Spencer Technique versus Mobilization Techniques in Patients with Adhesive Capsulitis: A Systematic Review of Randomized and Quasi-Experimental Studies
Spencer Technique versus Mobilization in Adhesive Capsulitis
Keywords:
Bursitis, Musculoskeletal Manipulations, Osteopathic Medicine, Physical Therapy Modalities, Shoulder PainAbstract
Background: Adhesive capsulitis causes shoulder pain, stiffness and disability. The Spencer technique and mobilization techniques such as Mulligan mobilization with movement (MWM) are both widely used, yet it is unclear which works better. This review compared the Spencer technique with mobilization techniques for pain, range of motion (ROM), functional disability and quality of life in adults with adhesive capsulitis.
Methods: Five databases (PubMed/MEDLINE, Cochrane CENTRAL, Scopus, Web of Science, PEDro) were searched from January 2015 to March 2026 and supplemented by Google Scholar, trial registers and citation tracking. Eligible studies were randomized and quasi-experimental studies in adults with adhesive capsulitis in which the Spencer technique was compared with MWM or passive accessory mobilization. Screening, data extraction and risk-of-bias appraisal (RoB 2 and ROBINS-I V2) were each performed independently by two reviewers. Findings were synthesized narratively following the SWiM guideline, and the certainty of evidence was rated using GRADE.
Results: Of 1,500 records, ten studies (436 participants) were included: eight randomized controlled trials (RCTs) comparing the Spencer technique with MWM, and one RCT and one quasi-experimental study comparing it with passive accessory mobilization. Against MWM, the Spencer technique produced less abduction in all seven trials that measured it (significantly in six) and significantly less external rotation in six of seven. Shoulder Pain and Disability Index scores were 7–12 points lower after MWM in the six trials with interpretable data. Pain differences were inconsistent and mostly below clinically important thresholds. Against passive accessory mobilization, the RCT favored mobilization and the quasi-experimental study favored the Spencer technique. Risk of bias raised some concerns in six RCTs and was high in three. Certainty was low for abduction, external rotation and disability, and very low for other outcomes.
Conclusion: MWM may give greater short-term gains in shoulder mobility and function than the Spencer technique. However, this finding rests on small, unregistered trials, and the comparison with passive accessory mobilization remains very uncertain. Larger registered trials with blinded assessment and longer follow-up are needed.
DOI: https://doi.org/10.59564/amrj/04.04/015
References
Millar NL, Meakins A, Struyf F, Willmore E, Campbell AL, Kirwan PD, et al. Frozen shoulder. Nat Rev Dis Primers. 2022;8(1):59. https://doi.org/10.1038/s41572-022-00386-2
de la Serna D, Navarro-Ledesma S, Alayón F, López E, Pruimboom L. A comprehensive view of frozen shoulder: a mystery syndrome. Front Med (Lausanne). 2021;8:663703. https://doi.org/10.3389/fmed.2021.663703
Pandey V, Madi S. Clinical guidelines in the management of frozen shoulder: an update! Indian J Orthop. 2021;55(2):299–309. https://doi.org/10.1007/s43465-021-00351-3
Dyer BP, Rathod-Mistry T, Burton C, van der Windt D, Bucknall M. Diabetes as a risk factor for the onset of frozen shoulder: a systematic review and metaanalysis. BMJ Open. 2023;13(1):e062377. https://doi.org/10.1136/bmjopen-2022-062377
Berner JE, Nicolaides M, Ali S, Pafitanis G, Preece J, Hopewell S, et al. Pharmacological interventions for early-stage frozen shoulder: a systematic review and network meta-analysis. Rheumatology (Oxford). 2024;63(12):3221–33. https://doi.org/10.1093/rheumatology/keae176
Mertens MGCAM, Meert L, Struyf F, Schwank A, Meeus M. Exercise therapy is effective for improvement in range of motion, function, and pain in patients with frozen shoulder: a systematic review and metaanalysis. Arch Phys Med Rehabil. 2022;103(5):9981012. https://doi.org/10.1016/j.apmr.2021.07.806
Nakandala P, Nanayakkara I, Wadugodapitiya S, Gawarammana I. The efficacy of physiotherapy interventions in the treatment of adhesive capsulitis: a systematic review. J Back Musculoskelet Rehabil. 2021;34(2):195–205. https://doi.org/10.3233/BMR-200186
de Sire A, Agostini F, Bernetti A, Mangone M, Ruggiero M, Dinatale S, et al. Non-surgical and rehabilitative interventions in patients with frozen shoulder: umbrella review of systematic reviews. J Pain Res. 2022;15:2449–64. https://doi.org/10.2147/JPR.S371513
Sarwar N, Eisha-Tur-Razzia, Siddique S, Jawa R. Efficacy of Spencer technique and scapular mobilization in the management of adhesive capsulitis: a narrative review. Pak J Rehabil. 2026;15(1):5–8 https://doi.org/10.36283/pjr.zu.15.1/003
Phansopkar P, Qureshi MI. Impact of Spencer technique on pain, range of motion, and functional disability in patients with frozen shoulder: a pilot study. Cureus. 2024;16(1):e53263. https://doi.org/10.7759/cureus.53263
Satpute K, Reid S, Mitchell T, Mackay G, Hall T. Efficacy of mobilization with movement (MWM) for shoulder conditions: a systematic review and metaanalysis. J Man Manip Ther. 2022;30(1):13–32. https://doi.org/10.1080/10669817.2021.1955181
Khyathi P, Vinod Babu K, Sai Kumar N, Asha D. Comparative effect of Spencer technique versus Mulligan's technique for subjects with frozen shoulder: a single blind study. Int J Physiother. 2015;2(2):448–58. https://doi.org/10.15621/ijphy/2015/v2i2/65255
Haveela B, Dowle P, Chandrashekar P. Effectiveness of Mulligan's technique and Spencer's technique in adjunct to conventional therapy in frozen shoulder: a randomised controlled trial. Int J Adv Res Dev. 2018;3(1):253–60.
Shera D, Mustafa Z, Pria A, Khan T, Yasir F, Ijaz R, et al. Comparison of effectiveness of Mulligan's mobilization and Spencer technique along with conventional therapy for frozen shoulder: randomized controlled trial. Br J Multidiscip Adv Stud. 2023;4(6):7383. https://doi.org/10.37745/bjmas.2022.0381
Riaz H, Javed A, Ali H, Kazmi YA, Naz S, Sazeen, et al. Comparative effect of Spencer technique vs Mulligan mobilization on ROM and functional disability among adhesive capsulitis patients. Insights J Health Rehabil. 2025;3(1):156–64. https://doi.org/10.71000/xj48r153
Sundar Rajan MS, Kotteeswaran K, Kamalakannan M, Hariharan J, Seemathan P, Kavya DD, et al. Effectiveness of Mulligan "MWM" versus Spencer technique on functional ability in subjects with adhesive capsulitis of the shoulder joint. Fizjoter Pol. 2025;25(2):54–9. https://doi.org/10.56984/8ZG7D19F64U
Kalphidaa MK, Jayabharathi R, Guhan S, Ashashanthi L, Ponprakash R. A study is to find out the effects of joint mobilization technique and Spencer muscle energy technique on pain and functional disability among patients with adhesive capsulitis. IJOPT. 2026;7(2):223–8. https://doi.org/10.63299/ijopt.0702161
Kumar P, Patel M, Dubey YK, Mishra AK, Chandel AK. Effect of Spencer technique versus Mulligan mobilization with movement on pain, ROM and functional disability in patients with adhesive capsulitis. Adolesc Saude. 2026;21(8s):213–23. https://doi.org/10.67440/ahj.vi.2296
Imran A, Irshad A, Khurshid S, Ahmad U, Naveed M. Comparative efficacy of Spencer's technique versus Mulligan's technique on pain, range of motion, and quality of life in patients with stage II frozen shoulder. Int J Adv Res. 2026;3(5):1418–35. https://doi.org/10.5281/zenodo.22808730
Prasanth SK, Sudhan MA, Sreedharan SM, Subbarayalu AV, Shahul Hameed P. Comparative effect of Gong's mobilization and Spencer technique to manage frozen shoulder. Physiother Q. 2023;31(3):5764. https://doi.org/10.5114/pq.2023.115415
Wajid W, Hafeez T, Yasir S, Faiz T, Ahmad E, Riaz L. Comparative effects of mobilization with movement versus Spencer technique combined with scapular stabilization exercises on pain, range of motion, and functional disability in patients with adhesive capsulitis. Healer J Physiother Rehabil Sci. 2026;6(3):170–6. https://doi.org/10.55735/cnbrd779
Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, et al., editors. Cochrane handbook for systematic reviews of interventions. 2nd ed. Chichester (UK): John Wiley & Sons; 2019. https://doi.org/10.1002/9781119536604
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. https://doi.org/10.1136/bmj.n71
Hoffmann TC, Glasziou PP, Boutron I, Milne R, Perera R, Moher D, et al. Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide. BMJ. 2014;348:g1687. https://doi.org/10.1136/bmj.g1687
Roy JS, MacDermid JC, Woodhouse LJ. Measuring shoulder function: a systematic review of four questionnaires. Arthritis Rheum. 2009;61(5):623–32. https://doi.org/10.1002/art.24396
Tawatkiratipol T, Phongamwong C. The minimal important difference of the Thai version of the Shoulder Pain and Disability Index and the bodily pain subscale of the Thai Short Form 36 version 2 among patients with shoulder pain. J Health Sci 2025;43(6):e20251185. https://doi.org/10.31584/jhsmr.20251185
Sterne JAC, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ. 2019;366:l4898. https://doi.org/10.1136/bmj.l4898
ROBINS-I V2 Development Group. Risk Of Bias In Nonrandomized Studies – of Interventions, Version 2 (ROBINS-I V2) [Internet]. 2024 [cited 2026 Nov 1]. Available from: https://www.riskofbias.info/welcome/robins-i-v2
McGuinness LA, Higgins JPT. Risk-of-bias VISualization (robvis): an R package and Shiny web app for visualizing risk-of-bias assessments. Res Synth Methods. 2021;12(1):55–61. https://doi.org/10.1002/jrsm.1411
Campbell M, McKenzie JE, Sowden A, Katikireddi SV, Brennan SE, Ellis S, et al. Synthesis without metaanalysis (SWiM) in systematic reviews: reporting guideline. BMJ.
;368:l6890. https://doi.org/10.1136/bmj.l6890
Boon MH, Thomson H. The effect direction plot revisited: application of the 2019 Cochrane Handbook guidance on alternative synthesis methods. Res Synth Methods. 2021;12(1):29–33. https://doi.org/10.1002/jrsm.1458
Young I, Dunning J, Escaloni J, Maselli F, Prall J, Mourad F, et al. Reliability, construct validity, responsiveness and minimum clinically important difference of the numeric pain rating scale and shoulder pain and disability index in patients with subacromial pain syndrome. Musculoskelet 2025;79:103372. https://doi.org/10.1016/j.msksp.2025.103372
Guyatt G, Agoritsas T, Brignardello-Petersen R, Mustafa RA, Rylance J, Foroutan F, et al. Core GRADE 1: overview of the Core GRADE approach. BMJ. 2025;389:e081903. https://doi.org/10.1136/bmj-2024-081903
Cuello-Garcia CA, Santesso N, Morgan RL, Verbeek J, Thayer K, Ansari MT, et al. GRADE guidance 24: optimizing the integration of randomized and nonrandomized studies of interventions in evidence syntheses and health guidelines. J Clin Epidemiol. 2022;142:200–8. https://doi.org/10.1016/j.jclinepi.2021.11.026
Keter DL, Bialosky JE, Brochetti K, Courtney CA, Funabashi M, Karas S, et al. The mechanisms of manual therapy: a living review of systematic, narrative, and scoping reviews. PLoS 2025;20(3):e0319586. https://doi.org/10.1371/journal.pone.0319586
Guyatt G, Wang Y, Eachempati P, Iorio A, Murad MH, Hultcrantz M, et al. Core GRADE 4: rating certainty of evidence: risk of bias, publication bias, and reasons for rating up certainty. BMJ. 2025;389:e083864. https://doi.org/10.1136/bmj-2024-083864
Arienti C, Armijo-Olivo S, Ferriero G, Feys P, Hoogeboom T, Kiekens C, et al. The influence of bias in randomized controlled trials on rehabilitation intervention effect estimates: what we have learned from meta-epidemiological studies. Eur J Phys Rehabil Med. 2024;60(1):135–44. https://doi.org/10.23736/S1973-9087.23.08310-7
Hopewell S, Chan AW, Collins GS, Hróbjartsson A, Moher D, Schulz KF, et al. CONSORT 2025 statement: updated guideline for reporting randomised trials. Lancet. 2025;405(10489):1633–40. https://doi.org/10.1016/S0140-6736(25)00672-5
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