Mulligan Mobilization Versus PNF Technique in SIS

June 27, 2026 updated by: Mina Magdy Eshak Morkos, Cairo University

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.

Study Overview

Status

Recruiting

Conditions

Intervention / Treatment

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 Type

Interventional

Enrollment (Estimated)

69

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Contact Backup

Study Locations

  • Egypt
    • Tahta
      • Sohag, Tahta, Egypt
        • Recruiting
        • Magdy Eshak
        • Contact:
        • Contact:
        • Principal Investigator:
          • Mina Magdy, M.Sc. in Physical Therapy 2023

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  1. Sixty nine Males and females subjects with SIS, age between 20-40 years old and body mass index (BMI) 18-27.9 kg/m2
  2. The SIS group will be limited to patients who had history of shoulder pain of >1-week duration.
  3. Pain localized at the proximal anterolateral shoulder region.
  4. 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.

Exclusion Criteria:

  • Patients will be excluded if they had any of the following conditions:

    1. Open wounds, infection, acute injuries, swelling, rheumatoid arthritis, reflex sympathetic syndrome, or adhesive capsulitis.
    2. BMI greater than 28 kg/m².
    3. History of shoulder girdle fractures and dislocation, shoulder surgery in the last 12 months or full thickness rotator cuff tear.
    4. History of systemic or neurological disorder, cervical radiculopathy and subjects who had received physical therapy treatment for their shoulder within the past three months.
    5. History of corticosteroid injection in the shoulder region less than 12 weeks previously.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Double

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Active Comparator: standard conventional Program
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).
Other: Standard conventional program
Patients receive standard conventional program inform of exercise and TENS
Experimental: PNF technique + same standard conventional program
patients receive PNF diagonal pattern exercise program in addition to the same conventional program as in group A
Other: Proprioceptive neuromuscular facilitation (PNF) +Standard program
patients receive Proprioceptive neuromuscular facilitation (PNF) +Standard conventionalprogram
Experimental: MWM+ same standard conventional program
patients receive a posterolateral MWM in addition to conventional program as in group A.
Other: MWM +Standard program
patients receive MWM +Standard program

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
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
at baseline and after 6 weeks post intervention
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)
at baseline and after 6 weeks post intervention
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]
at baseline and after 6 weeks post-intervention

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Measuring isometric strength with Hand-held sphygmomanometer
Time Frame: at baseline and after 6 weeks post-intervention
A Hand-held sphygmomanometer (HHS) will been more commonly used to measure Internal and External rotation and shoulder scaption isometric strength
at baseline and after 6 weeks post-intervention
The Modified Lateral Scapular Slide test
Time Frame: at baseline and after 6 weeks post-intervention

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
at baseline and after 6 weeks post-intervention
Pectoralis minor length test
Time Frame: at baseline and after 6 weeks post-intervention
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
at baseline and after 6 weeks post-intervention

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Cairo University

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

Helpful Links

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

September 2, 2025

Primary Completion (Estimated)

August 1, 2026

Study Completion (Estimated)

August 1, 2026

Study Registration Dates

First Submitted

June 9, 2026

First Submitted That Met QC Criteria

June 27, 2026

First Posted (Actual)

June 30, 2026

Study Record Updates

Last Update Posted (Actual)

June 30, 2026

Last Update Submitted That Met QC Criteria

June 27, 2026

Last Verified

May 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • MWM versus PNF in SIS

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

UNDECIDED

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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