Neck Mobs and Impingement

All treatment will be provided by licensed physical therapist within the United States. The
clinicians affiliated with this study have experience in data collection and have
participated in a recent trial that was sponsored by Walsh University.

At baseline, after consent for the study, patients will be randomized into two groups: 1)
shoulder treatment and active mobilization to the neck and 2) shoulder treatment and placebo
mobilization to the neck. Baseline data will be collected including all self-report
measures.

Both groups will receive shoulder treatment with an emphasis on 1) range of motion
activities, 2) joint mobilization, 3) rotator cuff strengthening and 4) a home exercise
program that consists of shoulder strengthening exercises. The active neck group will
receive UPA's to the cervical spine; applied as 3 X 30 seconds, to each comparable (stiff or
painful) segment. The physical therapist will place their hands on the neck of the patient
for the placebo group but will not perform the oscillations that are characteristic of
mobilization.

All patients will receive a home program designed to increase range of motion and strength.
None of the home program focused exercises will be targeted to the neck. The shoulder
exercises will be tailored to each specific patient and will not be standardized.

Patients will be treated for the duration of their care using the same foci (1) range of
motion activities, 2) joint mobilization, 3) rotator cuff strengthening and 4) a home
exercise program that consists of shoulder strengthening exercises). The length of the
treatment will be determined by the progress of the patient and by the attending therapist.

Inclusion Criteria:

- Patients, age 18 and older, with shoulder impingement syndrome, who attend care at a
physical therapy outpatient setting, will be screened for eligibility for the study
by the treating physical therapists. For patients to meet inclusion requirements,
they require the following:

1. Report pain or dysfunction with elevated (overhead) arm activities, Demonstrate
pain during active shoulder movements

2. Demonstrate a positive Neer or Hawkins Kennedy Test

3. Report an onset that is non-traumatic

4. Report an onset within the last 12 months

5. Demonstrate a painful arc of movement during forward elevation of the arm from
60° to 120°

Exclusion Criteria:

- Exclusion criteria will include The presence of any red flags (i.e., tumor, metabolic
diseases, rheumatoid arthritis, osteoporosis, prolonged history of steroid use,
etc.), a history of frozen shoulder, disorders of the acromioclavicular joint,
degenerative arthritis of the glenohumeral joint, calcifying tendonitis, shoulder
instability, posttraumatic disorders, or shoulder surgery and/or elbow, hand, wrist
and blatantly misdiagnosed cervical spine disorders (e.g., cervical radiculopathy).