Mulligan Mobilization Versus PNF Technique in SIS

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.

Inclusion criteria

• 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.

Exclusion criteria

• 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.