Scapular Blackburn Stabilization Versus PNF in Impingement Syndrome

purpose of study to Aim to investigate effect(s) of scapular Blackburn stabilization exercises compared toscapular proprioceptive neuromuscular facilitation (SPNF) exercise in addition to conventional exercises on shoulder pain, function, shoulder,sacpular ROM, scapular muscle strength and scapular orientation in patients with sub acromial impingement syndrome

Participants will be randomly allocated to three groups as follow:

Group A (n=17): will receive a program of conventional exercise include rotator cuff strengthening ,stretching for posterior capsule and stretching for pectoralis minor for 18 sessions (3 sessions per week for six weeks) Group B (n=17): will receive a scapular PNF exercise program in addition to conventional Exercise with the same frequency. Group C (n=17): will receive a scapular Blackburn stabilization exercises in addition to conventional Exercise with the same frequency

Sub-acromial impingement syndrome(SIS) is the most frequent cause of pain and overhead reach limitation in the shoulder area. It occurs when there is impingement of tendons or bursa in the shoulder from bones of the shoulder. Intrinsic and extrinsic factors that contribute to the development of SIS include inflammation in the supra humeral space, inhibition of the rotator cuff muscles, degeneration of the rotator cuff tendons, abnormal scapular position and kinematics. Currently SIS covers a range of pathologies from sub acromial bursitis to rotator cuff tendinopathy and full thickness rotator cuff tears.

The trial will guide physical therapists in selecting effective therapeutic interventions for patients with SAIS and scapular dyskinesia, aiming to reduce the number of treatment sessions, speed up recovery, and improve shoulder pain and functional abilities.

Scapular Blackburn stabilization exercise minimizes excessive superior translation of the humeral head in the glenoid fossa during elevation and subacromial space impingement, consequently addressing shoulder impingement. It also strengthens the scapulothoracic and rotator cuff muscles and decreases muscle imbalance.

Proprioceptive Neuromuscular Facilitation has been described as a comprehensive rehabilitation concept, promoting motor learning, motor control, strength and mobility.

This comprehensive rehabilitation approach includes task-oriented training with manual facilitation aimed at motor learning and motor control.

therefore, what are the effects of scapular Blackburn stabilization and PNF techniques in addition to conventional exercises on shoulder pain, function, shoulder ROM, scapular muscle strength, and scapular orientation in patients with sub acromial impingement syndrome?

Eligibility Criteria:
Inclusion Criteria:

* 1. Fifty one Male and female patients with SIS and aged between 30-50.

  2. Body mass index (BMI) 18.5-29.9 kg/m2.

  3. patients complaining primary shoulder impingement.

  4. patients with altered scapular resting positions with scapular dyskinesia with positive lateral scapular slide test.

  5- patients will be included at least three special tests positive from the following tests:

A-Hawkins-Kennedy Impingement Test:

B-Neer"s Impingement Test:

C- "Empty Can" or Jobe Test D-painful arc test

E-External rotation resistance test

F-Cross-body adduction test

G-Drop arm sign

Exclusion Criteria:

* 1- Neurological deficit affecting the shoulder function during daily activities.

  2-Cervical disc pathology.

  3- Brain injures.

  4- Fractures in the upper limb

  5-Undergone shoulder surgery