Subacromial impingement syndrome (SAIS) is the most common cause of shoulder pain, accounting for a large proportion of musculoskeletal complaints. It is characterized by narrowing of the subacromial space, leading to pain, weakness, limited range of motion, and impaired shoulder function. Muscle weakness, especially of the rotator cuff and scapular stabilizers, plays a major role in its pathomechanics.
Although conventional strengthening exercises are effective, they are often delayed until pain subsides, which may prolong recovery. Blood Flow Restriction (BFR) training and Pilates exercises have recently emerged as promising approaches that may enhance strength and function during earlier, painful stages of rehabilitation. However, limited research has compared both interventions in patients with SAIS. Therefore, this study aims to compare the effectiveness of BFR training versus Pilates exercises, in addition to conventional therapy, on pain, function, range of motion, muscle strength, and proprioception in patients with painful SAIS.
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Parallel
Low load resistance training with BFR
Other interventionParticipants will perform low-load resistance training combined with Blood Flow Restriction (BFR) 3 times per week for 4 weeks. Each session will last 45 minutes and include exercises for shoulder muscles with cuffs applied to the upper arm to partially restrict blood flow, ensuring safety and gradual load progression.
Pilates exercises
Other interventionParticipants will perform supervised Pilates exercises 3 times per week for 4 weeks. Each session will last 45 minutes and include mat-based exercises, resistance band work, and equipment-assisted movements targeting shoulder mobility, stability, and posture. Exercises will be progressively adjusted according to participant tolerance and performance.
Cool's shoulder exercises
Other intervention: Participants will perform standard Cool's exercises 3 times per week for 4 weeks. Each session will last 45 minutes and focus on targeted shoulder rehabilitation movements designed to improve flexibility, muscle activation, and pain reduction. Exercises will be supervised and progressively adapted based on participant performance
Shoulder Pain
Pain intensity will be measured using the Visual Analogue Scale, a 0-10 scale where 0 indicates no pain and 10 indicates worst imaginable pain. Patients will mark their pain at rest and during shoulder activity. This outcome assesses the effectiveness of the interventions in reducing pain.
Shoulder Function (SPADI)
Shoulder function will be evaluated using the Shoulder Pain and Disability Index (SPADI), which includes pain and disability subscales. Scores range from 0-100, with higher scores indicating greater disability. This measure evaluates functional improvement after the intervention.
Range of Motion (ROM)
Active shoulder ROM (flexion, abduction) will be measured using a Inclinometer by a physical therapist. This assesses the interventions' effect on mobility.
Muscle Strength
Shoulder abduction and external rotation strength will be measured using a hand-held dynamometer. The outcome evaluates changes in muscular capacity after the intervention
Shoulder proprioception
Measures the participant's ability to actively reproduce specific shoulder angles. Assesses improvement in sensorimotor control after intervention.
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