disability Index (SPADI) - Disability Outcome | The Shoulder Pain and Disability Index (SPADI) is a validated, self-administered questionnaire designed to measure pain and functional disability in patients with shoulder conditions. It consists of 13 items divided into two subscales: Pain subscale (5 items) - assesses severity of shoulder pain during specific activities Disability subscale (8 items) - assesses difficulty in performing functional tasks such as dressing, reaching, lifting, and carrying objects Each item is scored on a Visual Analog Scale (0-10), where higher scores indicate greater pain and disability. The total SPADI score is calculated as a percentage, with 0% representing no disability and 100% representing maximum disability. | upto 4 weeks |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Samrood Akram, PhD* | Contact | 03324806143 | samrood.akram@riphah.edu.pk |
| Name | Affiliation | Role |
|---|---|---|
| Iqra Nazir, MSPT* | Riphah International University | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| University of Lahore Teaching Hospital, Lahore HOD Physio Department | Lahore | Punjab Province | 54000 | Pakistan |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 30285401 | Background | Varacallo MA, El Bitar Y, Sina RE, Mair SD. Rotator Cuff Syndrome. 2024 Mar 5. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Available from http://www.ncbi.nlm.nih.gov/books/NBK531506/ | |
| Background | Kuhn JE. Prevalence, natural history, and nonoperative treatment of rotator cuff disease. Operative techniques in sports medicine. 2023;31(1):150978. | ||
| 34148475 |
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| Neil Asher Technique (NAT) + conservative physiotherapy Group | Other | The NAT is a non-invasive trigger point therapy that applies a specific sequence of ischemic compressions to deactivate active trigger points, stimulate reflex responses, and promote muscular balance. Apply several deep strokes over the fibrous band and then each trigger point is treated with sustained manual pressure for 20-30 seconds, repeated 2-3 times per session. Hot Pack Application: A moist hot pack will be applied over the affected shoulder for 5 minutes using a protective towel. Shoulder Stretching Routine: Includes flexion/extension, abduction/adduction, and internal/external rotation (each stretch held for 20-30 seconds and repeated 3-5 times). |
|
| Background |
| Meyers AR, Wurzelbacher SJ, Krieg EF, Ramsey JG, Crombie K, Christianson AL, Luo L, Burt S. Work-Related Risk Factors for Rotator Cuff Syndrome in a Prospective Study of Manufacturing and Healthcare Workers. Hum Factors. 2023 May;65(3):419-434. doi: 10.1177/00187208211022122. Epub 2021 Jun 20. |
| Background | Zahra T, Altaf F, Akhtar H, Awan SS, Sher UA, Waris S. Sleep Quality and Nocturnal Pain in Patients of Rotator Cuff Syndrome. Pakistan Journal of Medical & Health Sciences. 2022;16(09):394-. |
| 34276924 | Background | Kwan CK, Ko MC, Fu SC, Leong HT, Ling SK, Oh JH, Yung PS. Are muscle weakness and stiffness risk factors of the development of rotator cuff tendinopathy in overhead athletes: a systematic review. Ther Adv Chronic Dis. 2021 Jul 3;12:20406223211026178. doi: 10.1177/20406223211026178. eCollection 2021. |
| 40511351 | Background | Sidiropoulos K, Samundeeswari S, Giannatos V, Kotsapas M, Arrigoni P, Montoya F, Brilakis E, Latz D, Koukos C. Partial Cuff Repair in Rotator Cuff Tears: Current Concepts and Clinical Considerations. Indian J Orthop. 2025 Feb 4;59(6):743-755. doi: 10.1007/s43465-025-01338-0. eCollection 2025 Jun. |
| 34089878 | Background | Zhao J, Luo M, Pan J, Liang G, Feng W, Zeng L, Yang W, Liu J. Risk factors affecting rotator cuff retear after arthroscopic repair: a meta-analysis and systematic review. J Shoulder Elbow Surg. 2021 Nov;30(11):2660-2670. doi: 10.1016/j.jse.2021.05.010. Epub 2021 Jun 2. |
| 35257948 | Background | Giri A, O'Hanlon D, Jain NB. Risk factors for rotator cuff disease: A systematic review and meta-analysis of diabetes, hypertension, and hyperlipidemia. Ann Phys Rehabil Med. 2023 Feb;66(1):101631. doi: 10.1016/j.rehab.2022.101631. Epub 2022 Nov 30. |
| 39966503 | Background | Khadour FA, Khadour YA, Alharbi NSK, Alhatem W, Albarroush D, Dao X. Risk factors for rotator cuff tear in Syrian adults: a cross-sectional study. Sci Rep. 2025 Feb 18;15(1):5837. doi: 10.1038/s41598-025-89878-1. |
| 29494017 | Background | Javed O, Maldonado KA, Ashmyan R. Anatomy, Shoulder and Upper Limb, Muscles. 2023 Jul 24. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Available from http://www.ncbi.nlm.nih.gov/books/NBK482410/ |
| 37875953 | Background | Cao Z, Li Q, Li Y, Wu J. The association of metabolic syndrome with rotator cuff tendinopathy: a two-sample Mendelian randomization study. Diabetol Metab Syndr. 2023 Oct 24;15(1):211. doi: 10.1186/s13098-023-01189-5. |
| ID | Term |
|---|---|
| D010146 | Pain |
| ID | Term |
|---|---|
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
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| ID | Term |
|---|---|
| C041665 | N-acetyltalosaminuronic acid |
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