The Effectiveness of Neuromuscular Training-Based Exercise Program

This randomised controlled study aimed to investigate the effectiveness of a neuromuscular training-based exercise program on pain, function, risk factors specific to shoulder injuries and performance in overhead athletes with shoulder pain.

The main hypothesis is;

H0: There is no difference between the "Thrower's Ten" exercise program and the neuromuscular training-based exercise program applied to overhead athletes with shoulder pain, on pain, function, risk factors specific to shoulder injuries, and performance.

H1: The effects of a neuromuscular training-based exercise program on pain, function, risk factors specific to shoulder injuries and performance in overhead athletes with shoulder pain are superior to the effects of "Thrower's Ten" exercise program

Overhead athletes with shoulder pain who met the inclusion criteria applied to Yeditepe University Hospital Orthopedics and Traumatology Clinic for a randomized controlled study will be included to demonstrate the effectiveness of a neuromuscular training-based exercise program in overhead athletes with shoulder pain.

Athletes will be included in two different exercise programs (Thrower's Ten and Neuromuscular Training Based groups) by simple randomization.

Athletes evaluated by the orthopaedic surgeon will be included in the study if willing to participate in the rehabilitation program. The treatment program to be applied, hands-off treatment, was determined as exercise therapy. In our study, the athletes participating in the Neuromuscular Training-Based Exercise Program (Group 1) and the ''Thrower's Ten'' Exercise Program (Group 2) will participate in 24 physiotherapy sessions, three days a week, for eight weeks.

Before starting the treatment program, the participants' sociodemographic characteristics, comorbidities, dominant sides, sports histories, training routine (frequency/week, duration, etc.), and previous injury histories will be questioned with a structured evaluation form. Before randomization, a clinical examination for shoulder pain will be done by the orthopaedic surgeon. Pain intensity, pressure pain threshold, muscle tone, shoulder functional status, risk factors specific to shoulder injuries, sportive performance and kinesiophobia will be evaluated before treatment, at the end of the eight-week exercise program,

Eligibility Criteria:
Inclusion Criteria:

* Giving consent to be a volunteer for participating
* 18-35 years of age
* Athletes playing overhead sports like volleyball, water polo, tennis, baseball, cricket, swimming, badminton, and basketball for at least 2 days a week (Unilateral sports).
* Patients with unilateral shoulder pain lasting \>6 weeks.
* Suitable and referred for conservative treatment by an orthopedist (non-surgical patients)
* Having one positive sign in the following 3 categories; the painful arc of movement, Neer or Hawkins-Kennedy impingement signs and pain during resisted external rotation, abduction, or empty can test performed by the orthopedist.
* Participating in regular training with the team for at least 3 years of experience in overhead sports

Exclusion Criteria:

* Bilateral shoulder pain
* Having an acute shoulder pain
* Having a non-specific shoulder pain
* Reflected pain
* Having some severe shoulder patholojies such as adhesive capsulitis, osteoarthritis, rheumatoid arthritis, fracture, dislocation and instability
* Shoulder pain originating from non-musculoskeletal system
* Having the shoulder and neck surgery and non-traumatic injuries within the last six months
* Having severe pathologies during the rehabilitation program (cardiac, diabetes mellitus and neuropsychiatric problems)
* Presence of diagnosed significant comorbidity (neurological and systemic disorders)
* Current and past carcinoma
* Type 3 acromion
* Avulsion fracture
* Non-compliance with treatment
* Symptomatic cervical spine pathology
* Antidepressant usage
* Clinical signs of full-thickness rotator cuff tears (positive lag signs)