Are Alterations in Shoulder Rotations and Core Stability Effective for Water Polo Shoulder Problems?

Study Overview
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Brief Summary
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Hypothesis of the clinical study: There are differences between the Water Polo Group and the Non-Water Polo Group in terms of shoulder parameters and core (lumbopelvic) parameters and there are differences between the throwing and non-throwing sides in terms of shoulder parameters in Water Polo Group.

Official Title
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Are Alterations in Shoulder Rotations and Core Stability Effective for Water Polo Shoulder Problems?

Conditions
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Shoulder Injuries, Sport Injury, Sports Physical Therapy

Intervention / Treatment
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* Other: Shoulder and core evaluations


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Participating to the study in a voluntary basis. Participant in ages between 10-30 years of age. Parent permission for participants younger than 18 Giving consent for older than 18 Exclusion Criteria: Having a history of orthopaedic surgery in the shoulder girdle within the last 6 months Having a history of fracture within the shoulder girdle complex Having a shoulder problem within the last 6 months continuing more than 3 months Having a history of pathology in lumbar area within the last 6 months

Ages Eligible for Study
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Minimum Age: 10 Years
Maximum Age: 30 Years

Sexes Eligible for Study
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Male

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Water Polo Group<br>Participants were active water polo players who train regularly with ages in between 10-30 years. Five main parameters of the shoulder were assessed: the flexibility of pectoralis minor muscle, tightness of the posterior shoulder capsule, glenohumeral range of motion of internal and external rotation (sum of internal and external rotation: total range of motion), the strength of rotator cuff muscles and scapula position. As core parameters, trunk muscle endurance (flexor, extensor, and laterals) and core stability were evaluated. | Other: Shoulder and core evaluations<br>* Five main parameters of the shoulder were assessed: the flexibility of pectoralis minor muscle, tightness of the posterior shoulder capsule, glenohumeral range of motion of internal and external rotation (sum of internal and external rotation: total range of motion), the strength of rotator cuff muscles and scapula position. As core parameters, trunk muscle endurance (flexor, extensor, and laterals) and core stability were evaluated.<br>|
| Non-Water Polo Group<br>Participants who do not engage in overhead sports with ages in between 10-30 years. Five main parameters of the shoulder were assessed: the flexibility of pectoralis minor muscle, tightness of the posterior shoulder capsule, glenohumeral range of motion of internal and external rotation (sum of internal and external rotation: total range of motion), the strength of rotator cuff muscles and scapula position. As core parameters, trunk muscle endurance (flexor, extensor, and laterals) and core stability were evaluated. | Other: Shoulder and core evaluations<br>* Five main parameters of the shoulder were assessed: the flexibility of pectoralis minor muscle, tightness of the posterior shoulder capsule, glenohumeral range of motion of internal and external rotation (sum of internal and external rotation: total range of motion), the strength of rotator cuff muscles and scapula position. As core parameters, trunk muscle endurance (flexor, extensor, and laterals) and core stability were evaluated.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Shoulder Internal and External Rotation Range of Motion Measurement | Glenohumeral rotations were assessed with the subject lying supine with their shoulder in 90° abduction, 90° elbow flexion and the forearm pronated. Shoulder and elbow alignment were provided with the help of the towel. For external rotation, the goniometer's axis was placed on olecranon process of ulna, the stationary arm was placed perpendicular to the floor and moving arm was placed on ulnar border of forearm toward ulnar styloid process. For internal rotation, the goniometer's axis was positioned on the same area. Then, its stationary arm was positioned perpendicular to the floor and the moving arm was placed on ulnar border of forearm toward ulnar styloid process. The angle was recorded in degrees, three trials were performed and the average taken. Subjects were evaluated by the same physiotherapist to control measurement error. | 5 minutes | 
| Posterior Shoulder Capsule Tightness | Goniometer measurement of horizontal adduction (Add) angle was used for Posterior shoulder tightness (PST). Shoulder was 90° of abduction (Abd) and elbow was flexed 90° of flexion in supine position. The scapula was stabilized using the thenar part of hand on the lateral edge of the scapula and the other hand was used to move the arm in horizontal Add. The goniometer's axis was placed on Acromioclavicular joint (ACJ), the stationary arm was directed parallel to the ground and the goniometer's mobile arm was placed on lateral epicondyle of the humerus. No scapular protraction and elevation were allowed. Shoulders with a smaller horizontal abduction angle showed a stiffness of posterior capsule. | 5 minutes | 
| Shoulder Strength Assessment | Maximum isometric shoulder rotation strengths were evaluated using a hand-held dynamometer (HHD) with all measurements recorded in newton meter. The arm was positioned at 45° of abduction, elbow was flexed to 90° and shoulder was at 30° of horizontal adduction. For evaluation of internal rotation strength, the HHD was located on the volar side of the wrist 2 cm proximal to the radial styloid and on the dorsal aspect for testing of external rotation strength. To evaluate external rotation strength, the subject was instructed to externally rotate the examining shoulder against HHD while the humerus was stabilized; under same circumstances to measure internal rotation strength the subject was instructed to internally rotated. Subjects were instructed to perform isometric contraction for 5 seconds during the test. Between maximal isometric contractions, 30 seconds of resting intervals were given. The average values of the three trials were taken. | 10 minutes | 
| Trunk Muscles Endurance Test - (McGill Trunk Endurance Test) | For endurance of the trunk extensors, subjects were positioned in prone lying with spina iliaca anterior superior level over the edge of the treatment table and their body were stabilized by straps. The upper body was supported by hands before initiation of the test. With the initiation of the test, hands were crossed across their chest and start to keep their upper body parallel to the ground. During the test, participants were instructed to maintain the horizontal position as long as possible. For trunk lateral flexors, subjects were side-lying position on the exercise mat with extended legs and arm must be in full contact with the body. As soon as the participants lift the hips, the test was initiated. Subjects were instructed to maintain a straight line along with the vertebrae by controlling lateral flexor muscles of the trunk as long as possible. The lateral flexors were assessed on both sides. | 15 minutes | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Shoulder Pectoralis Minor Muscle Length | Pectoralis Minor muscle flexibility decision was measuring distance between the acromion of the scapula and examination table by tape in supine, when both shoulders were in loose position. Elbow flexion was obtained by using a towel for reducing the activity of Biceps Brachii and the Coracobrachialis muscles. The absence of anterior tilt of the shoulder was considered as normal. | 5 minutes | 
| Sahrmann Core Stability Test | Pressure Biofeedback Unit was positioned on under lumbar spine (level of L2 and L3 vertebrae) and the pressure level of the bio-feedback unit was inflated to 40 mm-Hg. Subjects were instructed to maintain pressure 40 mm Hg ±10 during the all test levels. The test consists of 5 levels and increasingly difficult with each level. The scoring of the test was performed in proportional increments of the test levels. To progress through the levels, core stability must be sustained with no more than a 10 mm Hg increase or decrease in pressure. | 10 minutes |