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Clinical Trial Details — Status: Completed

Administrative data

NCT number NCT03476395
Other study ID # 2017-00762
Secondary ID
Status Completed
Phase
First received December 21, 2017
Last updated March 18, 2018
Start date September 1, 2017
Est. completion date March 18, 2018

Study information

Verified date March 2018
Source Zurich University of Applied Sciences
Contact n/a
Is FDA regulated No
Health authority
Study type Observational

Clinical Trial Summary

The shoulder joint is the second most affected body part of all overuse injuries in overhead athletes. Due to the repetitive throwing motion overhead athletes show the following characteristic adaptations of their dominant shoulder: Loss of internal rotation (IR) and gain of external rotation (ER), reduced muscle strength of the shoulder external rotators and scapular dyskinesis. On the one hand these adaptations are normal and necessary for a powerful throwing performance. On the other hand the amount of adaptation seems to play a crucial role in developing overuse symptoms and therefore becoming a risk factor. Most previous studies investigating throwing specific adaptations and risk factors focused on overhead sports like baseball, handball or tennis, whereas similar research in volleyball is still insufficient. Therefore the aim of this study is to evaluate if sport specific adaptations are present in female volleyball players and if yes, if there is a difference of the extent of these adaptations in volleyball players with overuse symptoms and players without.


Description:

Background The shoulder joint is the second most affected body part of all overuse injuries in overhead athletes.Prevalence of a history of shoulder problems related to overuse in volleyball players was reported to be approximately 60%. Typical overuse symptoms like pain seriously limit progress in performance and the individual career options of volleyball players.

Due to the repetitive throwing motion overhead athletes show the following characteristic adaptations of their dominant (Ds), compared to the non-dominant (NDs) shoulder: 1) Loss of internal rotation (IR) and gain of external rotation (ER), by preserving the total rotational motion (TROM). 2) Reduced muscle strength of the shoulder external rotators (ER). 3) Scapular dyskinesis. On the one hand these adaptations are normal and necessary for a powerful throwing performance. On the other hand the amount of adaptation seems to play a crucial role in developing overuse symptoms and therefore becoming a risk factor; e.g. loss of IR, also known as glenohumeral internal rotation deficit (GIRD) of more than 20° side difference, and a loss of TROM of the Ds, were defined as risk factors in baseball players. Moreover decreased muscle strength of ER (OR: 0.71 per 10N decrease) in the Ds as well as obvious scapular dyskinesis were associated with increased risk of overuse related shoulder symptoms (ORSS). Nevertheless there are still overhead athletes showing these adaptations or risk factors without being symptomatic.

Recently, several authors underlined the importance of core stability related to the kinetic chain during an overhead throwing task. It is hypothesised that symptomatic athletes may overload the shoulder girdle through altered biomechanics in an effort to compensate for insufficient power generated by the core musculature. The most reliable measurements to asses core stability components are core endurance tests.

Most previous studies investigating throwing specific adaptations and risk factors focused on overhead sports like baseball, handball or tennis, whereas similar research in volleyball is still insufficient. Moreover, no one ever investigated core endurance and its possible association with (ORSS) in volleyball players.

Objective The first aim is, to evaluate if sport specific adaptations such as IR ROM deficit, gain of ER ROM, ER strength deficit, alterations in TROM and scapular dyskinesis are present in female volleyball players and if yes, if there is a difference of the extent of these adaptations in volleyball players with ORSS and players without.

The second aim is, to evaluate if there is a difference in core endurance in volleyball players with ORSS and players without and if there is a correlation of core endurance and shoulder related risk factors such as ER strength deficit and scapular dyskinesis?


Recruitment information / eligibility

Status Completed
Enrollment 60
Est. completion date March 18, 2018
Est. primary completion date November 30, 2017
Accepts healthy volunteers Accepts Healthy Volunteers
Gender Female
Age group 16 Years and older
Eligibility Inclusion Criteria:

- female

- being member of a Nat. League B/Nat. League A Volleyball Team in season 2017/2018

- minimum age 16 years

- sufficient understanding/speaking of the German language

- signed informed consent

Exclusion Criteria:

- having had any surgery at the shoulder joint of the dominant or non- dominant side within last six month

- having had any self reported trauma at the shoulder joint of the dominant or non-dominant side, which limits training or match participation of more than 50%

- limitation of more than 50% in training or match participation caused by a surgery or trauma at the core or lower extremity

Study Design


Related Conditions & MeSH terms

  • Overuse Related Shoulder Problems

Intervention

Other:
shoulder range of motion in IR/ER, strength of the IR/ER muscles and Scapular Dyskinesis Test. Core endurance test.
Passive shoulder range of motion using a digital application Clinometer. Isometric strength of the shoulder IR/ER using a HHD measured. Scapular Dyskinesis Test uses a visual scoring system. Core Endurance is teste by measuring the time (s).

Locations

Country Name City State
Switzerland ZHAW Winterthur

Sponsors (1)

Lead Sponsor Collaborator
Zurich University of Applied Sciences

Country where clinical trial is conducted

Switzerland, 

References & Publications (12)

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. Review. — View Citation

Burkhart SS, Morgan CD, Kibler WB. The disabled throwing shoulder: spectrum of pathology Part I: pathoanatomy and biomechanics. Arthroscopy. 2003 Apr;19(4):404-20. Review. — View Citation

Burkhart SS, Morgan CD, Kibler WB. The disabled throwing shoulder: spectrum of pathology Part III: The SICK scapula, scapular dyskinesis, the kinetic chain, and rehabilitation. Arthroscopy. 2003 Jul-Aug;19(6):641-61. Review. — View Citation

Clarsen B, Bahr R, Heymans MW, Engedahl M, Midtsundstad G, Rosenlund L, Thorsen G, Myklebust G. The prevalence and impact of overuse injuries in five Norwegian sports: Application of a new surveillance method. Scand J Med Sci Sports. 2015 Jun;25(3):323-30. doi: 10.1111/sms.12223. Epub 2014 Mar 30. — View Citation

Cools AM, Johansson FR, Borms D, Maenhout A. Prevention of shoulder injuries in overhead athletes: a science-based approach. Braz J Phys Ther. 2015 Sep-Oct;19(5):331-9. doi: 10.1590/bjpt-rbf.2014.0109. Epub 2015 Sep 1. — View Citation

Evans K, Refshauge KM, Adams R. Trunk muscle endurance tests: reliability, and gender differences in athletes. J Sci Med Sport. 2007 Dec;10(6):447-55. Epub 2006 Dec 1. — View Citation

Kibler WB, Press J, Sciascia A. The role of core stability in athletic function. Sports Med. 2006;36(3):189-98. — View Citation

Myklebust G, Hasslan L, Bahr R, Steffen K. High prevalence of shoulder pain among elite Norwegian female handball players. Scand J Med Sci Sports. 2013 Jun;23(3):288-94. doi: 10.1111/j.1600-0838.2011.01398.x. Epub 2011 Nov 11. — View Citation

Reeser JC, Fleisig GS, Bolt B, Ruan M. Upper limb biomechanics during the volleyball serve and spike. Sports Health. 2010 Sep;2(5):368-74. — View Citation

Ruotolo C, Price E, Panchal A. Loss of total arc of motion in collegiate baseball players. J Shoulder Elbow Surg. 2006 Jan-Feb;15(1):67-71. — View Citation

Seminati E, Minetti AE. Overuse in volleyball training/practice: A review on shoulder and spine-related injuries. Eur J Sport Sci. 2013;13(6):732-43. doi: 10.1080/17461391.2013.773090. Epub 2013 Mar 5. Review. — View Citation

Wilk KE, Arrigo CA, Hooks TR, Andrews JR. Rehabilitation of the Overhead Throwing Athlete: There Is More to It Than Just External Rotation/Internal Rotation Strengthening. PM R. 2016 Mar;8(3 Suppl):S78-90. doi: 10.1016/j.pmrj.2015.12.005. Review. — View Citation

* Note: There are 12 references in allClick here to view all references

Outcome

Type Measure Description Time frame Safety issue
Primary isometric strength of shoulder internal and extern rotators Isometric strength is measured in Newton (N) using a digital handheld dynamometer (HHD; Model 01165, Lafayette Instrument Company, USA). The participants are placed in supine with their shoulder in 0° abduction (ABD) a small towel roll is used to maintain the humerus in a neutral position and their elbow flexed to 90°. The forearm is fixed to the core using a fixation band. The HHD is placed on the dorsal or ventral aspect of the forearm for ER and IR, directly proximal to wrist joint line. Players are asked to perform all strength measures twice with a rest of 30 sec. between the two attempts. The mean of the two attempts is recorded. 2017
Primary passive glenohumeral range of motion in internal and external rotation Glenohumeral ROM is measured in degrees (°) on both sides using a digital application Clinometer (Plaincode Software Solutions, Peter Breitling, Stephanskirchen Germany, version 4.5 (1511062) on iOS). Participants are placed supine, the shoulder positioned in 90° of abduction, a small towel roll is used to maintain the position of the humerus in neutral and their elbow is flexed to 90°. A splint is fastened around the forearm, to attach the smartphone. The assessor palpates the coracoid process with the thumb and the spine of the scapula with the fingers to control for scapular movement. The shoulder is passively moved to the end of ROM (EOR) into IR and ER. EOR of IR and ER is defined at the point at which the scapula is moving. The mean of two trials for IR and ER is used for data analysis. 2017
Primary scapular dyskinesis Scapular control is evaluated using the scapular dyskinesis test (SDT). In standing position players held two dumbbells each in one hand. Players are instructed to bilaterally elevate their arms overhead as far as possible to a 3-second count with thumbs positioned upwards and then lower to a 3-second count. Five repetitions are performed while they are visually observed from posterior. The final rating classifies scapula control as normal, subtle abnormal or obvious abnormal. 2017
Secondary core stability Core stability is assessed using core endurance tests in seconds (s). Tests are performed in a sit up position in 60° Flexion and in side plank position on both sides. Players are instructed to hold their back and hip to the upright position for as long as possible. The test terminates, when the player is not able to hold the position anymore. 2017