Competitive Swimming and Shoulder Adaptations: The Role of Stroke Specialty in Adolescent Swimmers

N/ACompletedNCT06909864

Hacettepe University76 enrolled

Overview

Objectives: To examine the sport-specific adaptations and investigate the effect of swimming stroke specialization in shoulder complex among adolescent competitive swimmers. Design: Observational study. Setting: Athletic facilities. Participants: A total of 76 adolescents participated including n = 28 non-swimmers as Control Group (CG) and n = 48 competitive swimmers as Swimmers Group (SWG). Main Outcome Measures: Strength of glenohumeral (GH) and scapular muscles (SM), mobility of GH (GH ROMs) joint, proprioception, pectoralis minor length (PML), posterior shoulder tightness (PST) were evaluated for all participants. Kerlan Jobe Orthopaedic Score (KJOC) was sed to evaluate for SWG. The tested shoulder physical performance parameters were compared between the groups.

Study Type

OBSERVATIONAL

Enrollment

76

Conditions

Swimming Shoulder Adolescent

Eligibility

Sex: ALLMin age: 13 YearsMax age: 18 YearsHealthy volunteers:

Medical Language ↔ Plain English

Inclusion Criteria for Swimmer Group: * aged between 13 to 18 years * the asymptomatic swimmers with no history of major upper limb injury or surgery and no injury history of upper limb in last 6 months * having experience in at least 5 years competitive swimming, * actively participating in competitive swimming at least 1 year, * competing at least in national level and having swimming stroke specialization in competitive swimming Inclusion Criteria for Control Group: * aged between 13 to 18 years, * no competed in overhead sports like swimming, basketball, volleyball, tennis, baseball as professional or recreational, * no history of major upper limb injury or surgery in last 6 months. Exclusion Criteria for all participants: * if they had at least two positive signs by shoulder screening tests (Hawkin's/Kennedy Subacromial Impingement Test, Jobe/Empty Can Test, External Rotation Resistance Test, Apprehension Instability Test, Speed Test and Gerber Lift-Off Test), * a BMI of 30 kg/m² or greater than 30 kg/m², * competing in paralympic sports, * if they had any major upper limb injuries or surgeries, * if they had any systemic, neurological or rheumatological diseases, * being pre-pubertal stage (Tanner I) according to Tanner Scale, * indicated their unwillingness to participate to this study.

Outcomes

Primary Outcomes

Muscle Strength

Muscle strength was assessed with break test by using hand-hold dynamometer (Jamaar Hand Dynamometer, USA). Assessments were applied for both shoulders and 3 times for each position. Shoulder flexion, extension, abduction, full-can, glenohumeral IR and ER, upper, middle and lower trapezius, serratus anterior muscle tests were applied. GH ER/IR ratio was calculated as well (21-26). Measurements were recorded in Newton (N).

Time frame: From October 2019 to September 2021

Range of Motion

Passive Range of Motion (PROM) of both shoulders was assessed using a digital inclinometer (Get My ROM, version 1.0.3 for iOS; Interactive Medical Productions, Hampton, NH, USA). Shoulder internal rotation (IR), external rotation (ER), and total-rotational ROM were assessed (ICC = 0.92-94). Shoulder IR and ER PROM were obtained with the participant lying supine on a standard examination table, with the shoulder initially abducted to 90° with 0° rotation and the elbow flexed to 90° with neutral pronation/supination. In addition, Total-rotational ROM was calculated by summing the IR and ER ROMs average degrees of each shoulder.

Time frame: From October 2019 to September 2021

Pectoralis Minor Length

Digitized 2 anatomical landmarks representing the length of the pectoralis minor. These 2 points were the medial-inferior angle of the coracoid process and just lateral to the sternocostal junction of the inferior aspect of the fourth rib. Measurements of pectoralis minor muscle length was taken with tape measure (ICC = 0.96). Because of height and muscle length variability among subjects, a normalization index was developed. The pectoralis minor index (PMI) was calculated by dividing the resting muscle length measurement by the subject height and multiplying by 100.

Time frame: From October 2019 to September 2021

Proprioception

For proprioception testing, participants attempted to reproduce 45° ER angle. Participants were positioned as lying supine with arm abducted to 90°, elbow flexed at 90°. The ''Get My ROM'' digital inclinometer was used to measure the angles; the iPhone was securely attached to participants forearm using a strap with the screen facing the tester (ICC = 0.87-89). The participant was instructed to close their eyes by using an eye patch throughout testing. The arm was passively rotated to 45° ER and held in this position for 3 seconds. The participant was asked to remember this position. Following the return to neutral the participant was asked to actively return the arm back to the angle shown. The amount of degrees away from 45° was recorded.

Time frame: From October 2019 to September 2021

Posterior Shoulder Tightness

Participants were positioned supine with both shoulders flush against a standard examination table. The tester stood at the head of the examination table toward the head of the subject and positioned the test shoulder and elbow in 90 of both abduction and flexion. To measure GH horizontal adduction, The ''Get My ROM'' digital inclinometer was aligned with the ventral midline of the humerus. The angle created by the end position of the humerus with respect to 0 of horizontal adduction was then recorded as the total amount of GH horizontal adduction motion (ICC = 0.79).

Time frame: From October 2019 to September 2021

Secondary Outcomes

Scapular Dyskinesis

Each participant performed 5 repetitions of bilateral, active, weighted shoulder flexion and bilateral, active, weighted shoulder abduction (frontal plane) while they were observed from the posterior views. First of all, the scapula was observed while participants in rest and then weighted shoulder flexion and abduction movements from the posterior views. Kibler et al. reported the reliability of a visually based classification system for scapular dysfunction that defined 3 different types of motion abnormalities: Type 1 = inferior angle prominence, Type II = medial border prominence and Type III = excessive superior border elevation. Normal, symmetric scapular motion was considered Type IV (ICC = 0.32-42).

Time frame: From October 2019 to September 2021

Kerlan-Jobe Orthopaedic Clinic Shoulder and Elbow Score (KJOC)

KJOC has been designed specifically as a subjective assessment tool to measure functional status of the upper extremities in overhead athletes. The KJOC was translated from English to Turkish to enable use of questionnaires in Turkish overhead athletes by Turgut et al. KJOC was used to measure functional status of the upper extremities in competitive adolescent swimmers and the scores compared in different stroke specialty among the swimmers in this study.

Time frame: From October 2019 to September 2021

NCT06909864 - Competitive Swimming and Shoulder Adaptations: The Role of Stroke Specialty in Adolescent Swimmers | Crick | Crick