Effect of Blood Flow Restriction Training Versus Pilates on Shoulder Impingement Syndrome

Shoulder pain is one of the most prevalent musculoskeletal complaints, ranking as thethird most common condition encountered in primary care settings. Among the variouscauses of shoulder pain, subacromial impingement syndrome (SAIS) represents the mostfrequent diagnosis, accounting for nearly half to two‐thirds of reported shoulder paincases. SAIS is characterized by narrowing of the subacromial space, resulting incompression and irritation of soft tissues such as the supraspinatus tendon, long head ofbiceps tendon, subacromial bursa, and joint capsule.Clinically, patients with SAIS present with pain during overhead activities, muscleweakness, and a painful arc of motion, particularly between 60° and 120° of shoulderelevation. Weakness of the rotator cuff and scapular stabilizing muscles contributessignificantly to altered scapulohumeral rhythm and compromised glenohumeral stability.Consequently, muscle strengthening is considered a cornerstone in rehabilitationprograms.Traditional resistance training typically requires moderate to high loads (around 60% ofone‐repetition maximum) to achieve strength gains. However, during the painful phases ofSAIS, patients may not tolerate heavy loading, leading to delayed initiation ofstrengthening exercises and prolonged recovery time. Therefore, alternative strengtheningstrategies that minimize mechanical stress while promoting muscle adaptation are needed.Blood Flow Restriction (BFR) training is a technique that applies controlled externalpressure to partially restrict arterial inflow and venous outflow, enabling strengthgains with low‐load resistance (approximately 20‐30% of 1RM). It stimulates metabolicstress and anabolic pathways, enhancing muscle hypertrophy and strength while reducingjoint stress.Pilates exercises, on the other hand, are mind‐body exercises based on principles ofcontrol, concentration, centering, precision, breathing, and flow. They emphasizeneuromuscular control, core stability, scapular alignment, and coordinated movementpatterns. Previous studies have demonstrated beneficial effects of Pilates in improvingpain, function, and muscle strength in various musculoskeletal disorders, includingshoulder conditions.Despite the promising effects of both BFR and Pilates, limited evidence directly comparestheir effectiveness in shoulder rehabilitation, particularly in patients with SAIS. Tothe author's knowledge, no previous study has directly compared these two interventionsin managing painful subacromial impingement syndrome. Therefore, this study aims toevaluate and compare the effects of BFR training and Pilates exercises, in addition toconventional therapy, on pain intensity, functional disability, shoulder range of motion,muscle strength, and proprioception in patients with SAIS.