the aim of this study is to investigate the Effect of mulligan technique on sub-acromial space in patients with shoulder impingement syndrome

Shoulder Impingement Syndrome (SIS) is defined as the mechanical entrapment of the rotator cuff (mainly the supraspinatus tendon) or the sub-acromial bursa in the sub-acromial space between the humeral head and the acromion or coracohumeral ligament .It is typically exacerbate when the arm is elevated or when overhead throwing activities are performed . Mulligan technique is a type of manual therapy with hypoalgesic effects, increases joint ROM, enhances muscle function and treats specific pathologies. Mobilization with movement (MWM) can be defined as the application of a sustained passive accessory force / glide to a joint while the patient actively performs a task that was previously identified as being problem.

Inclusion Criteria:

age of patients from 30- 55 years old . Both Male and female.

Shoulder pain and two out of four specified objective signs and symptoms:

Positive Neer impingement test. Positive Hawkins-Kennedy impingement test. Painful or limitation of active shoulder elevation (flexion, abduction, scaption).

Pain or limitation with the functional movement patterns of hand-behind-back or hand-behind-head.

Exclusion Criteria:

Systemic or neurological disorder. Adhesive capsulitis. Cervical radiculopathy. History of shoulder surgery. Corticosteroid injection within the past month Subjects who had received physical therapy treatment for their shoulder within the past three months.

permuted block