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Purpose: This study investigated the effects of combined extracorporeal shock wave therapy (ESWT) and joint mobilization (JM) on acromiohumeral distance (AHD) and pressure pain threshold (PPT) in patients with shoulder impingement syndrome (SIS). Methods: Thirty patients with SIS were randomly assigned to an experimental group that received ESWT+JM (n=15) or a control group that performed shoulder stabilization exercises (n=15). The interventions were delivered three times weekly for four weeks. AHD was measured using ultrasonography and PPT using a digital algometer. Baseline homogeneity was confirmed for both AHD (p=0.587) and PPT (p=0.830). Statistical analyses included paired t-tests, independent t-tests, and two-way repeated measures ANOVA with partial eta squared (η²). Results: Both the experimental and control groups showed significant improvements in AHD (experimental: t = –4.314, p=0.001; control: t= –2.618, p = 0.020) and PPT (experimental: t = –6.236, p<0.001; control: t = –4.101, p=0.001). The post-intervention values were significantly higher in the experimental group for AHD (t=3.178, p=0.004) and PPT (t=2.560, p=0.016). ANOVA revealed significant time effects and group × time interactions for both AHD and PPT [time effects: (AHD: F=24.559, p<0.001, η²=0.467; PPT: F=55.709, p<0.001, η²=0.666); group × time interactions: (AHD: F=C6.811, p=0.004, η²=0.259; PPT: F=8.910, p=0.006, η²=0.241)]. Group effect was significant for AHD (F=4.009, p=0.047) but not for PPT (p=0.127). Conclusion: ESWT combined with JM produced superior improvements in AHD and PPT compared with stabilization exercise alone. Large interaction effects indicated complementary mechanisms, supporting this combined approach as an effective rehabilitation strategy for SIS.