Combined Effect of Biofeedback and Scapular Stabilization Exercises in Children With Swimmer's Shoulder

NCT ID: NCT07067216

Last Updated: 2025-07-16

Basic Information

• Recruitment Status: NOT_YET_RECRUITING
• Clinical Phase: NA
• Total Enrollment: 40 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2025-07-12
• Study Completion Date: 2025-10-26

Brief Summary

The purpose of this study is to investigate the combined effect of biofeedback and scapular stabilization exercises on swimmer's shoulder in pediatric elite swimmers.

Detailed Description

Swimmer's shoulder is the most common injury in swimmers and is defined as a painful syndrome that occurs mostly in the anterior region of the shoulder and results from repetitive impingement of the rotator cuff under the coracoacromial arch during the technical gesture of swimming.

Shoulder injuries have been reported in up to 90% of swimmers. The scapula is vital in shoulder function and abnormal scapulothoracic mechanics and scapula-humeral rhythm have been implicated in shoulder pathologies, including glenohumeral impingement and rotator cuff tears.

When weakness or dysfunction is present in the scapular musculature, normal scapular positioning and mechanics may become altered which result in abnormal stresses to the capsular structures, rotator cuff compression and reduced performance.

Knowledge of scapulothoracic movements is regarded as crucial in the development of preventative strategies and treatment programs in athletes with shoulder pathology.

Scapula upward rotation is the dominant scapula action throughout shoulder elevation and has been previously implicated in the development of impingement.

In swimming, an athlete's scapular musculature plays a pivotal role in stabilizing and preventing impingement because its continuous activation is required throughout the swim stroke.

During all movements of the glenohumeral joint especially overhead elevation of the arm, it is of great importance that the scapular- stabilizing musculature should be strong enough to properly position the scapula. The main scapula stabilizers are the Levator Scapulae, Rhomboids major and minor, Serratus anterior, and Trapezii. These muscle groups function through synergistic co- contraction with rotator cuff to control the scapular movement. Scapular stabilization exercise aims to restore scapular position, orientations, motor control of muscles, and movement pattern, thereby attaining stability of scapula for better kinematics of shoulder. Due to lack of research area of scapular stabilization using a pressure biofeedback on swimmer's shoulder in pediatric swimmers, so the purpose of the study is to investigate the combined effect of scapular stabilization and biofeedback in children with swimmer's shoulder.

Conditions

Swimmer Shoulder

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: NONE

Study Groups

Designed scapular stabilization using pressure biofeedback

This group will consist of 20 participants, who will receive a designed scapular stabilization exercise program using pressure biofeedback. The program will be applied for one hour, two times per week, for 6 successive weeks.

Group Type: EXPERIMENTAL

Designed scapular stabilization using pressure biofeedback

Intervention Type: OTHER

Patients will attend 1-hour physical therapy sessions twice weekly for 6 weeks. The program will include posterior capsule mobilization, scapular stabilization using pressure biofeedback (targeting lower trapezius, latissimus dorsi, pectoralis major, deep cervical flexors, and scapular retractors), and strengthening exercises using therabands: external rotation, shoulder diagonals, rows, and extensions. Additional training will involve physioball scapular exercises (up/down \& side/side), prone scapular strengthening (e.g., TYI, superman), and scapular-clock drills to improve mobility, proprioception, and stability.

Designed physical therapy program

This group will consist of 20 participants, who will receive a designed physical therapy program. The program will be applied for one hour, two times per week, for 6 successive weeks.

Group Type: ACTIVE_COMPARATOR

Designed physical therapy program

Intervention Type: OTHER

Patients will receive cryotherapy and perform stretching exercises for the pectoralis minor and posterior capsule. Strengthening exercises using theraband will target the rotator cuff (especially external rotators) and scapular depressors/retractors. Scapular stabilization will be trained through prone exercises on a ball (T, Y, W) and on a plinth, including rowing, horizontal abduction, extension, superman, and TYI exercises. Additionally, patients will perform the scapular-clock exercise to enhance mobility, control, and proprioception.

Interventions

Designed scapular stabilization using pressure biofeedback

Patients will attend 1-hour physical therapy sessions twice weekly for 6 weeks. The program will include posterior capsule mobilization, scapular stabilization using pressure biofeedback (targeting lower trapezius, latissimus dorsi, pectoralis major, deep cervical flexors, and scapular retractors), and strengthening exercises using therabands: external rotation, shoulder diagonals, rows, and extensions. Additional training will involve physioball scapular exercises (up/down \& side/side), prone scapular strengthening (e.g., TYI, superman), and scapular-clock drills to improve mobility, proprioception, and stability.

Intervention Type: OTHER

Designed physical therapy program

Patients will receive cryotherapy and perform stretching exercises for the pectoralis minor and posterior capsule. Strengthening exercises using theraband will target the rotator cuff (especially external rotators) and scapular depressors/retractors. Scapular stabilization will be trained through prone exercises on a ball (T, Y, W) and on a plinth, including rowing, horizontal abduction, extension, superman, and TYI exercises. Additionally, patients will perform the scapular-clock exercise to enhance mobility, control, and proprioception.

Intervention Type: OTHER

Eligibility Criteria

Inclusion Criteria

• Both sexes form 9-13 years old and active in competitive swimming clubs
• Swimming styles will be selected are butterfly and backstroke styles and the swimmers undergone an average minimum of 4 hours of swimming per week.
• All pediatric swimmers have shoulder pain.
• All of them are not allowed to practice swimming during study.

Exclusion Criteria

• Pediatric swimmers who practice any sport related to overhead activities.
• Swimmers who had dermatological problems.
• Past history of upper limb fractures or surgeries.
• Swimmers who had any neurological condition (like winging scapula due to nerve damage).
• Swimmers who had dorsal scoliosis (s or c shaped).
• Swimmers who integrate in swimming competitions at the same time of study.

• Minimum Eligible Age: 9 Years
• Maximum Eligible Age: 13 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Cairo University

OTHER

Sponsor Role: lead

Responsible Party

Osama Ali Hamed Mohamed

Principal Investigator

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Nanees Essam Mohamed Salem, PhD

Role: STUDY_CHAIR

Professor, Cairo university

Shimaa Mohamed Reffat, PhD

Role: STUDY_DIRECTOR

Assistant Professor, Cairo university

Locations

EL Hawar and Geziret Elward sporting clubs

Al Mansurah, , Egypt

Countries

Egypt

Central Contacts

Osama Ali Hamed Mohamed, M.Sc

Role: CONTACT

Dr.osaali24888@gmail.com

+20 102 635 3854

Shimaa Mohamed Reffat, PhD

Role: CONTACT

Shimaa_dpt@cu.edu.eg

Facility Contacts

Osama Ali Hamed Mohamed, M.Sc

Role: primary

Dr.osaali24888@gmail.com

+20 102 635 3854

Other Identifiers

P.T.REC/012/004998

Identifier Type: -

Identifier Source: org_study_id