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CTRI Number  CTRI/2026/01/102096 [Registered on: 27/01/2026] Trial Registered Prospectively
Last Modified On: 23/01/2026
Post Graduate Thesis  Yes 
Type of Trial  Interventional 
Type of Study   Physiotherapy (Not Including YOGA) 
Study Design  Randomized, Parallel Group, Active Controlled Trial 
Public Title of Study   Best Physiotherapy Techniques for Scapulocostal Syndrome” 
Scientific Title of Study   Effectiveness of Pulsed Muscle Energy Technique as compared with Scapular stabilization exercises on Functional Capacity, Pain and Quality of life in patients with Scapulocostal Syndrome – A Randomized Controlled Trial 
Trial Acronym   
Secondary IDs if Any  
Secondary ID  Identifier 
Nil  NIL 
 
Details of Principal Investigator or overall Trial Coordinator (multi-center study)  
Name  Aliver Justin 
Designation  Professor 
Affiliation  Kerala University of Health Sciences  
Address  Department of Physiotherapy DR.SMCSI MEDICAL COLLEGE AND HOSPITAL Karakonam , Thiruvananthapuram, Kerala
Dr.SMCSI MEDICAL COLLEGE AND HOSPITAL
Thiruvananthapuram
KERALA
695504
India 
Phone  09952828928  
Fax    
Email  aliverpt@gmail.com  
 
Details of Contact Person
Scientific Query  
Name  DR. Jeniffer Augustina  
Designation  Assistant Professor 
Affiliation  Hindustan Institute of technology and science. 
Address  Hindustan Institute of technology and Science,Rajiv Gandhi salai,Padur,Chennai

Chennai
TAMIL NADU
603103
India 
Phone  9962448947  
Fax    
Email  sjenifera@hindustanuniv.ac.in  
 
Details of Contact Person
Public Query  
Name  Mr. Ammuthan 
Designation  manager 
Affiliation  Muthu Neuro Centre 
Address  Muthu neuro centre, Ashok Nager,Chunkankadai, Nagercoil

Kanniyakumari
TAMIL NADU
695503
India 
Phone  09952828928  
Fax    
Email  amuthan.mnch@gmail.com  
 
Source of Monetary or Material Support  
Dr.SMCSI Medical college and Hospital, Karakonam, Thiruvandrum, Kerala - 695504 
 
Primary Sponsor  
Name  P Aliver Justin 
Address  Dr.SMCSI Medical college and Hospital, Karakonam, Thiruvandrum - 695504 
Type of Sponsor  Other [Self] 
 
Details of Secondary Sponsor  
Name  Address 
Muthu Neuro Centre  Chunkankadai, Nagercoil 
 
Countries of Recruitment     India  
Sites of Study  
No of Sites = 1  
Name of Principal Investigator  Name of Site  Site Address  Phone/Fax/Email 
Dr Acksen Thanka Raja  Somerville Memorial Medical college and Hospital   Department of Physiotherapy,Dr.SMCSI Medical college and hospital, Karakonam, Thiruvananthapuram, kerala
Thiruvananthapuram
KERALA 		 8778908404

acksen@gmail.com 
 
Details of Ethics Committee  
No of Ethics Committees= 1  
Name of Committee  Approval Status 
Dr.SMCSI Medical college  Approved 
 
Regulatory Clearance Status from DCGI  
Status 
Not Applicable 
 
Health Condition / Problems Studied  
Health Type  Condition 
Patients  (1) ICD-10 Condition: M625||Muscle wasting and atrophy, not elsewhere classified,  
 
Intervention / Comparator Agent  
Type  Name  Details 
Intervention  Pulsed Muscle Energy Technique and Scapular Stabilization Exercises   Pulsed Muscle Energy Technique (PMET) is an advanced form of the traditional Muscle Energy Technique (MET), developed to produce therapeutic effects through controlled, rhythmic, and intermittent isometric contractions. Unlike conventional MET, which relies on a sustained isometric contraction of 5–10 seconds followed by a period of relaxation and passive stretch, PMET employs a series of gentle, repetitive (pulsed) muscle contractions interspersed with brief relaxation phases. This rhythmic modulation of muscle activity aims to restore optimal length–tension relationships, enhance neuromuscular coordination, and facilitate pain-free mobility within the physiological range of motion. Patient Preparation and Positioning • Environment: Quiet, comfortable with adequate space for therapist movement around the patient. • Patient Position: Usually in prone lying or sitting posture depending on comfort and therapist access. o Prone position: The patient lies face-down with arms resting by the side, allowing the scapula to rest in slight protraction. o Sitting position: The patient sits upright with the therapist positioned behind, stabilizing the shoulder girdle. • Therapist Position: Standing or seated beside the affected side, ensuring proper leverage and stabilization of the thoracic cage. • Assessment: Identify areas of palpable tenderness, taut bands, or trigger points over the medial border of the scapula through palpation and confirm restricted scapular motion. Procedure 1. Engagement of the Restriction Barrier: The therapist passively moves the scapula into gentle protraction or elevation until the first tissue resistance is felt, without provoking pain. This establishes the barrier position for treatment. 2. Instruction to the Patient: The patient is instructed to attempt a gentle isometric contraction of the scapular retractors (rhomboids and middle trapezius) — as if trying to pull the shoulder blade toward the spine — while the therapist resists the movement. 3. Pulsed Contraction Phase: o The patient performs repetitive submaximal isometric contractions (approximately 20–30% of maximal effort) in a rhythmic pulsed pattern—1 to 2 contractions per seconds followed by 1 second relaxation. o Each set consists of 5–10 pulsed contractions. o The therapist maintains counterforce during each pulse to ensure isometric control and prevents compensatory movements. 4. Relaxation and Repositioning: After each set, the patient relaxes completely, and the therapist gently repositions the scapula into a new barrier of increased mobility. The process is repeated for 3–5 sets, depending on tolerance and clinical response. 5. Re-assessment: Following treatment, scapular mobility, resting tone, and tenderness are reassessed. 
Comparator Agent  Scapular Stabilization Exercises   Scapular Stabilization Exercises (SSE) are targeted therapeutic exercises designed to restore normal scapulothoracic kinematics by strengthening weak periscapular muscles (primarily the serratus anterior, lower trapezius) and down-regulating or stretching overactive muscles (upper trapezius, pectoralis minor). They aim to correct scapular dyskinesis, improve shoulder control during arm elevation, decrease mechanical impingement, and reduce pain and disability in a range of shoulder and cervicothoracic conditions. 
 
Inclusion Criteria  
Age From  18.00 Year(s)
Age To  60.00 Year(s)
Gender  Both 
Details  1. Diagnosed with scapulocostal syndrome by using Scapular Compression Test: Stabilizing the scapula during movement can alleviate symptoms if scapular instability is contributing. (Unilateral or Bilateral)
2. Presence of self-reported shoulder girdle dysfunction as indicated by a minimum score of 20% disability on the Shoulder Pain and Disability Index (SPADI).
3. Report a minimum pain intensity of 4 and maximum 8 on the Numeric Pain Rating Scale (NPRS) in the last 7 days.
4. willing to provide informed consent and adhere to the study protocol.
5. Participants with intact neuromuscular control and no evidence of upper motor neuron lesion.

 
 
ExclusionCriteria 
Details  1.Individuals with cervical radiculopathy, thoracic outlet syndrome, cervical spondylosis, or intervertebral disc pathology confirmed clinically.
2.Patients presenting with rotator cuff injuries, adhesive capsulitis, subacromial impingement, or any post-traumatic shoulder pathology will be excluded, as these conditions may independently alter scapular mechanics.
3.Patients who have received corticosteroid injections, or analgesic therapy within the past two weeks.
4.Subjects with spinal deformities (e.g., scoliosis, kyphosis) or significant postural deviations that affect scapular alignment will not be included.
5.Pregnant or lactating women, and individuals with systemic illnesses affecting musculoskeletal health (e.g., rheumatoid arthritis)
 
 
Method of Generating Random Sequence   Computer generated randomization 
Method of Concealment   Sequentially numbered, sealed, opaque envelopes 
Blinding/Masking   Investigator Blinded 
Primary Outcome  
Outcome  TimePoints 
1. Functional Performance: Measured by Shoulder Pain and Disability Index (SPADI)
2. Pain Intensity: Measured by Numeric Pain Rating Scale (NPRS, 0–10)
 		 Pre intervention, Post intervention, 2week follow up, 6 week follow up 
 
Secondary Outcome  
Outcome  TimePoints 
Secondary Outcomes:
1. Health-Related Quality of Life (QoL): Measured by Short Form-36 (SF-36)
2. Pain Pressure Threshold (PPT): Measured using algometer
3. Range of Motion (ROM): Scapular and shoulder mobility measurements
 		 Pre intervention, Post intervention, 2week follow up, 6 week follow up. 
 
Target Sample Size   Total Sample Size="60"
Sample Size from India="60" 
Final Enrollment numbers achieved (Total)= "Applicable only for Completed/Terminated trials"
Final Enrollment numbers achieved (India)="Applicable only for Completed/Terminated trials" 
Phase of Trial   Phase 3/ Phase 4 
Date of First Enrollment (India)   20/03/2026 
Date of Study Completion (India) Applicable only for Completed/Terminated trials 
Date of First Enrollment (Global)  Date Missing 
Date of Study Completion (Global) Applicable only for Completed/Terminated trials 
Estimated Duration of Trial   Years="2"
Months="3"
Days="0" 
Recruitment Status of Trial (Global)   Not Yet Recruiting 
Recruitment Status of Trial (India)  Not Yet Recruiting 
Publication Details   N/A 
Individual Participant Data (IPD) Sharing Statement

Will individual participant data (IPD) be shared publicly (including data dictionaries)?  

Response - NO
Brief Summary  

This randomized controlled trial investigates the effectiveness of Pulsed Muscle Energy Technique (PMET) compared to Scapular Stabilization Exercises (SSE) on functional capacity, pain, and quality of life in patients with Scapulocostal Syndrome (SCS). Sixty participants aged 18 to 60 years, clinically diagnosed with SCS, will be recruited from the Physiotherapy Department at Dr. SMCSI Medical College. Participants will be randomly allocated into two groups: Group A (PMET) and Group B (SSE). The study aims to compare both interventions using validated outcome measures such as the Shoulder Pain and Disability Index (SPADI) for function, Numeric Pain Rating Scale (NPRS) for pain, and SF 36 for quality of life. Additional measures including Pain Pressure Threshold (PPT) and scapular range of motion will serve as secondary outcomes.

The PMET intervention involves rhythmic, submaximal isometric contractions of scapular stabilizer muscles, including the rhomboids and middle trapezius, applied in short pulses to release myofascial tension and improve scapular mobility. In contrast, the SSE program emphasizes motor control, muscle activation, and postural correction through progressive exercises targeting the serratus anterior and lower trapezius. Both interventions will be administered three times per week for six weeks, with evaluations conducted at baseline, two weeks, and six weeks. The study integrates artificial intelligence based tools such as Elicit, Scite AI, and Kinovea to support literature synthesis, data accuracy, and motion analysis, ensuring methodological precision and minimizing human error during data collection and analysis.

Data will be analyzed using SPSS version 29 with statistical significance set at p less than 0.05. Independent t tests and chi square tests will assess baseline comparability, while mixed model repeated measures ANOVA will examine within group and between group effects over time. AI assisted validation and double entry procedures will ensure data integrity, and blinding of assessors will minimize bias. This study aims to provide evidence based insights into the comparative efficacy of PMET and SSE in improving pain, functional performance, and overall quality of life in individuals with scapulocostal syndrome, guiding future physiotherapy interventions for scapulothoracic dysfunction.

 
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