Virtual Reality Based Exercise Training Versus Mulligan Mobilization on Shoulder Posture and Function in Subacromial Impingement Syndrome

Inclusion criteria

• Patients will be referred from the orthopedic surgeon with a diagnosis of stage II SIS with the following criteria:

• Participants ranged in age from 30-50 years old.
• Participants are from non-athletes from the general population.
• Unilateral shoulder pain that is localized either anteriorly or laterally to the acromion. Pain that occurs or worsens when the affected shoulder is in flexion and/or abduction.
• Four of the following should be present in the included patients: Neer impingement test, Hawkins' test, Pain was replicated in the supraspinatus empty-can test, a painful arc of movement from 70° to 120°, and painful greater tuberosity of the humerus.
• BMI range 18.5- 29.9 Kg/m².

Exclusion criteria

• 1) Patients who, during the previous three months, underwent shoulder physical treatment and/or an acute pain flare.

• Patients who have undergone surgeries for tendon repair. 3) Malignancy, epilepsy, pregnant women, and/or systemic conditions like chronic renal or liver failure.

• Mini-Mental State Examination test (MMSE) (< 24/30) to exclude cognitive impairment and/or significant vision impairment (if they couldn't read the introduction while wearing the Head Mounted Device (HMD).

• Corticosteroid injection during the last three months or used steroids chronically.

• Adhesive capsulitis, glenohumeral joint instability, Numbness or tingling of the upper limb, and/or full-thickness tear of the rotator cuff.