The Effect of Thoracic Mulligan Mobilization on Sub-acromial Impingement Syndrome

"Extension Thoracic Sustained Natural Apophyseal Glides :~Patient position: The patient sits astride the end of the table with hands placed behind the neck to protract the scapulae allowing access to the mid thoracic spine for the therapist's hand.~Therapist position: Therapist stands on their most efficient side for a centrally applied Sustained Natural Apophyseal Glides.~Therapist grasp: The therapist's mobilizing hand (ulnar border) will apply a cephalad glide in line with the facet joint plane of the involved spinal level and the other arm holds the thoracic wall above the level to be mobilized.~Traction is applied prior to glide, which is achieved by therapist knee extension~Repetitions: Three sets of ten repetitions will be done after a trial for the patient to be familial with the technique.~and traditional treatment."

"includes: Ice pack and Pendulum exercise and shoulder range of motion (elevation, depression, flexion, abduction, rotations).Stretching exercise for internal rotators and posterior capsule.~Strengthening exercise will be isometric in nature include external shoulder rotators, internal rotators, biceps, deltoid, and scapular stabilizers (rhomboids, trapezius, serratus anterior, Latissimus Dorsi , and pectoralis major muscles)."