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The Effects of Upper-Extremity Plyometric Combined Strength Training in Overhead Athletes With Shoulder Instability

Primary Purpose

Glenohumeral Subluxation, Shoulder Subluxation, Shoulder Instability Subluxation Bilateral

Status
Recruiting
Phase
Not Applicable
Locations
Taiwan
Study Type
Interventional
Intervention
Plyometric and strengthening exercises
Strengthening exercise
Sponsored by
National Yang Ming University
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Glenohumeral Subluxation focused on measuring Plyometric, Strengthening, Overhead athlete, Shoulder instability

Eligibility Criteria

20 Years - 40 Years (Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria: Have experience of at least 1 of the following symptoms of shoulder instability during upper extremity movement: (a) pain, clicking, a sense of the shoulder coming apart, (b) dead-arm syndrome, or (c) subluxation of the joint. Self-reported decreased performance or feeling fear to perform shoulder movements during sports or daily activities Positive findings on ≥ 1 of the following 5 tests: load and shift test, apprehension, relocation, & surprise tests, Gagey hyperabduction test, sulcus sign, Feagin test Recreational overhead athletes who keep practicing ≥ 4 hours/week in the recent 1 month and with ≥ 1 year overhead sports experience Exclusion Criteria: Full contact sport athletes Severe shoulder instability with > 5 shoulder dislocations history Obvious shoulder bony/labrum lesion in the dominant side warranted for surgery first as decided by the orthopedic surgeon Previous surgery or fracture in the shoulder area on the dominant side within 1 year Voluntary instability (the ability to deliberately dislocate one's shoulder) During acute phase after shoulder dislocation event Not suitable to start plyometric training yet: Shoulder muscle weakness (manual muscle test <3) or range of motion limitation (<90 abduction, <70 external rotation) in the dominant side Pregnancy Cancer, neck pain, brain & neurological impairment Ehlers-Danlos syndrome or Marfan syndrome Unable to attend 6 weeks supervised training

Sites / Locations

  • National Yang Ming Chiao Tung UniversityRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Active Comparator

Arm Label

Plyometric training group

Strengthening training group

Arm Description

Participants in this group will receive upper extremity plyometric training in body weight or with weight ball and strengthening exercises with band, dumbbell and barbell. The difficulty and intensity of the movement protocol will increase weekly. They will be trained 2 times per week for 6 weeks with an average duration of 50 min per session.

Participants in this group will receive upper extremity strengthening exercises with band, dumbbell and barbell. The intensity of the movement protocol will increase weekly. They will be trained 2 times per week for 6 weeks with an average duration of 50 min per session.

Outcomes

Primary Outcome Measures

Shoulder isokinetic muscle strength
Shoulder isokinetic muscle strength will be measured by dynamometer in 3 modes (concentric/concentric, concentric/eccentric, eccentric/concentric) at 3 angular velocities (90°/s, 180°/s, & 240°/s), 1 set of 5 repetitions for each angular velocities. Shoulder isokinetic muscle strength will be normalized by body weight (BW) and described with peak torque/BW (N·m·kg-1).
Shoulder acceleration time, deceleration time, and amortization time
Shoulder acceleration time, deceleration time, and amortization time will be measured by dynamometer in concentric/concentric mode at 3 angular velocities (90°/s, 180°/s, & 240°/s) and will be described with millisecond (ms).
Shoulder proprioception
Shoulder proprioception will be measured by dynamometer in 90° shoulder abduction and 90° elbow flexion position, including active joint position sense and passive joint position sense. The proprioception will be described with degree of error from target position.
Seated medicine ball throw distance
Subjects will throw a 2kg soft weighted ball as far forward as possible with dominant arms while sitting with back against a wall and legs bending with feet flat on the floor. Outcomes include average throwing distance and maximal throwing distance (cm). The distances are measured with measure tape.

Secondary Outcome Measures

Shoulder function
Shoulder function will be measured by the disabilities of the arm, shoulder and hand (DASH) questionnaire, including the disability/symptom section (30 items, scored 1-5) and the optional high performance Sport/Music or Work section (4 items, scored 1-5). A higher score indicates greater disability.
Visual analogue scale (VAS) of shoulder pain and instability
Shoulder pain and instability will be measured by visual analogue scale (VAS). Subjects need to mark the point that they feel represent their perception of their current state on a 10-cm line. Scores range from 0 (no symptom) to 100 (maximum symptom).
Global rating of change (GRC)
The improvements in a patient's condition will be measured with 15-point self-report GRC scale. Score ranges from -7 (lack of progress) to 7 (maximum of progress).

Full Information

First Posted
April 11, 2023
Last Updated
July 11, 2023
Sponsor
National Yang Ming University
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1. Study Identification

Unique Protocol Identification Number
NCT05857540
Brief Title
The Effects of Upper-Extremity Plyometric Combined Strength Training in Overhead Athletes With Shoulder Instability
Official Title
The Effects of Upper-Extremity Plyometric Combined Strength Training in Overhead Athletes With Shoulder Instability
Study Type
Interventional

2. Study Status

Record Verification Date
July 2023
Overall Recruitment Status
Recruiting
Study Start Date
May 20, 2023 (Actual)
Primary Completion Date
March 30, 2024 (Anticipated)
Study Completion Date
June 30, 2024 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
National Yang Ming University

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No

5. Study Description

Brief Summary
The purpose of this randomized controlled trial is to investigate the additional effects of upper extremity plyometric training versus strength training alone in recreational overhead athletes with shoulder instability. The investigators hypothesis that compared to strengthening training alone, plyometric training combined with strengthening training will significantly improve shoulder isokinetic strength, proprioception, scapular kinematics, symptoms of shoulder instability, and shoulder function.
Detailed Description
Background: Shoulder instability is a common problem in active young adults with a wide spectrum ranging from microinstability, subluxation to dislocation. In patients with instability of Stanmore polar type 2 or 3, recurrent shoulder instability may be related to abnormal movement patterns but not result from trauma. Non-operative management is suggested to this subgroup as the first-line treatment. Previous rehabilitation protocols including progressive shoulder muscles strengthening and neuromuscular control training have shown positive effects on functional outcomes in individuals with shoulder instability. Recent protocols for shoulder instability usually include various types of plyometric training to prepare injured athletes to return to sports. Plyometric training in lower extremity has been wildly used for knee injury prevention. In upper extremity, plyometrics also has been shown to improve isokinetic strength, throwing performance, and proprioception in healthy subjects and healthy overhead athletes. However, it is still not well-understood that whether a strengthening training combined with plyometrics would be more effective to improve shoulder neuromuscular control and shoulder function in subjects with instability. The purpose of this study is to investigate the additional effects of upper extremity plyometric training in recreational overhead athletes with anterior shoulder instability. The investigators hypothesis that compared to strengthening training alone, plyometric training combined with strengthening training will significantly improve strength, proprioception, shoulder kinematic and muscle activity, shoulder pain and shoulder function. Methods: A total of 64 participants with anterior shoulder instability will be randomized to either an experimental group (plyometric and strengthening training) or a control group (strengthening training). Both groups will receive a 50-minute supervised training protocol twice a week for 6 weeks. The primary outcomes include (1) isokinetic assessment of internal and external rotation (peak torque, time to peak torque, and amortization time); (2) proprioception (active and passive joint position sense); (3) seated medicine ball throw test (distance in cm). The secondary outcomes include (1) shoulder pain and instability with 10-cm visual analogue scale (VAS); (2) shoulder function assessed with the Disability of Arm, Shoulder and Hand (DASH) questionnaire; (3) Global rating of change (GRC). GRC will be measured after the end of 12 session of intervention, and all the other outcomes will be measured at baseline and following 12 sessions of exercise training. The two-way repeated measures ANOVAs will be used to compare primary and secondary outcome variables between groups. The significant level was set at 0.05.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Glenohumeral Subluxation, Shoulder Subluxation, Shoulder Instability Subluxation Bilateral
Keywords
Plyometric, Strengthening, Overhead athlete, Shoulder instability

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Masking
Participant
Allocation
Randomized
Enrollment
64 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Plyometric training group
Arm Type
Experimental
Arm Description
Participants in this group will receive upper extremity plyometric training in body weight or with weight ball and strengthening exercises with band, dumbbell and barbell. The difficulty and intensity of the movement protocol will increase weekly. They will be trained 2 times per week for 6 weeks with an average duration of 50 min per session.
Arm Title
Strengthening training group
Arm Type
Active Comparator
Arm Description
Participants in this group will receive upper extremity strengthening exercises with band, dumbbell and barbell. The intensity of the movement protocol will increase weekly. They will be trained 2 times per week for 6 weeks with an average duration of 50 min per session.
Intervention Type
Procedure
Intervention Name(s)
Plyometric and strengthening exercises
Intervention Description
Each session includes 2 upper-extremity plyometric exercises in bodyweight or with weight ball for 15-20 minutes and 4-5 strengthening exercises with band, dumbbell or barbell for 30-35 minutes. The difficulty of the movement protocol will increase weekly. They will be trained 2 times per week for 6 weeks with an average duration of 50 min per session.
Intervention Type
Procedure
Intervention Name(s)
Strengthening exercise
Intervention Description
Each session includes 5 upper-extremity strengthening exercises with band, dumbbell or barbell for 50 minutes. The difficulty of the movement protocol will increase weekly. They will be trained 2 times per week for 6 weeks with an average duration of 50 min per session.
Primary Outcome Measure Information:
Title
Shoulder isokinetic muscle strength
Description
Shoulder isokinetic muscle strength will be measured by dynamometer in 3 modes (concentric/concentric, concentric/eccentric, eccentric/concentric) at 3 angular velocities (90°/s, 180°/s, & 240°/s), 1 set of 5 repetitions for each angular velocities. Shoulder isokinetic muscle strength will be normalized by body weight (BW) and described with peak torque/BW (N·m·kg-1).
Time Frame
Change from baseline shoulder isokinetic muscle strength through completion of 12-session intervention, an average of 6 weeks
Title
Shoulder acceleration time, deceleration time, and amortization time
Description
Shoulder acceleration time, deceleration time, and amortization time will be measured by dynamometer in concentric/concentric mode at 3 angular velocities (90°/s, 180°/s, & 240°/s) and will be described with millisecond (ms).
Time Frame
Change from baseline shoulder isokinetic muscle strength through completion of 12-session intervention, an average of 6 weeks
Title
Shoulder proprioception
Description
Shoulder proprioception will be measured by dynamometer in 90° shoulder abduction and 90° elbow flexion position, including active joint position sense and passive joint position sense. The proprioception will be described with degree of error from target position.
Time Frame
Change from baseline shoulder external rotation joint position sense through completion of 12-session intervention, an average of 6 weeks
Title
Seated medicine ball throw distance
Description
Subjects will throw a 2kg soft weighted ball as far forward as possible with dominant arms while sitting with back against a wall and legs bending with feet flat on the floor. Outcomes include average throwing distance and maximal throwing distance (cm). The distances are measured with measure tape.
Time Frame
Change from baseline seated medicine ball throw distance through completion of 12-session intervention, an average of 6 weeks
Secondary Outcome Measure Information:
Title
Shoulder function
Description
Shoulder function will be measured by the disabilities of the arm, shoulder and hand (DASH) questionnaire, including the disability/symptom section (30 items, scored 1-5) and the optional high performance Sport/Music or Work section (4 items, scored 1-5). A higher score indicates greater disability.
Time Frame
Change from baseline DASH questionnaire through completion of 12-session intervention, an average of 6 weeks
Title
Visual analogue scale (VAS) of shoulder pain and instability
Description
Shoulder pain and instability will be measured by visual analogue scale (VAS). Subjects need to mark the point that they feel represent their perception of their current state on a 10-cm line. Scores range from 0 (no symptom) to 100 (maximum symptom).
Time Frame
Change from baseline VAS of shoulder pain and instability through completion of 12-session intervention, an average of 6 weeks
Title
Global rating of change (GRC)
Description
The improvements in a patient's condition will be measured with 15-point self-report GRC scale. Score ranges from -7 (lack of progress) to 7 (maximum of progress).
Time Frame
through completion of 12-session intervention, an average of 6 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
20 Years
Maximum Age & Unit of Time
40 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Have experience of at least 1 of the following symptoms of shoulder instability during upper extremity movement: (a) pain, clicking, a sense of the shoulder coming apart, (b) dead-arm syndrome, or (c) subluxation of the joint. Self-reported decreased performance or feeling fear to perform shoulder movements during sports or daily activities Positive findings on ≥ 1 of the following 5 tests: load and shift test, apprehension, relocation, & surprise tests, Gagey hyperabduction test, sulcus sign, Feagin test Recreational overhead athletes who keep practicing ≥ 4 hours/week in the recent 1 month and with ≥ 1 year overhead sports experience Exclusion Criteria: Full contact sport athletes Severe shoulder instability with > 5 shoulder dislocations history Obvious shoulder bony/labrum lesion in the dominant side warranted for surgery first as decided by the orthopedic surgeon Previous surgery or fracture in the shoulder area on the dominant side within 1 year Voluntary instability (the ability to deliberately dislocate one's shoulder) During acute phase after shoulder dislocation event Not suitable to start plyometric training yet: Shoulder muscle weakness (manual muscle test <3) or range of motion limitation (<90 abduction, <70 external rotation) in the dominant side Pregnancy Cancer, neck pain, brain & neurological impairment Ehlers-Danlos syndrome or Marfan syndrome Unable to attend 6 weeks supervised training
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Yin-Liang Lin, PhD
Phone
+886-2-2826-7288
Email
yllin1020@nycu.edu.tw
First Name & Middle Initial & Last Name or Official Title & Degree
Tzu-Hsuan Huang, BS
Phone
+886-910775771
Email
tzuhsuan1997@gmail.com
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Yin-Liang Lin, PhD
Organizational Affiliation
National Yang Ming Chiao Tung University
Official's Role
Principal Investigator
Facility Information:
Facility Name
National Yang Ming Chiao Tung University
City
Taipei
State/Province
台北市
ZIP/Postal Code
112
Country
Taiwan
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
YIN-LIANG LIN
Phone
+886-2-28267288
Email
yllin1020@nycu.edu.tw

12. IPD Sharing Statement

Learn more about this trial

The Effects of Upper-Extremity Plyometric Combined Strength Training in Overhead Athletes With Shoulder Instability

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