Changes in Shoulder Kinematics Following an Isokinetic Fatigue Protocol in Tennis Players

August 31, 2022 updated by: Yin-Liang Lin, National Yang Ming University
A typical tennis match can take 1 to 5 hours. Tennis serve can be divided into eight stages and three phases. Injuries usually happen in the cocking stage and acceleration phase of the serve, where it requires large shoulder range of motion and proper scapular motion, including sufficient scapular upper rotation, external rotation, and posterior tilt to produce a powerful serve. Altered shoulder kinematics are associated with shoulder injuries in tennis players, including delayed shoulder horizontal adduction, and early external rotation. Due to the long duration and repetition of activity in a match, fatigue may happen and result in decreases in sensory input, passive range of motion, ball speed, and muscle strength. These changes may further lead to altered glenohumeral and scapular kinematics. However, previous studies mainly focused on the effects of fatigue on scapular kinematics in constrain movements and applied different fatigue protocols, which lead to inconsistent results. Tennis serve in cocking stage and the acceleration phase require high activation of shoulder external rotators and internal rotators, including infraspinatus, pectoralis major, subscapularis, latissimus dorsi and serratus anterior. However, to our knowledge, no study has investigated how fatigue of shoulder rotators influences shoulder kinematic as well as scapular kinematics during the late cocking stage and acceleration phase of tennis serve. Therefore, the investigators aim to investigate whether fatigue of shoulder rotator affects shoulder kinematics in healthy tennis players during the late cocking stage and acceleration phase of tennis serve.This is a single group, pretest-posttest measurement study. In a fatigue protocol, investigators use an isokinetic dynamometer to induce fatigue of shoulder rotators. Outcome measures will be tested before and after the fatigue protocol, including peak torque of shoulder rotators, humerothoracic kinematics, scapulothoracic kinematics, and median power frequency recorded by a surface electromyography. Peak torque of shoulder rotators will be measured with an isokinetic dynamometer. Surface electromyography will be used to measure peripheral muscle fatigue by maximum voluntary isometric contraction. Humerothoracic kinematics and scapulothoracic kinematics during a functional tennis serve and scaption will be collected with a motion capture system.

Study Overview

Status

Status

Indicates the current recruitment status or the expanded access status.
Completed

Conditions

Conditions

The disease, disorder, syndrome, illness, or injury that is being studied. On ClinicalTrials.gov, conditions may also include other health-related issues, such as lifespan, quality of life, and health risks.

Intervention / Treatment

Intervention / Treatment

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Study Type

Study Type

Describes the nature of a clinical study. Study types include interventional studies (also called clinical trials), observational studies (including patient registries), and expanded access.
Observational

Enrollment (Actual)

Enrollment

The number of participants in a clinical study. The "anticipated" enrollment is the target number of participants that the researchers need for the study.
26

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Taiwan
      • New Taipei City, Taiwan, 242062
        • Fu Jen Catholic University

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Eligibility Criteria

The key requirements that people who want to participate in a clinical study must meet or the characteristics they must have. Eligibility criteria consist of both inclusion criteria (which are required for a person to participate in the study) and exclusion criteria (which prevent a person from participating). Types of eligibility criteria include whether a study accepts healthy volunteers, has age or age group requirements, or is limited by sex.

Ages Eligible for Study

16 years to 41 years (Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Sampling Method

Non-Probability Sample

Study Population

All of the subjects are healthy during the test to avoid the risk of injury.

Description

Inclusion Criteria:

Healthy tennis players

  1. Age ranges from 20-45 years old
  2. Engaging in tennis for at least 1 year
  3. Routine training 3 times a week
  4. No history of cervical and/or shoulder injury in the past one year, or injury with VAS (visual analog pain scale) lower than 3 and without cervical-shoulder pain 7 days before testing
  5. No operation on the shoulder, no shoulder subluxation, labral tear, and rotator cuff tear.
  6. Neer's test, empty can test, and Hawkins Kennedy test are negative.

Exclusion Criteria:

  1. History of cervical and/or shoulder injury in the past one year, or injury with VAS (visual analog pain scale) bigger than 3 and with cervical-shoulder pain 7 days before testing
  2. Operation on the shoulder, history of shoulder subluxation, labral tear, and rotator cuff tear.
  3. One of the three test results is positive: Neer's test, empty can test, and Hawkins Kennedy test.
  4. Perform upper extremity resist training and tennis training 24 hours before testing.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Observational Models: Other
  • Time Perspectives: Cross-Sectional

Cohorts and Interventions

Group / Cohort

Group / Cohort

A group or subgroup of participants in an observational study that is assessed for biomedical or health outcomes.
Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.
Healthy tennis players
Participants in this group need to perform arm elevation in the scapular plane three times and successful flat tennis serve three times before and after a fatigue protocol. Surface electromyography on infraspinatus, pectoralis major, anterior deltoid ,and latissimus dorsi will be used to detect muscle activity related to fatigue.
Device: isokinetic dynamometer
We will use an isokinetic dynamometer to conduct the concentric isokinetic fatigue protocol. The start position is shoulder abduction 90°, elbow flexion 90°and range of motion is set from 0 ° (internal rotation) to 90 ° (external rotation) under 120°/s. To calculate maximum torque of shoulder external and internal rotation, the subject will perform maximum isokinetic test 5 times before fatigue. Fatigue protocol include 10 sets, and each set include 32 repetitions with 30 seconds of rest between sets. The fatigue protocol will be stopped under three conditions: 1. the torque decreases 50% of maximum torque three times in one set or 2.rating of perceived exertion (RPE) abrove 15 and players can not perform the fatigue protocol or 3. finish the whole test.

What is the study measuring?

Primary Outcome Measures

Primary Outcome Measures

In a clinical study's protocol, the planned outcome measure that is the most important for evaluating the effect of an intervention/treatment. Most clinical studies have one primary outcome measure, but some have more than one.
Outcome Measure
Measure Description
Time Frame
Serve sequence pattern
Time Frame: immediately after the intervention (fatigue protocol)
Including the timing of shoulder horizontal adduction above 0 degree and the timing of shoulder external rotation above 90 degree during a tennis serve. Time would be normalized into 100 percentage and calculate the difference between shoulder horizontal adduction and external rotation described with percentage (%).
immediately after the intervention (fatigue protocol)
Scapular kinematics
Time Frame: immediately after the intervention (fatigue protocol)
Including anterior/posterior tilt, upward/downward rotation, and internal/external rotation during arm elevation in scapular plane at 30°, 60°, 90°, and 120°, and during late cocking stage of tennis serve and at the end of acceleration phase of the serve. Scapulothoracic kinematics will be calculated and will be described with degree (°).
immediately after the intervention (fatigue protocol)
Shoulder kinematics
Time Frame: immediately after the intervention (fatigue protocol)
Including shoulder external/internal rotation, horizontal adduction/abduction, elevation in the cocking stage of tennis serving and at the end of acceleration phase,will be calculated and will be described with degree (°).
immediately after the intervention (fatigue protocol)

Secondary Outcome Measures

Secondary Outcome Measures

In a clinical study's protocol, a planned outcome measure that is not as important as the primary outcome measure for evaluating the effect of an intervention but is still of interest. Most clinical studies have more than one secondary outcome measure.
Outcome Measure
Measure Description
Time Frame
Median frequency
Time Frame: immediately after the intervention (fatigue protocol)
The median frequency calculated from electromyographic data of infraspinatus, pectoralis major, anterior deltoid, and latissimus dorsi. The percentage change in median frequency will be calculated and will be described with percentage (%).
immediately after the intervention (fatigue protocol)
Shoulder internal and external rotation torque
Time Frame: immediately after the intervention (fatigue protocol)
The first three and the last three of shoulder rotation torque will be recorded and be described with Newton metre (Nm).
immediately after the intervention (fatigue protocol)
Relative fatigue ratio
Time Frame: immediately after the intervention (fatigue protocol)
Last three torque of shoulder external rotation and internal rotation will be divided by the first three torque of shoulder external rotation and internal rotation described with percentage (%).
immediately after the intervention (fatigue protocol)
ER/IR ratio
Time Frame: immediately after the intervention (fatigue protocol)
The torque of shoulder external rotation divided by the torque of shoulder internal rotation and will be described with ratio before and after fatigue protocol.
immediately after the intervention (fatigue protocol)

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Sponsor

The organization or person who initiates the study and who has authority and control over the study.
National Yang Ming University

Collaborators

Collaborators

An organization other than the sponsor that provides support for a clinical study. This support may include activities related to funding, design, implementation, data analysis, or reporting.
Fu Jen Catholic University

Investigators

Investigators

A researcher involved in a clinical study. Related terms include site principal investigator, site sub-investigator, study chair, study director, and study principal investigator.
  • Principal Investigator: Yin-Liang Lin, PhD, National Yang Ming University

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

Study Start

The actual date on which the first participant was enrolled in a clinical study. The "anticipated" study start date is the date that the researchers think will be the study start date.
November 10, 2021

Primary Completion (Actual)

Primary Completion

The date on which the last participant in a clinical study was examined or received an intervention to collect final data for the primary outcome measure. Whether the clinical study ended according to the protocol or was terminated does not affect this date. For clinical studies with more than one primary outcome measure with different completion dates, this term refers to the date on which data collection is completed for all the primary outcome measures. The "anticipated" primary completion date is the date that the researchers think will be the primary completion date for the study.
March 5, 2022

Study Completion (Actual)

Study Completion

The date on which the last participant in a clinical study was examined or received an intervention/treatment to collect final data for the primary outcome measures, secondary outcome measures, and adverse events (that is, the last participant's last visit). The "anticipated" study completion date is the date that the researchers think will be the study completion date.
March 5, 2022

Study Registration Dates

First Submitted

First Submitted

The date on which the study sponsor or investigator first submitted a study record to ClinicalTrials.gov. There is typically a delay of a few days between the first submitted date and the record's availability on ClinicalTrials.gov (the first posted date).
May 20, 2021

First Submitted That Met QC Criteria

First Submitted That Met QC Criteria

The date on which the study sponsor or investigator first submits a study record that is consistent with National Library of Medicine (NLM) quality control (QC) review criteria. The sponsor or investigator may need to revise and submit a study record one or more times before NLM's QC review criteria are met. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
May 20, 2021

First Posted (Actual)

First Posted

The date on which the study record was first available on ClinicalTrials.gov after National Library of Medicine (NLM) quality control (QC) review has concluded. There is typically a delay of a few days between the date the study sponsor or investigator submitted the study record and the first posted date.
May 25, 2021

Study Record Updates

Last Update Posted (Actual)

Last Update Posted

The most recent date on which changes to a study record were made available on ClinicalTrials.gov. There may be a delay between when the changes were submitted to ClinicalTrials.gov by the study's sponsor or investigator (the last update submitted date) and the last update posted date.
September 6, 2022

Last Update Submitted That Met QC Criteria

Last Update Submitted That Met QC Criteria

The most recent date on which the study sponsor or investigator submitted changes to a study record that are consistent with National Library of Medicine (NLM) quality control (QC) review criteria. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
August 31, 2022

Last Verified

Last Verified

The most recent date on which the study sponsor or investigator confirmed the information about a clinical study on ClinicalTrials.gov as accurate and current. If a study with a recruitment status of recruiting; not yet recruiting; or active, not recruiting has not been confirmed within the past 2 years, the study's recruitment status is shown as unknown.
August 1, 2022

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

Other Study ID Numbers

Identifiers or ID numbers other than the NCT number that are assigned to a clinical study by the study's sponsor, funders, or others. These numbers may include unique identifiers from other trial registries and National Institutes of Health grant numbers.
  • C109047

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

Undecided

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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