Objectives: Shoulder pain and impairment is a prevalent and disabling condition. While some Mulligan mobilization with movement (MWM) techniques have been shown to have beneficial effects, Hand Behind Back (HBB) MWM has not been investigated. The aim of this study was to investigate the effects of HBB MWM on shoulder pain, impairment and disability. Methods: We conducted a double blind randomized controlled trial in 44 subjects with shoulder pain and movement impairment presenting to an Indian general hospital. Subjects were allocated to receive either MWM and exercise/hot pack (n=22) or exercise/hot pack alone (n=22). The primary outcome was HBB range of motion (ROM). Secondary variables were shoulder internal rotation ROM, pain intensity score, and shoulder disability identified by the Shoulder Pain and Disability index (SPADI). All variable were evaluated by a blinded assessor before and immediately after 9 treatment sessions spread over 3-weeks. Results: A total of 60 patients were screened and 44 randomized. The average duration of symptoms was 4.1 and 4.7 weeks in the exercise and MWM groups respectively. Paired t-tests revealed that both groups demonstrated statistically significant improvements (p< 0.001) with large effect sizes for all variables. However, for all variables the MWM with exercise group showed significantly greater improvements (p< 0.05) than the exercise group. HBB ROM showed a mean difference of 9.31˚ (95% CI 7.38 to 11.27), favoring greater improvement in the MWM with exercise group. Conclusions: Shoulder HBB MWM with exercise improves outcomes in patients with acute shoulder pain and disability greater than exercise/hot packs alone.