The Effect of a Water-Based Training Program on Pain, Range of Motion and Joint Position Sense in Elite Female Swimmers with Impingement Syndrome

Document Type : Original research papers

Abstract

One of the most common causes of shoulder problems in competitive swimmers is thought to be damage to the sub-acromial structures known as shoulder impingement syndrome. The present study aimed was to investigate the effect of a water-based training program on pain, range of motion, and joint position sense of the shoulder joint in elite female swimmers with shoulder impingement syndrome. Thirty elite female swimmers with an age range of aged 20-30 were randomly assigned to experimental or control groups. The experimental group performed a water-based training protocol, and the control group performed conventional swimming stretching exercises for eight-week. Pain, range of motion, and shoulder joint position sense were assessed before and after the intervention. The results showed a significant difference between the mean of variables in the two experimental and control groups before and after the exercise protocol (p˂ 0.001). The mean pain intensity in the experimental group decreased compared to pre-exercise, which was statistically significant (p˂ 0.001), and no significant statistical difference was observed in the control group. Besides, the range of motion, internal and external rotation, flexion, and abduction in the experimental group had increased compared to condition before the training, which was statistically significant (p˂ 0.001). In this section, no significant statistical difference was observed in the control group. The results also show a significant improvement in the joint position sense of in the experimental group compared to the control group (p˂ 0.001). According to the results, the eight-week program of water-based training was effective in improving pain, range of motion, and the joint position sense of women swimmers with shoulder impingement. This can be explained by the improvement of muscle imbalance between the dynamic stabilizers of the shoulder complex and maintain of the subacromial space in a way that prevents soft tissue impinge, reduces pain, and consequently increases range of motion and improve joint position sense in people with this complication.

Keywords

Main Subjects


1.        Pink MM, Tibone JE. The painful shoulder in the swimming athlete. Orthop Clin North Am. 2000;31(2):247–61.
2.        Bradley J, Kerr S, Bowmaker D, Gomez J-F. Review of shoulder injuries and shoulder problems in competitive swimmers. Am J Sport Sci Med. 2016;4(3):57–73.
3.        Pink MM, Edelman GT, Mark R, Rodeo S a. Section Ii Applied Biomechanics of Selected Sport Activities. Athl Sport issues Musculoskelet Rehabil Elsevier Saunders St Louis, Missouri, 2011; Chapter 14, pp 331-349.
4.        Garving C, Jakob S, Bauer I, Nadjar R, Brunner UH. Impingement syndrome of the shoulder. Dtsch Arztebl Int. 2017;114(45):765–76.
5.        Törös K, Schmidtka-Várnagy A, Szendrő G, Bálint L, Mayer Á. 122 The incidence of swimmer’s shoulder and its relevance with the range of movement amongst young swimmers. Br J Sports Med. 2020;54(Suppl 1):A53.
6.        Matzkin E, Suslavich K, Wes D. Swimmer’s shoulder: painful shoulder in the competitive swimmer. J Am Acad Orthop Surg. 2016;24(8):527–36.
7.        Ludewig PM, Reynolds JF. The association of scapular kinematics and glenohumeral joint pathologies. J Orthop Sport Phys Ther. 2009;39(2):90–104.
8.        Ben Kibler W. The role of the scapula in athletic shoulder function. Am J Sports Med. 1998;26(2):325–37.
9.        Khanmohammadi R, Talebian S, Shadmehr A, Entezari E. Latency and recruitment order of the shoulder muscles in dynamic complex movement in patients with shoulder impingement syndrome. Razi J Med Sci. 2011;18(85):17–26.
10.      Kelly SM, Wrightson PA, Meads CA. Clinical outcomes of exercise in the management of subacromial impingement syndrome: a systematic review. Clin Rehabil. 2010;24(2):99–109.
11.      Yeganeh A, Abdollahi M, Nakhaei Amroodi M, Farahini H. Comparison of the efficacy of local corticosteroid injection and physical therapy on pain severity, joint range of motion and muscle strength in patients with shoulder impingement syndrome referred to Rasool-e-Akram Medical Center from April 2008 to Septe. Med J Islam Repub Iran. 2011;25(3):142–52.
12.      Delkhoush CT, Maroufi N, Takamjani IE, Farahmand F, Shakourirad A, Haghani H. Dynamic comparison of segmentary scapulohumeral rhythm between athletes with and without impingement syndrome. Iran J Radiol. 2014;11(2).
13.      Steuri R, Sattelmayer M, Elsig S, Kolly C, Tal A, Taeymans J, et al. Effectiveness of conservative interventions including exercise, manual therapy and medical management in adults with shoulder impingement: A systematic review and meta-analysis of RCTs. Br J Sports Med. 2017;51(18):1340–7.
14.      Clausen MB, Bandholm T, Rathleff MS, Christensen KB, Zebis MK, Graven-Nielsen T, et al. The Strengthening Exercises in Shoulder Impingement trial (The SExSI-trial) investigating the effectiveness of a simple add-on shoulder strengthening exercise programme in patients with long-lasting subacromial impingement syndrome: Study protocol for a p. Trials. 2018;19(1):1–17.
15.      Senbursa G, Baltacı G, Atay A. Comparison of conservative treatment with and without manual physical therapy for patients with shoulder impingement syndrome: a prospective, randomized clinical trial. Knee surgery, Sport Traumatol Arthrosc. 2007;15(7):915–21.
16.      Torres-ronda L, Schelling X. The Properties of Water and their Applications for Training by. J Hum Kinet. 2014;44(December):237–48.
17.      Bagheri S, Hosseini SH, Saki F, Nikoo MR, Yarahmdi A. The effects of water-based posterolateral hip muscle strengthening on pain intensity and function in females with patellofemoral pain syndrome. Sci J Kurdistan Univ Med Sci. 2017;21(6):99–109.
18.      Saquetto MB, da Silva CM, Martinez BP, Sena C da C, Pontes SS, da Paixão MTC, et al. Water-Based Exercise on Functioning and Quality of Life in Poststroke Persons: A Systematic Review and Meta-Analysis. J Stroke Cerebrovasc Dis. 2019;28(11).
19.      de Castro LA, Felcar JM, de Carvalho DR, Vidotto LS, da Silva RA, Pitta F, et al. Effects of land-and water-based exercise programmes on postural balance in individuals with COPD: additional results from a randomised clinical trial. Physiotherapy. 2020;107:58–65.
20.      Brody LT, Geigle PR. Aquatic exercise for rehabilitation and training. Human Kinetics; 2009.
21.      Alberton CL, Cadore EL, Pinto SS, Tartaruga MP, Da Silva EM, Kruel LFM. Cardiorespiratory, neuromuscular and kinematic responses to stationary running performed in water and on dry land. Vol. 111, European Journal of Applied Physiology. 2011. p. 1157–66.
22.      Land H, Gordon S, Watt K. Clinical assessment of subacromial shoulder impingement–Which factors differ from the asymptomatic population? Musculoskelet Sci Pract. 2017;27:49–56.
23.      Worsley P, Warner M, Mottram S, Gadola S, Veeger HEJ, Hermens H, et al. Motor control retraining exercises for shoulder impingement: effects on function, muscle activation, and biomechanics in young adults. J shoulder Elb Surg. 2013;22(4):e11–9.
24.      Farrar JT, Young JP, LaMoreaux L, Werth JL, Poole RM. Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale. Pain. 2001;94(2):149–58.
25.      Ganji ZB, Dehghan-manshadi F, Kalantari KK-, Ghasemi M. The immediate effect of Kinesio tape on the variation of shoulder position sense at different angles in patients with impingement syndrome Background and Aim : Kinesio tape has been considered as a supplementary treatment method for shoulder impingement s. J Rehab Med. 2015;4(2):37–45.
26.      Bronner S, Agraharasamakulam S, Ojofeitimi S. Reliability and validity of a new ankle electrogoniometer. J Med Eng Technol. 2010;34(5–6):350–5.
27.      Bae YH, Lee GC, Shin WS, Kim TH, Lee SM. strengthening exercises on pain, function, strength and the range of motion of patients with shoulder impingement syndrome. J Phys Ther Sci. 2011;23(4):687–92.
28.      Dilek B, Gulbahar S, Gundogdu M, Ergin B, Manisali M, Ozkan M, et al. Efficacy of proprioceptive exercises in patients with subacromial impingement syndrome: a single-blinded randomized controlled study. Am J Phys Med Rehabil. 2016;95(3):169–82.
29.      Herrington L, Horsley I, Rolf C. Evaluation of shoulder joint position sense in both asymptomatic and rehabilitated professional rugby players and matched controls. Phys Ther Sport. 2010;11(1):18–22.
30.      Thompson KR, Mikesky A, Bahamonde RE, Burr DB. Effects of physical training on proprioception in older women. J Musculoskelet Neuronal Interact. 2003;3(3), 223-.
31.      Kaya E, Zinnuroglu M, Tugcu I. Kinesio taping compared to physical therapy modalities for the treatment of shoulder impingement syndrome. Clin Rheumatol. 2011;30(2):201–7.
32.      Celik D, Akyuz G, Yeldan I. Comparison of the effects of two different exercise programs on pain in subacromial impingement syndrome. Acta Orthop Traumatol Turc. 2009;43(6):504–9.
33.      Roy J-S, Moffet H, Hébert LJ, Lirette R. Effect of motor control and strengthening exercises on shoulder function in persons with impingement syndrome: a single-subject study design. Man Ther. 2009;14(2):180–8.
34.      Ludewig PM, Braman JP. Shoulder impingement: biomechanical considerations in rehabilitation. Man Ther. 2011;16(1):33–9.
35.      Alibakhshi E, Golpayegani M, Kazemipour M, Mollanorouzi K, Parastesh M. Comparison of physical therapy, massage therapy, mechanotherapy and compound programs on rotator cuff muscles in shoulder impingement syndrome patients. Iran J Mil Med Summer. 2010;12(2):81–8.
36.      Arami J, Rezasoltani A, Khalkhali Zaavieh M, Rahnama L. The effect of two exercise therapy programs (proprioceptive and endurance training) to treat patients with chronic non-specific neck pain. J Babol Univ Med Sci. 2012;14(1):77–84.
37.      Allegrucci M, Whitney SL, Lephart SM, Irrgang JJ, Fu FH. Shoulder kinesthesia in healthy unilateral athletes participating in upper extremity sports. J Orthop Sport Phys Ther. 1995;21(4):220–6.
38.      Suprak DN, Osternig LR, Van Donkelaar P, Karduna AR. Shoulder joint position sense improves with elevation angle in a novel, unconstrained task. J Orthop Res. 2006;24(3):559–68.
39.      Shumway-Cook A, Woollacott MH. Motor control: translating research into clinical practice. Lippincott Williams & Wilkins; 2007.
40.      Lee M-Y, Lee H-Y, Yong M-S. Characteristics of cervical position sense in subjects with forward head posture. J Phys Ther Sci. 2014;26(11):1741–3.
41.      Howe LP, Blagrove RC. Shoulder function during overhead lifting tasks: implications for screening athletes. Strength Cond J. 2015;37(5):84–96.