ORIGINAL PAPER
Core stability in adolescent swimmers with swimmer’s shoulder syndrome
 
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1
Biomechanics Department, Faculty of Physical Therapy, Cairo University, Giza, Egypt
 
2
Biomechanics Department, Faculty of Physical Therapy, October 6 University, Giza, Egypt
 
 
Submission date: 2020-02-25
 
 
Acceptance date: 2020-07-02
 
 
Publication date: 2021-11-30
 
 
Physiother Quart. 2021;29(4):33-41
 
KEYWORDS
TOPICS
ABSTRACT
Introduction:
Swimmer’s shoulder syndrome (SSS) is the most common overuse injury affecting swimmers and surfers. Core stability is crucial to prevent SSS. The study investigated the effect of isokinetic core strength of trunk flexors and extensors and core endurance on shoulder stability in adolescent swimmers with SSS.

Methods:
The study involved 30 swimmers, assigned to 2 equal groups. The experimental group (A) suffered from SSS; the control group (B) included healthy swimmers with no history of shoulder pain or instability. The mean values of age, body mass, and height were 12.86 ± 1.59 years, 41.73 ± 3.99 kg, and 142.0 ± 3.96 cm, respectively, in group A and 13.2 ± 1.56 years, 42.66 ± 3.9 kg, and 142.26 ± 4.39 cm, respectively, in group B. Isokinetic peak torque (PT) for trunk flexors and extensors was measured with a Biodex isokinetic dynamometer. Four functional tests assessed core endurance: side bridge endurance test, static back endurance test, ball bridge test, and unilateral bridge test.

Results:
There was a statistically significant between-group difference in mean PT of trunk extension at both angular velocities: 60°/s, 180°/s. No significant differences were detected in mean PT of trunk flexion. All functional core stability tests revealed a greater endurance time in group B.

Conclusions:
Weak core inhibits shoulder muscles, which is a major risk factor for shoulder instability and SSS. It is crucial to incorporate core stability training into the rehabilitation plan to provide proximal stability for obtaining safe and proper distal mobility across the shoulder joint.

REFERENCES (43)
1.
Wolf BR, Ebinger AE, Lawler MP, Britton CL. Injury patterns in Division I collegiate swimming. Am J Sports Med. 2009;37(10):2037–2042; doi: 10.1177/0363546509339364.
 
2.
O’Donnell CJ, Bowen J, Fossati J. Identifying and managing shoulder pain in competitive swimmers: how to minimize training flaws and other risks. Phys Sportsmed. 2005;33(9):27–35; doi: 10.3810/psm.2005.09.195.
 
3.
Madsen PH, Bak K, Jensen S, Welter U. Training induces scapular dyskinesis in pain-free competitive swimmers: a reliability and observational study. Clin J Sport Med. 2011;21(2):109–113; doi: 10.1097/JSM.0b013e3182041de0.
 
4.
Borsa PA, Laudner KG, Sauers EL. Mobility and stability adaptations in the shoulder of the overhead athlete: a theoretical and evidence-based perspective. Sports Med. 2008;38(1):17–36; doi: 10.2165/00007256-200838010-00003.
 
5.
Oyama S. Profiling physical characteristics of the swimmer’s shoulder: comparison to baseball pitchers and non-overhead athletes. Master’s thesis. Pittsburgh: University of Pittsburgh; 2006.
 
6.
Hibberd EE, Myers JB. Practice habits and attitudes and behaviors concerning shoulder pain in high school competitive club swimmers. Clin J Sport Med. 2013;23(6):450–455; doi: 10.1097/JSM.0b013e31829aa8ff.
 
7.
Sein ML, Walton J, Linklater J, Appleyard R, Kirkbride B, Kuah D, et al. Shoulder pain in elite swimmers: primarily due to swim-volume-induced supraspinatus tendinopathy. Br J Sports Med. 2010;44(2):105–113; doi: 10.1136/bjsm.2008.047282.
 
8.
De Martino I, Rodeo SA. The swimmer’s shoulder: multi-directional instability. Curr Rev Musculoskelet Med. 2018;11(2):167–171; doi: 10.1007/s12178-018-9485-0.
 
9.
Hill L, Collins M, Posthumus M. Risk factors for shoulder pain and injury in swimmers: a critical systematic review. Phys Sportsmed. 2015;43(4):412–420; doi: 10.1080/00913847.2015.1077097.
 
10.
Nichols AW. Medical care of the aquatics athlete. Curr Sports Med Rep. 2015;14(5):389–396; doi: 10.1249/JSR.0000000000000194.
 
11.
Bak K, Faunø P. Clinical findings in competitive swimmers with shoulder pain. Am J Sports Med. 1997;25(2):254–260; doi: 10.1177/036354659702500221.
 
12.
Matzkin E, Suslavich K, Wes D. Swimmer’s shoulder: painful shoulder in the competitive swimmer. J Am Acad Orthop Surg. 2016;24(8):527–536; doi: 10.5435/JAAOS-D-15-00313.
 
13.
Wanivenhaus F, Fox AJS, Chaudhury S, Rodeo SA. Epidemiology of injuries and prevention strategies in competitive swimmers. Sports Health. 2012;4(3):246–251; doi: 10.1177/1941738112442132.
 
14.
Kibler WB, Ludewig PM, McClure PW, Michener LA, Bak K, Sciascia AD. Clinical implications of scapular dyskinesis in shoulder injury: the 2013 consensus statement from the ‘Scapular Summit’. Br J Sports Med. 2013;47(14):877–885; doi: 10.1136/bjsports-2013-092425.
 
15.
Akuthota V, Ferreiro A, Moore T, Fredericson M. Core stability exercise principles. Curr Sports Med Rep. 2008;7(1):39–44; doi: 10.1097/01.CSMR.0000308663.13278.69.
 
16.
Fredericson M, Moore T. Muscular balance, core stability, and injury prevention for middle- and long-distance runners. Phys Med Rehabil Clin N Am. 2005;16(3):669–689; doi: 10.1016/j.pmr.2005.03.001.
 
17.
Zazulak BT, Hewett TE, Reeves NP, Goldberg B, Cholewicki J. The effects of core proprioception on knee injury: a prospective biomechanical-epidemiological study. Am J Sports Med. 2007;35(3):368–373; doi: 10.1177/0363546506297909.
 
18.
Behm DG, Leonard AM, Young WB, Bonsey WAC, Mac­Kinnon SN. Trunk muscle electromyographic activity with unstable and unilateral exercises. J Strength Cond Res. 2005;19(1):193–201; doi: 10.1519/1533-4287(2005)19<193:TMEAWU>2.0.CO;2.
 
19.
Sahrmann S. Diagnosis and treatment of movement impairment syndromes. St. Louis: Mosby; 2002.
 
20.
Richardson CA, Snijders CJ, Hides JA, Damen L, Pas MS, Storm J. The relation between the transverse abdominis muscle, sacroiliac joint mechanics, and low back pain. Spine. 2002;27(4):399–405; doi: 10.1097/00007632-200202150-00015.
 
21.
Barr KP, Griggs M, Cadby T. Lumbar stabilization: core concepts and current literature, part 1. Am J Phys Med Rehabil. 2005;84(6):473–480; doi: 10.1097/01.phm.0000163709.70471.42.
 
22.
McGill S. Low back disorders: evidence-based prevention and rehabilitation. Champaign: Human Kinetics; 2002.
 
23.
Matsen FA 3rd, Chebli C, Lippitt S, American Academy of Orthopaedic Surgeons. Principles for the evaluation and management of shoulder instability. J Bone Joint Surg Am. 2006;88(3):648–659; doi: 10.2106/00004623-200603000-00026.
 
24.
Cools AM, Geerooms E, Van den Berghe DF, Cambier DC, Witvrouw EE. Isokinetic scapular muscle performance in young elite gymnasts. J Athl Train. 2007;42(4):458–463.
 
25.
Turgut E, Duzgun I, Baltaci G. Effects of scapular stabilization exercise training on scapular kinematics, disability, and pain in subacromial impingement: a randomized controlled trial. Arch Phys Med Rehabil. 2017;98(10):1915–1923.e3; doi: 10.1016/j.apmr.2017.05.023.
 
26.
Beasley L, Faryniarz DA, Hannafin JA. Multidirectional instability of the shoulder in the female athlete. Clin Sports Med. 2000;19(2):331–349; doi: 10.1016/s0278-5919(05)70207-6.
 
27.
Bertocci GE, Munin MC, Frost KL, Burdett R, Wassinger CA, Fitzgerald SG. Isokinetic performance after total hip replacement. Am J Phys Med Rehabil. 2004;83(1):1–9; doi: 10.1097/01.PHM.0000098047.26314.93.
 
28.
Drouin JM, Valovich-McLeod TC, Shultz SJ, Gansneder BM, Perrin DH. Reliability and validity of the Biodex System 3 Pro isokinetic dynamometer velocity, torque and position measurements. Eur J Appl Physiol. 2004;91(1):22–29; doi: 10.1007/s00421-003-0933-0.
 
29.
Remaud A, Cornu C, Guével A. A methodologic approach for the comparison between dynamic contractions: influences on the neuromuscular system. J Athl Train. 2005;40(4):281–287.
 
30.
Kongsgaard M, Reitelseder S, Pedersen TG, Holm L, Aagaard P, Kjaer M, et al. Region specific patellar tendon hypertrophy in humans following resistance training. Acta Physiol. 2007;191(2):111–121; doi: 10.1111/j.1748-1716.2007.01714.x.
 
31.
Dvir Z, Keating J. Reproducibility and validity of a new test protocol for measuring isokinetic trunk extension strength. Clin Biomech. 2001;16(7):627–630; doi: 10.1016/s0268-0033(01)00038-9.
 
32.
Aly SM, Abd El-Mohsen AM, El Hafez SM. Effect of six weeks of core stability exercises on trunk and hip muscles’ strength in college students. Int J Ther Rehabil Res. 2017;6(2):9–15; doi: 10.5455/ijtrr.000000237.
 
33.
Shirado O, Ito T, Kaneda K, Strax TE. Flexion-relaxation phenomenon in the back muscles. A comparative study between healthy subjects and patients with chronic low back pain. Am J Phys Med Rehabil. 1995;74(2):139–144.
 
34.
Stanton R, Reaburn PR, Humphries B. The effect of short-term Swiss ball training on core stability and running economy. J Strength Cond Res. 2004;18(3):522–528; doi: 10.1519/1533-4287(2004)18<522:TEOSSB>2.0.CO;2.
 
35.
Willardson JM. Core stability training: applications to sports conditioning programs. J Strength Cond Res. 2007;21(3):979–985; doi: 10.1519/R-20255.1.
 
36.
Zedka M, Prochazka A, Knight B, Gillard D, Gauthier M. Voluntary and reflex control of human back muscles during induced pain. J Physiol. 1999;520(2):591–604; doi: 10.1111/j.1469-7793.1999.00591.x.
 
37.
Fritz JM, Cleland JA, Childs JD. Subgrouping patients with low back pain: evolution of a classification approach to physical therapy. J Orthop Sports Phys Ther. 2007;37(6):290–302; doi: 10.2519/jospt.2007.2498.
 
38.
Sinnott KA, Milburn P, McNaughton H. Factors associated with thoracic spinal cord injury, lesion level and rotator cuff disorders. Spinal Cord. 2000;38(12):748–753; doi: 10.1038/sj.sc.3101095.
 
39.
Rizio L, Uribe JW. Overuse injuries of the upper extremity in baseball. Clin Sports Med. 2001;20(3):453–468; doi: 10.1016/s0278-5919(05)70262-3.
 
40.
Neumann DA. Kinesiology of the musculoskeletal system: foundations for physical rehabilitation, 2nd ed. St. Louis: Mosby; 2010.
 
41.
Cholewicki J, Juluru K, McGill SM. Intra-abdominal pressure mechanism for stabilizing the lumbar spine. J Biomech. 1999;32(1):13–17; doi: 10.1016/s0021-9290(98)00129-8.
 
42.
Johnson JN, Gauvin J, Fredericson M. Swimming biomechanics and injury prevention: new stroke techniques and medical considerations. Phys Sportsmed. 2003;31(1):41–46; doi: 10.3810/psm.2003.01.165.
 
43.
Tse MA, McManus AM, Masters RSW. Development and validation of a core endurance intervention program: implications for performance in college-age rowers. J Strength Cond Res. 2005;19(3):547–552; doi: 10.1519/15424.1.
 
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