Background Subacromial impingement syndrome (SIS) is a common condition in overhead athletes, associated with pain, impaired function, and altered shoulder mechanics. Conventional physiotherapy may not fully address underlying myofascial restrictions and neuromuscular deficits. Myofascial Release Therapy (MFR) and Isokinetic Training (IT) are promising interventions; however, their combined effects remain underexplored. Objective This study aimed to evaluate the effectiveness of combining MFR and IT on pain, function, and radiological outcomes in collegiate basketball players with SIS. Methods A prospective randomized controlled trial was conducted over an eight-week intervention period, with additional follow-up assessments performed up to six months after baseline. Sixty basketball players (45 males, 15 females) aged 18-25 years with clinically and radiographically confirmed SIS were randomly assigned to either an intervention group (MFR + IT; n = 30) or control group (conventional physiotherapy; n = 30) through computer-generated allocation method. Primary outcome was pain intensity measured using the Numerical pain rating scale (NPRS). Secondary outcomes included pain pressure threshold measured using an algometer, shoulder range of motion (ROM) assessed with a goniometer, shoulder function evaluated with the Shoulder Pain and Disability Index (SPADI), and radiographic parameters such as the coracohumeral interval and supraspinatus tendon thickness & subacromial space measured through MRI and ultrasound. Due to the nature of the interventions, it was not feasible to blind the participants or therapists. However, the outcome assessors and data analysts were blinded. Results At the 6-month follow-up, the intervention group demonstrated significantly greater improvements compared to the control group across all outcomes. Pain intensity decreased significantly (MD = 2.6; 95% CI: 2.34 to 2.85). Pain pressure threshold increased (MD = - 27.2 kPa; 95% CI: -43.73 to - 10.66). Shoulder range of motion improved significantly in abduction (MD = - 17.2°; 95% CI: -20.05 to - 14.34) and external rotation (MD = - 5.9°; 95% CI: -7.5 to - 4.29). Shoulder function (SPADI, %) improved (MD = 10.5%; 95% CI: 9.35 to 11.64). Radiological outcomes showed significant changes in coracohumeral interval space (MD = - 2.3 mm; 95% CI: -2.63 to - 1.96), supraspinatus tendon thickness (MD = 0.5 mm; 95% CI: 0.26 to 0.73), and subacromial bursa thickness (MD = 0.4 mm; 95% CI: 0.05 to 0.74). Conclusion The combination of MFR and IT is more effective than conventional physiotherapy in reducing pain, improving shoulder function, and increasing the coracohumeral interval space, as well as improving supraspinatus tendon and sub-acromial bursa thickness in athletes with SIS over a 6-month follow-up period. Trial registration The trial was registered in the clinical trial registry with registration number CTRI/2020/06/025602 on 04/06/2020.
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