Additional Effects of Kinetic Chain Training Combined With Standard Shoulder Exercises in Subacromial Pain Syndrome

Inclusion criteria * Age between 35-60 years * Both Gender * Unilateral shoulder pain consistent with SAPS. * pain during activities with abduction, external rotation and overhead activities * NPRS score 4-7 at baseline. * Symptom duration six weeks to 3 months * Pain reproduced with any two of the following tests Hawkins-Kennedy, painful arc sign, Infraspinatus (External Rotation) Resistance Tests * Thoracic extension ROM \< 20° Exclusion criteria * Age below 35 years or above 60 years * History or clinical signs of complete supraspinatus or long-head biceps tendon tear * History of fracture or dislocation of the shoulder, history of surgery around the shoulder with in last year * Restrictions in passive movements of the GH joint (adhesive capsulitis) * GH OA, RA, cervical rib * Diagnosed bursitis, inflammatory arthropathies, active infection or systemic disease affecting shoulder * Suspected cancer or red-flag symptoms. * Bilateral shoulder pain. * Sign of nerve root irritation * Diagnosed with internal shoulder impingement * History of shoulder pain from traumatic onset * Positive sulcus sign and apprehension special tests pointing to ligamentous laxity * Corticosteroid injection was administered to the shoulder within a year before the study