Study Design: A prospective randomized clinical trial. Background: Manual physical therapy combined with exercise is a commonly applied but currently unproven clinical treatment for impingement syndrome of the shoulder. Objective: To compare the effectiveness of manual physical therapy with and without supervised exercise program in shoulder impingement syndrome. Methods: Random assignment of sixty patients (29 male, 31 female) diagnosed with shoulder impingement syndrome was done to 1 of 2 treatment groups. The exercise group performed supervised flexibility and strengthening exercises. The manual therapy group performed the same program and received manual physical therapy treatment. Both groups received the selected intervention 12 times over 1- month. Outcome measures were pain, pain-free abduction range, strength of shoulder abductors, internal and external rotators and functional activities. Pre and posttreatment measures were taken. Results: The study result shows statistically significant pain reduction, increase in pain-free shoulder abduction and improvement in strength of shoulder abductors, external and internal rotators within the groups. The shoulder function score showed statistically significant improvement in manual therapy group while supervised exercise group although showed improvement but could not be proved statistically. Results of all the outcome measures in manual therapy group were statistically significant when compared to supervised exercise group. Conclusion: Manual therapy with supervised exercise program is more effective than supervised exercise program alone for reducing pain, enhancing pain-free abduction ROM, improving function and strength in patients with shoulder impingement syndrome.