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

NCT06909864 | Completed

• 1 other identifier: GO 19/823
• Study Type: observational
• Target: 76
• Locations: 1 country
• Sites: 1

Brief Summary

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.

Conditions

Swimming; Shoulder; Adolescent

Keywords

Swimming; Shoulder; Adolescent; Musculoskeletal screening

Outcome Measures

Primary Outcomes (5)

• 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).

  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.

  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.

  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.

  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).

  From October 2019 to September 2021

Secondary Outcomes (2)

• Scapular Dyskinesis

  From October 2019 to September 2021

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

  From October 2019 to September 2021

Study Arms (2)

Swimming Group (SWG)

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 were included

Control Group (CG)

The non-athlete peers with no competed in overhead sports like swimming, basketball, volleyball, tennis, baseball as professional or recreational, no history of major upper limb injury or surgery and no injury history in last 6 months participated in this study.

Eligibility Criteria

• Age: 13 Years - 18 Years
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Child (0-17), Adult (18-64)
• Sampling Method: Probability Sample

Study Population

A total of 55 adolescent competitive swimmers and 40 non-athlete peers were screened. 48 swimmers and 28 non-athlete peers aged between 13 to 18 years met the inclusion criteria and participated in this study

You may qualify if:

• 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
• 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.

You may not qualify if:

• 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.

Sponsors & Collaborators

• Hacettepe University: lead

Study Sites (1)

Cebeci Sports Complex

Istanbul, Turkey (Türkiye)

Location

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Study Design

• Study Type: observational
• Observational Model: CASE CONTROL
• Time Perspective: CROSS SECTIONAL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Clinical Physical Therapist

Study Record Dates

• First Submitted: March 20, 2025
• First Posted: April 4, 2025
• Study Start: October 16, 2019
• Primary Completion: September 10, 2021
• Study Completion: October 16, 2021
• Last Updated: April 4, 2025

Record last verified: 2025-03

Locations

TU (1)