Subacromial Impingement SyndromeNCT07675655
Mulligan Mobilization Versus PNF Technique in SIS
A study testing Standard conventional program, Proprioceptive neuromuscular facilitation (PNF) +Standard program and MWM +Standard program in people with Subacromial Impingement Syndrome, run by Cairo University at 1 site in Egypt.
Trial summary
To investigate the differences between adding Mulligan mobilization and PNF to the conventional physical therapy program on shoulder pain, function, shoulder muscles strength, glenohumeral flexion, abduction, external rotation, and internal rotation ROM, scapular symmetry, and pectoralis minor length in patients with… Read more about this study
- Who is it for?
- Ages 20 to 40 years
- Conditions the study is for
- Subacromial Impingement Syndrome
- What is being tested?
- Standard conventional program, Proprioceptive neuromuscular facilitation (PNF) +Standard program and MWM +Standard program
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 69 participants
- Where
- 1 siteEgypt
- Study dates
- 2 Sep 2025to 1 Aug 2026
- Phase
- Interventional
- Are there results?
- Not yet: the study is under way
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 20 to 40 years
- All sexes
- No healthy volunteers
- Adult
Who may be able to join
- Sixty nine Males and females subjects with SIS, age between 20-40 years old and body mass index (BMI) 18-27.9 kg/m2
- The SIS group will be limited to patients who had history of shoulder pain of >1-week duration.
- Pain localized at the proximal anterolateral shoulder region.
- Patients with subacromial pain syndrome with positive results of 3 of 5 tests: painful arc, pain or weakness with resisted external rotation, Neer test, Hawkins Kennedy test, and Jobe/empty can test.
Who cannot join
- Patients will be excluded if they had any of the following conditions:
- Open wounds, infection, acute injuries, swelling, rheumatoid arthritis, reflex sympathetic syndrome, or adhesive capsulitis.
- BMI greater than 28 kg/m².
- History of shoulder girdle fractures and dislocation, shoulder surgery in the last 12 months or full thickness rotator cuff tear.
- History of systemic or neurological disorder, cervical radiculopathy and subjects who had received physical therapy treatment for their shoulder within the past three months.
- History of corticosteroid injection in the shoulder region less than 12 weeks previously.
Trial locations and contacts
1 site in 1 country. Contact the study team or a site near you to ask about taking part.
Egypt1 site, 1 recruiting
- Recruiting
Magdy Eshak
Sohag, Tahta
Mina Magdy Eshak, M.Sc. in Physical Therapy 2023, 01277660470, mina.magdy.9595@gmail.com
Marihan zakaria, Lecturer at Cairo University, 01201227971, marihan_aziz@cu.edu.eg
About this study
Official title: Shoulder Mulligan Mobilization Versus Proprioceptive Neuromuscular Facilitation Technique In Subacromial Impingement Syndrome
To investigate the differences between adding Mulligan mobilization and PNF to the conventional physical therapy program on shoulder pain, function, shoulder muscles strength, glenohumeral flexion, abduction, external rotation, and internal rotation ROM, scapular symmetry, and pectoralis minor length in patients with SIS.
Read the detailed description
i need brief summery with same means Shoulder pain affects 4.7%-46.7% of adults annually and is the third most common musculoskeletal complaint. It accounts for 13% of sick leaves and $7 billion in healthcare costs, posing a significant economic and societal burden. SIS is the leading cause of shoulder pain and overhead reach limitation, accounting for 44-65% of cases. SIS space narrowing has two causes: intrinsic impingement (tendon degeneration from overuse, tension overload, or trauma) and extrinsic impingement (tendon inflammation from mechanical compression by an external structure).
Extrinsic factors contributing to SIS include poor posture, altered scapular or GH kinematics, posterior capsular tightness, and acromial pathology. Research demonstrates that SIS patients show restricted GH external rotation and increased humeral head translation, leading to subacromial space narrowing and tissue compression. the scapula exhibits a pattern of posterior tilting, external rotation, and upward rotation during GH elevation. Patients show altered scapular kinematics that include decreased upward rotation and increased anterior tilting and internal rotation.
rotation. The scapular muscle plays a crucial function in stabilizing the scapula, to maintain the base of the GH during motion. The upper trapezius (UT), lower trapezius (LT) and serratus anterior (SA) function as a force couple to induce scapular upward rotation, allowing the tissues beneath the coracoacromial arch to move freely. In individuals with SIS, SA activity is reduced, whereas UT and LT activity is elevated. Maintaining proper scapulohumeral rhythm is essential, particularly in the mid-range of arm elevation, to prevent subacromial impingement. The treatment approach for SIS are corticosteroid injections, nonsteroidal anti-inflammatory medications, electrotherapy treatments, manual techniques like joint mobilization, proprioceptive neuromuscular facilitation (PNF) exercises, progressive resistive exercises, taping, and stabilisation exercises. PNF is a therapeutic exercise method that enhances neuromuscular control and motor response. Adding PNF to conventional physiotherapy significantly improves pain and function compared to conventional treatment only. Also, Adding PNF to conventional program enhances early ROM gains in SIS treatment and sustain improvements post-treatment. In the manual therapy approach known as Mobilization with Movement (MWM), which was created by Brian Mulligan, the therapist applies a specially directed glide to a painful joint as the patient actively moves that same joint. The fundamental idea of MWM is to identify and correct joint positional faults caused by soft or bony tissue lesions around the joint. Four sessions of MWM significantly improve pain, pain-free shoulder flexion, maximal flexion, and external rotation in SIS patients.
To the authors' knowledge, none of the studies have investigated the differences between integrating Mulligan mobilization and PNF to the conventional physical therapy program to achieve better outcomes.
- Conditions
- Subacromial Impingement Syndrome
- Being tested
- Standard conventional program, Proprioceptive neuromuscular facilitation (PNF) +Standard program, MWM +Standard program
- Keywords
- Rotator Cuff Impingement Syndrome, PROPRIOCEPTIVE NEUROMUSCLAR FACILITATION TECHNIQUE, mulligan mobilization
- Medical subject headings
- Shoulder Impingement Syndrome
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Standard conventional programOther
Patients receive standard conventional program inform of exercise and TENS
Proprioceptive neuromuscular facilitation (PNF) +Standard programOther
patients receive Proprioceptive neuromuscular facilitation (PNF) +Standard conventionalprogram
MWM +Standard programOther
patients receive MWM +Standard program
| Study group | Role | What they receive |
|---|---|---|
| standard conventional Program | Active comparator | patients receive conventional program alone, include strengthening for scapular stabilizers, Posterior shoulder stretching exercises (PSSEs) (modified cross-body stretch and modified sleeper stretch), stretching for pectoralis minor and transcutaneous electrical nerve stimulation (TENS). Receives: Other: Standard conventional program |
| PNF technique + same standard conventional program | Experimental | patients receive PNF diagonal pattern exercise program in addition to the same conventional program as in group A Receives: Other: Proprioceptive neuromuscular facilitation (PNF) +Standard program |
| MWM+ same standard conventional program | Experimental | patients receive a posterolateral MWM in addition to conventional program as in group A. Receives: Other: MWM +Standard program |
What is being measured
The primary outcome is the main question the study is designed to answer.
The Shoulder Pain and Disability Index (SPADI)
assesses pain and disability in shoulder pathology. Patients answer five questions related to pain and eight questions related to function
Measured: at baseline and after 6 weeks post intervention
Shoulder ROM
the smartphone inclinometer will be used to perform clinical measurements of shoulder motion (Flexion, Abduction, External Rotation in 90- of Abduction, Internal Rotation in 90- of Abduction)
Measured: at baseline and after 6 weeks post intervention
The Timed Functional Arm and Shoulder Test (TFAST)
Task 1: Hand to Head and Back (HHB) 30s Movement: Move arm from the side to touch the back of the head (palm preferred), then move down to touch the small of the back with the back of the hand.
Scoring: 1 rep per head touch. Task 2: Wall Wash (Inward/Outward) 60s per direction Movement: Move a towel in a 12-inch diameter circle at shoulder height, touching 4 drawn marks. Start at the top mark.
Scoring: 1 rep each time the hand passes the top mark. Done clockwise and counter-clockwise.
Task 3: Gallon-Jug Lift - 30s Movement: Lift a 3.78 kg jug from a 36-inch high counter to lightly tap a shelf 20 inches above it, then lower it without resting.
Scoring: 1 rep per shelf tap. Total TFAST Score Calculation To equalize all tasks for a 30-second timeframe, the final score is calculated using this formula: [HHB + (wall wash inward and outward/4) + gallon-jug lift]
Measured: at baseline and after 6 weeks post-intervention
Secondary outcomes (3)
Measuring isometric strength with Hand-held sphygmomanometer
A Hand-held sphygmomanometer (HHS) will been more commonly used to measure Internal and External rotation and shoulder scaption isometric strength
Measured: at baseline and after 6 weeks post-intervention
The Modified Lateral Scapular Slide test
Shoulder position will be visually estimated, and the distance from the inferior angle of the scapulae and the spinous process of T7 .will be measured using a tape measure or goniometer in 3 different arm positions: neutral, 45°, and 90° The first position was with the arms by the side. The second was with the subject's hands on the hips, and the third was with the arms elevated to 90° of shoulder abduction in scaption with maximal internal rotation and
1 kg load hold in their hands
Measured: at baseline and after 6 weeks post-intervention
Pectoralis minor length test
Subjects will lie supine, relaxed, with legs bent and arms at their sides in neutral rotation. An investigator will measure the vertical distance from the posterolateral acromion to the table in millimeters using a metal scale. A positive test, indicating pectoralis minor tightness, is defined as a distance greater than 2.54 cm (1 inch), while a negative test is a measurement less than or equal to 2.6 cm
Measured: at baseline and after 6 weeks post-intervention
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted30 Jun 2026
- Study start2 Sep 2025
- Primary completion1 Aug 2026 (estimated)
- Study completion1 Aug 2026 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Subacromial Impingement SyndromeStudies of the same condition, open and under way.
- More trials run by Cairo UniversityThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Model description
- Group A: will receive a program of conventional exercise include strengthening for scapular stabilizers, Posterior shoulder stretching exercises (PSSEs) (modified cross-body stretch and modified sleeper stretch), stretching for pectoralis minor and transcutaneous electrical nerve stimulation (TENS). Group B : will receive PNF diagonal pattern exercise program in addition to conventional Exercise as in group A. Group C : will receive a posterolateral MWM in addition to conventional Exercise as in group A.
- Masking
- Double blind
- Who is masked
- Participant, Outcomes assessor
- Enrolment
- 69 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Cairo University
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Mina Magdy Eshak Morkos, Cairo University
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07675655
- Sponsor's protocol ID
- MWM versus PNF in SIS
- Status last verified
- May 2026
- First submitted
- 9 Jun 2026
- Last updated
- 30 Jun 2026
- Results posted
- No
- Data monitoring committee
- Yes
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- Undecided
Study at a glance
From the registry record, last updated by the sponsor on 30 Jun 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Shoulder Mulligan Mobilization Versus Proprioceptive Neuromuscular Facilitation Technique In Subacromial Impingement Syndrome
- ClinicalTrials.gov ID
- NCT07675655
- Acronym / sponsor ID
- MWM versus PNF in SIS
- Conditions
- Subacromial Impingement Syndrome
- Keywords
- Rotator Cuff Impingement Syndrome, PROPRIOCEPTIVE NEUROMUSCLAR FACILITATION TECHNIQUE, mulligan mobilization
- Study type
- Interventional
- Recruitment status
- Recruiting
- Enrolment
- 69 participants (estimated)
- Lead sponsor
- Cairo UniversityUniversity, hospital or other
- Study start
- 2 Sep 2025 (actual)
- Primary completion
- 1 Aug 2026 (estimated)
- Study completion
- 1 Aug 2026 (estimated)
- First posted
- 30 Jun 2026 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
To investigate the differences between adding Mulligan mobilization and PNF to the conventional physical therapy program on shoulder pain, function, shoulder muscles strength, glenohumeral flexion, abduction, external rotation, and internal rotation ROM, scapular symmetry, and pectoralis minor length in patients with SIS.
Detailed description
i need brief summery with same means Shoulder pain affects 4.7%-46.7% of adults annually and is the third most common musculoskeletal complaint. It accounts for 13% of sick leaves and $7 billion in healthcare costs, posing a significant economic and societal burden. SIS is the leading cause of shoulder pain and overhead reach limitation, accounting for 44-65% of cases. SIS space narrowing has two causes: intrinsic impingement (tendon degeneration from overuse, tension overload, or trauma) and extrinsic impingement (tendon inflammation from mechanical compression by an external structure).
Extrinsic factors contributing to SIS include poor posture, altered scapular or GH kinematics, posterior capsular tightness, and acromial pathology. Research demonstrates that SIS patients show restricted GH external rotation and increased humeral head translation, leading to subacromial space narrowing and tissue compression. the scapula exhibits a pattern of posterior tilting, external rotation, and upward rotation during GH elevation. Patients show altered scapular kinematics that include decreased upward rotation and increased anterior tilting and internal rotation.
rotation. The scapular muscle plays a crucial function in stabilizing the scapula, to maintain the base of the GH during motion. The upper trapezius (UT), lower trapezius (LT) and serratus anterior (SA) function as a force couple to induce scapular upward rotation, allowing the tissues beneath the coracoacromial arch to move freely. In individuals with SIS, SA activity is reduced, whereas UT and LT activity is elevated. Maintaining proper scapulohumeral rhythm is essential, particularly in the mid-range of arm elevation, to prevent subacromial impingement. The treatment approach for SIS are corticosteroid injections, nonsteroidal anti-inflammatory medications, electrotherapy treatments, manual techniques like joint mobilization, proprioceptive neuromuscular facilitation (PNF) exercises, progressive resistive exercises, taping, and stabilisation exercises. PNF is a therapeutic exercise method that enhances neuromuscular control and motor response. Adding PNF to conventional physiotherapy significantly improves pain and function compared to conventional treatment only. Also, Adding PNF to conventional program enhances early ROM gains in SIS treatment and sustain improvements post-treatment. In the manual therapy approach known as Mobilization with Movement (MWM), which was created by Brian Mulligan, the therapist applies a specially directed glide to a painful joint as the patient actively moves that same joint. The fundamental idea of MWM is to identify and correct joint positional faults caused by soft or bony tissue lesions around the joint. Four sessions of MWM significantly improve pain, pain-free shoulder flexion, maximal flexion, and external rotation in SIS patients.
To the authors' knowledge, none of the studies have investigated the differences between integrating Mulligan mobilization and PNF to the conventional physical therapy program to achieve better outcomes.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Double blind (participant, outcomes assessor)
- Number of arms
- 3
- Model description
- Group A: will receive a program of conventional exercise include strengthening for scapular stabilizers, Posterior shoulder stretching exercises (PSSEs) (modified cross-body stretch and modified sleeper stretch), stretching for pectoralis minor and transcutaneous electrical nerve stimulation (TENS). Group B : will receive PNF diagonal pattern exercise program in addition to conventional Exercise as in group A. Group C : will receive a posterolateral MWM in addition to conventional Exercise as in group A.
| Arm | Type | Receives |
|---|---|---|
| standard conventional Program | Active comparator | Other: Standard conventional programpatients receive conventional program alone, include strengthening for scapular stabilizers, Posterior shoulder stretching exercises (PSSEs) (modified cross-body stretch and modified sleeper stretch), stretching for pectoralis minor and transcutaneous electrical nerve stimulation (TENS). |
| PNF technique + same standard conventional program | Experimental | Other: Proprioceptive neuromuscular facilitation (PNF) +Standard programpatients receive PNF diagonal pattern exercise program in addition to the same conventional program as in group A |
| MWM+ same standard conventional program | Experimental | Other: MWM +Standard programpatients receive a posterolateral MWM in addition to conventional program as in group A. |
Who may qualify
- Ages
- 20 to 40 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult
Key inclusion criteria (4 listed)
- Sixty nine Males and females subjects with SIS, age between 20-40 years old and body mass index (BMI) 18-27.9 kg/m2
- The SIS group will be limited to patients who had history of shoulder pain of >1-week duration.
- Pain localized at the proximal anterolateral shoulder region.
- Patients with subacromial pain syndrome with positive results of 3 of 5 tests: painful arc, pain or weakness with resisted external rotation, Neer test, Hawkins Kennedy test, and Jobe/empty can test.
Key exclusion criteria (6 listed)
- Patients will be excluded if they had any of the following conditions:
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Standard conventional programPatients receive standard conventional program inform of exercise and TENS | Other | standard conventional Program |
| Proprioceptive neuromuscular facilitation (PNF) +Standard programpatients receive Proprioceptive neuromuscular facilitation (PNF) +Standard conventionalprogram | Other | PNF technique + same standard conventional program |
| MWM +Standard programpatients receive MWM +Standard program | Other | MWM+ same standard conventional program |
Primary outcome
The Shoulder Pain and Disability Index (SPADI)
Time frame: at baseline and after 6 weeks post intervention
assesses pain and disability in shoulder pathology. Patients answer five questions related to pain and eight questions related to function
Shoulder ROM
Time frame: at baseline and after 6 weeks post intervention
the smartphone inclinometer will be used to perform clinical measurements of shoulder motion (Flexion, Abduction, External Rotation in 90- of Abduction, Internal Rotation in 90- of Abduction)
The Timed Functional Arm and Shoulder Test (TFAST)
Time frame: at baseline and after 6 weeks post-intervention
Task 1: Hand to Head and Back (HHB) 30s Movement: Move arm from the side to touch the back of the head (palm preferred), then move down to touch the small of the back with the back of the hand. Scoring: 1 rep per head touch. Task 2: Wall Wash (Inward/Outward) 60s per direction Movement: Move a towel in a 12-inch diameter circle at shoulder height, touching 4 drawn marks. Start at the top mark. Scoring: 1 rep each time the hand passes the top mark. Done clockwise and counter-clockwise. Task 3: Gallon-Jug Lift - 30s Movement: Lift a 3.78 kg jug from a 36-inch high counter to lightly tap a shelf 20 inches above it, then lower it without resting. Scoring: 1 rep per shelf tap. Total TFAST Score Calculation To equalize all tasks for a 30-second timeframe, the final score is calculated using this formula: [HHB + (wall wash inward and outward/4) + gallon-jug lift]
3 secondary outcomes
Measuring isometric strength with Hand-held sphygmomanometer
Time frame: at baseline and after 6 weeks post-intervention
The Modified Lateral Scapular Slide test
Time frame: at baseline and after 6 weeks post-intervention
Pectoralis minor length test
Time frame: at baseline and after 6 weeks post-intervention
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 30 Jun 2026.
- Related InfoLink provided by the sponsor.
- Related InfoLink provided by the sponsor.
- Related InfoLink provided by the sponsor.
- Related InfoLink provided by the sponsor.
- Related InfoLink provided by the sponsor.
- Related InfoLink provided by the sponsor.
- Individual participant dataSharing planned: Undecided
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part.
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Standard conventional program, Proprioceptive neuromuscular facilitation (PNF) +Standard program and MWM +Standard program in people with Subacromial Impingement Syndrome, run by Cairo University at 1 site in Egypt.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 4 inclusion and 6 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: looking for participants now, as of the sponsor's last update on 30 Jun 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Egypt. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
Contact Mina Magdy, Master (01277660470 ext. 01220713396, mina.magdy.9595@gmail.com), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
The Shoulder Pain and Disability Index (SPADI) (time frame: at baseline and after 6 weeks post intervention). The study lists 3 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 30 Jun 2026; AzTrials last refreshed its copy on 26 Oct 2026.