Journal of Environmental Treatment Techniques  
2020, Volume 8, Issue 3, Pages: 1157-1162  
J. Environ. Treat. Tech.  
ISSN: 2309-1185  
Journal web link:  
Effect of High-Power Laser on Shoulder Mobility in  
Sub Acromial Impingement Syndrome: Randomized  
Controlled Trial  
Walid ahmed Kamal , Mahmood Saber , Khalid Aiad , Mohamed Serag Eldein Mahgoub  
Mostafa , Heba A. Bahey El- Deen  
Physical Therapist MSC, ministry of interior, Egypt  
Professor of laser application in surgery National institute of laser Enhanced science, Cairo University, Giza, Egypt  
Professor of orthopedic physical Therapy, Cairo University, Giza, Egypt  
Associate professor Basic Sciences department -Faculty of Physical Therapy, Cairo University, Giza, Egypt  
Associate Professor of Physical Therapy, Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Jouf University,  
Kingdom of Saudi Arabia and Assistant Professor of Physical Therapy, Department of Physical Therapy for Surgery, Faculty of Physical Therapy, Misr  
University for Science and Technology, Egypt  
Received: 06/05/2020  
Accepted: 15/07/2020  
Published: 20/09/2020  
The effect of high-power laser on shoulder mobility in subacromial impingement syndrome had been not investigated yet. Objective of  
study was to investigate the effect of high-power laser therapy on shoulder mobility in subacromial impingement syndrome. A Prospective,  
Randomized, pre - post- Test, controlled trial was conducted. Setting: Outpatient clinic of Cleopatra Hospital Egypt. The Study was conducted  
between June 2017 and Feb 2018. Participants: Forty Patients who were diagnosed with 1 - 2 stage impingement syndrome pain was randomly  
divided into two equal groups. Interventions. Group (A) received a program of Neodymium- yttrium aluminum Garnet Laser 1064 nm wave  
Length Hiro 3 high intensity pulsed Laser was used in the study, Power of 8 W, dose of 12 J/cm2 and Total maximum energy of 10000 J were  
Applied for 15 min and duration for single impulse 150 `us, fluency 760 mj, two sessions per week over six weeks' period in addition to  
exercise Group (B) Received Exercise in the form of Pendulum Ex. For 5 minutes, strengthen Ex for Anterior fiber of deltoid, stretching ex  
for sub scapularis muscle and anterior and posterior capsule. Main outcome measure: Visual Analogue Scale (VAS), active shoulder flexion  
and abduction, Ultrasonography of supraspinatus tendon thickness. Comparing both groups post-program revealed a statistically significant  
reduction in Ultrasonography Dimension of supraspinatus and VAS and significant increase in ROM of shoulder flexion and abduction in favor  
to group A in compared to group B (p > 0.05). It’s concluded that high level laser Therapy was yielding more improvement for shoulder  
mobility in impingement syndrome.  
Keywords: Impingement syndrome, High level Laser Therapy, Shoulder mobility  
SAIS induces edema, swelling, and can become chronic if  
appropriate treatment is not implemented, conservative and  
surgical treatment methods can be used to minimize discomfort,  
increase joint mobility, enhance muscle strength and quality of life  
in SAIS. Conservative treatment strategies include analgesic and  
non-steroidal anti-inflammatory or corticosteroid medications,  
resting, adjustment of routine triggers, approaches to physical  
activity, range of movement and strengthening exercises, local  
anesthetic subacromial injections [6]. Laser therapy is based on the  
belief that laser radiation and possible monochromatic light in  
general are capable of changing the function of the cell and tissue  
in a way that depends on the characteristics of the light itself, e.g.,  
wavelength, coherence [7]. High-intensive laser therapy (HILT)  
involving high-intensity laser radiation causing minor and slow  
light absorption by chromium spheres, this absorption is not  
obtained with concentrated, light by diffuse light in all directions  
subacromial impingement syndrome is characterized as an  
asymptomatic irritation of the rotator cuff and the subacromial  
bursa in the subacromial space [1] the term encompasses a wide  
range of disorders, causing an alteration in the relationship  
between the [inflammation] soft tissue and the [stiffness] structure,  
which is especially critical when the arm is removed in an arc  
between 60 degrees and 120 degrees [2]. Sub-acromial  
impingement syndrome (SIS) is characterized by extreme pain  
spreading across biceps and deltoid from the shoulder, pain rises  
at night, and with abduction and interned rotation [3]. Sub-  
acromial impingement syndrome is one of the most common  
causes of shoulder pain and occurs when the rotator cuff muscles  
are squeezed in the sub-acromial space and the acromial arch of  
curacao [4]. Numerous predisposing factors play a role in the  
development of SIS, with the most prominent risk factors being  
poor rotator cuff muscles, irregular scapular muscle function,  
articular capsule defects and long-term overhead arm movement,  
the muscle imbalances between upper and lower trapezius muscle  
activity are related to abnormal scapular motion in patients with  
shoulder pain [5].  
scattering phenomena, increasing mitochondrial oxidative  
reaction and adenosine triphosphate, RNA or DNA photochemical  
8]. This study reported that high power laser improves shoulder  
mobility in subacromial impingement syndrome. Up to our  
knowledge there is no one use ultrasonography as objective  
method to assess this improvement and also use different type of  
Corresponding author: Walid ahmed Kamal, Physical Therapist MSC, ministry of interior, Egypt. Email: