Investigating Association Between Spine, Scapular, Shoulder and Core in Swimmers

July 23, 2024 updated by: Poyraz Tuncer, Yeditepe University

Investigating Association Between Spine Posture, Spine Movement, Scapular Dyskinesia, Isometric and Eccentric Shoulder Strength and Core Muscle Endurance in Competitive Swimmers

The aim of this observational study is to investigate relationship between cervical, thoracic, lumbar and thoracolumbar spine posture, spine movement, isometric and eccentric shoulder strength, scapular dyskinesis and core muscle endurance in healthy competitive young swimmers in comparison with healthy recreational swimmers. The main question is whether spine posture affects spine movement, shoulder strength, scapular dyskinesia and core endurance. Participants will asked to complete a warm up period, after that spine posture, spine movement, scapular dyskinesia, shoulder strength and core endurance will be assessed by examiner. Researchers will compare competitive swimmer group and recreational swimmer group. Additionally correlation between spine posture, spine movement, scapular dyskinesia, shoulder strength and core muscle endurance will be investigated in competitive swimmer group. Aim of the study is to determine whether posture have any effect upon these parameters.

Study Overview

Status

Status

Indicates the current recruitment status or the expanded access status.
Enrolling by invitation

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

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.

Detailed Description

The aim of this observational study is to investigate relationship between cervical, thoracic, lumbar and thoracolumbar spine posture, spine movement, scapular dyskinesia, shoulder strength and core muscle endurance in healthy competitive youth swimmers in comparison with healthy recreational swimmers. Study expected to include 44 participants which is distributed into experiment (n=22) and control (n=22) groups. The participants will be taken from Turkish swimming clubs which are Fenerbahçe, Galatasaray, ENKA, etc. between march and may of 2024. All of the research will be done in PT Academy clinic which is located in Turkey. The ages of the swimmers will be between 12-24. Experiment group should be a competitive swimmer that were also, participating swimming training in 6 days a week which is consisting of at least 12 hours of swimming training. They should pass Turkish swimming championship qualification times in order to participate in this study. Participants who have any systemic, neurologic, tumoral and cardiopulmonary pathologies excluded. Swimmers that compete in open water races are excluded. Participants that had orthopedic problem or surgical procedure in the past 6 months had been excluded. Inclusion criteria of the control group are different than the experiment group. They don't need to be a competitive swimmer as well as they don't need prerequisites of being a competitive swimmer. But, exclusion criteria remained same with experimental group except being open water swimmer. Before assessments participants will perform 10 minutes of warm up consisting of thigh, arm and core muscles as well as steady state aerobic exercise. Cervical lordosis, thoracal kyphosis, lumbar lordosis and thoracolumbar position degree will be assessed with double inclinometer. Core endurance will be assessed with trunk anterior flexion test, trunk posterior extensor test and lateral plank test. Ratios of core endurance parameters will be used in statistical analysis in order to compare with normative data. Spinal movement will be assessed via bubble inclinometer. For spinal movement cervical, lumbar, thoracal and thoracolumbar flexion and extension motion will be assessed. Also, thoracal and thoracolumbar rotation range of motion will be recorded. Scapular dyskinesia test will be used in order to assess scapular dyskinesia. Shoulder strength will be assessed via using microfet hand held dynamometer. Both isometric and eccentric shoulder external rotation strength will be measured. Ratios between these two values will be used in the statistical analysis. Results will be compared with each other between competitive and recreational swimmer group. SPSS analysis system will be used in order to make statistical analysis. For mean analysis t test or Mann Whitney u test will be used according to distributions of the groups. For the correlation analysis regression and mediation analysis will be used. Mean comparison will be done in between group setting. On the other hand correlation investigation of parameters will be done within group setting only including competitive swimmer group. As a result difference between recreational and competitive swimmers will be revealed as well as association between posture and other variables will be revealed with correlation between parameters.

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 (Estimated)

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.
44

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

  • Turkey
    • Kadıköy
      • Istanbul, Kadıköy, Turkey, 34744
        • PT Academy

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

  • Child
  • Adult

Accepts Healthy Volunteers

Yes

Sampling Method

Non-Probability Sample

Study Population

Study population will be selected from swimmers in Fenerbahçe, Galatasaray, ENKA, İstek and TOHM clubs. Study takes place in İstanbul. Study will include swimmers that are also swimming in USA for their university teams due to their education which are also competing in Turkey for their aforementioned clubs in the Turkish Championship. Participant pool approximately between 200-300 swimmers. Both gender will be included.

Description

Inclusion Criteria:

  • Being a competitive swimmer.
  • Being between 12-24 ages.
  • Participating swimming training at least 6 days a week.
  • Swimming faster than Turkish National Championship participation qualification times in their age group.
  • Participating swimming training at least 12 hours a week.
  • Should start swimming at least 6 years before.

Exclusion Criteria:

  • Being an open water swimmer.
  • Having systemic, cardiopulmonary and neurological pathology.
  • Having orthopedic pathology in the past 6 months.
  • Having surgical history in past 6 months.
  • Having tumoral condition.
  • Having spine pathology in past 6 months.

Inclusion criteria for control group:

  • Being a recreational swimmer.
  • Being between 12-24 ages.

Exclusion criteria for control group:

  • Having systemic, cardiopulmonary and neurological pathology.
  • Having orthopedic pathology in the past 6 months.
  • Having surgical history in past 6 months.
  • Having tumoral condition.
  • Having spine pathology in past 6 months.

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

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.
Competitive Swimmer Group
Spine posture, spine movement, scapular dyskinesia, ısometric and eccentric shoulder strength and core muscle endurance will be assessed.
Procedure: Spine Posture Assessment
Spine posture will be assessed with double inclinometer method. After determining landmarks for each assessment, inclinometers will be placed and degree will be noted. Both degree which are obtained with different inclinometers will be used to summed up for determining postural alteration degree. Cervical, thoracal, thoracolumbar and lumbar spinal postures will be used. Spine postures are going to be expressed as, cervical lordosis degree, thoracal kyphosis degree, thoracolumbar posture degree and lumbar lordosis degree. Landmarks for cervical lordosis are C2 and C7, for thoracal kyphosis are T1 and T12, for lumbar lordosis are T12 and S1, for thoracolumbar posture C7 and S1.
Procedure: Spine Movement Assessment
Spine movement will be assessed via using bubble inclinometer in terms of degree. Bony landmarks will be spotted like done in spine posture assessment after that full spinal flexion and extension wanted in order to record degrees in inclinometers at the end range. As a result the difference between two inclinometer will give the motion of that segment. Lumbar and thoracolumbar spinal movement will be assessed with this method. For thoracal and cervical range of motion values will be recorded separately without substruction from both inclinometer. Thoracal rotation range of motion will be assessed with two landmarks and will be recorded separately according to landmark. Thoracolumbar range of motion will be assessed with two substruction of degrees. Landmarks for cervical range of motion are vertex and C7, for thoracal range of motion are T1 and T12, for lumbar range of motion are T12 and S1, for thoracolumbar range of motion C7 and S1.
Procedure: Core Muscle Endurance Assessment
Core muscle endurance is divided into three components. Trunk anterior flexion test will be used to assess anterior core region endurance. Lateral plank test will be used to determine lateral core muscle endurance. Trunk posterior extensor test will be used to determine endurance of the posterior core musculature. All of these test are calculated in predetermined positions according to literature with static contractions. Maximum duration of maintaining that position is needed. In trunk anterior flexion test participant will sit with 60 degree inclination from the ground while making contact with their feet when hips and knees are flexed. In lateral plank test participants should place their elbow to ground and lift their hip while feet are in contact with ground in side lying position. In trunk extensor endurance test participants will lie prone to the bed while maintaining contact with their ASIS and lower extremity. The upper body should stay outside of the bed.
Procedure: Scapular Dyskinesia
Scapular dyskinesia will be assessed with scapular dyskinesia test. Dumbbells which are 1,5kg will be used in the testing setting. Participant will perform full shoulder abduction for 5 times while examiner assesses the movement quality by ranking it as subtle dyskinesis, obvious dyskinesis and no dyskinesis according to the movement of the scapula. After that participant will perform 5 repetitions of shoulder flexion.
Procedure: Shoulder Strength
Shoulder strength will be assessed via usage of microfet hand held dynamometer. Isometric shoulder strength will be calculated in supine lying position while participant holding their arm at side with 90 degree elbow flexion. After that participant will apply maximal contraction towards external rotation while examiner resists that motion in order to prevent any motion with dynamometer. Eccentric shoulder strength will be assessed in sitting position. Participant will hold their shoulder at 90 degrees of abduction with 90 degree external rotation. Also elbow should be in 90 degree flexed position. After that examiner will give force towards neutral rotation while holding the arm. Participant will resist this motion eccentrically until neutral rotation is reached. Velocity of the shoulder should be same throughout all motion due to creation of isokinetic environment.
Recreational Swimmer Group
Spine posture, spine movement, scapular dyskinesia, ısometric and eccentric shoulder strength and core muscle endurance will be assessed.
Procedure: Spine Posture Assessment
Spine posture will be assessed with double inclinometer method. After determining landmarks for each assessment, inclinometers will be placed and degree will be noted. Both degree which are obtained with different inclinometers will be used to summed up for determining postural alteration degree. Cervical, thoracal, thoracolumbar and lumbar spinal postures will be used. Spine postures are going to be expressed as, cervical lordosis degree, thoracal kyphosis degree, thoracolumbar posture degree and lumbar lordosis degree. Landmarks for cervical lordosis are C2 and C7, for thoracal kyphosis are T1 and T12, for lumbar lordosis are T12 and S1, for thoracolumbar posture C7 and S1.
Procedure: Spine Movement Assessment
Spine movement will be assessed via using bubble inclinometer in terms of degree. Bony landmarks will be spotted like done in spine posture assessment after that full spinal flexion and extension wanted in order to record degrees in inclinometers at the end range. As a result the difference between two inclinometer will give the motion of that segment. Lumbar and thoracolumbar spinal movement will be assessed with this method. For thoracal and cervical range of motion values will be recorded separately without substruction from both inclinometer. Thoracal rotation range of motion will be assessed with two landmarks and will be recorded separately according to landmark. Thoracolumbar range of motion will be assessed with two substruction of degrees. Landmarks for cervical range of motion are vertex and C7, for thoracal range of motion are T1 and T12, for lumbar range of motion are T12 and S1, for thoracolumbar range of motion C7 and S1.
Procedure: Core Muscle Endurance Assessment
Core muscle endurance is divided into three components. Trunk anterior flexion test will be used to assess anterior core region endurance. Lateral plank test will be used to determine lateral core muscle endurance. Trunk posterior extensor test will be used to determine endurance of the posterior core musculature. All of these test are calculated in predetermined positions according to literature with static contractions. Maximum duration of maintaining that position is needed. In trunk anterior flexion test participant will sit with 60 degree inclination from the ground while making contact with their feet when hips and knees are flexed. In lateral plank test participants should place their elbow to ground and lift their hip while feet are in contact with ground in side lying position. In trunk extensor endurance test participants will lie prone to the bed while maintaining contact with their ASIS and lower extremity. The upper body should stay outside of the bed.
Procedure: Scapular Dyskinesia
Scapular dyskinesia will be assessed with scapular dyskinesia test. Dumbbells which are 1,5kg will be used in the testing setting. Participant will perform full shoulder abduction for 5 times while examiner assesses the movement quality by ranking it as subtle dyskinesis, obvious dyskinesis and no dyskinesis according to the movement of the scapula. After that participant will perform 5 repetitions of shoulder flexion.
Procedure: Shoulder Strength
Shoulder strength will be assessed via usage of microfet hand held dynamometer. Isometric shoulder strength will be calculated in supine lying position while participant holding their arm at side with 90 degree elbow flexion. After that participant will apply maximal contraction towards external rotation while examiner resists that motion in order to prevent any motion with dynamometer. Eccentric shoulder strength will be assessed in sitting position. Participant will hold their shoulder at 90 degrees of abduction with 90 degree external rotation. Also elbow should be in 90 degree flexed position. After that examiner will give force towards neutral rotation while holding the arm. Participant will resist this motion eccentrically until neutral rotation is reached. Velocity of the shoulder should be same throughout all motion due to creation of isokinetic environment.

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
Spinal Posture
Time Frame: 1 Day
Cervical lordosis, thoracal kyphosis, lumbar lordosis and thoracolumbar posture will be recorded. All parameters will be calculated in degree.
1 Day
Cervical Movement
Time Frame: 1 Day
Cervical flexion and extension will be calculated. All parameters will be calculated in degree.
1 Day
Thoracic Movement
Time Frame: 1 Day
Thoracic flexion and extension will be recorded. Also thoracal rotation will be recorded. All parameters will be calculated in degree.
1 Day
Lumbar Movement
Time Frame: 1 Day
Lumbar flexion and extension will be recorded. All parameters will be calculated in degree.
1 Day
Thoracolumbar Movement
Time Frame: 1 Day
Thoracolumbar flexion and extension will be recorded. Thoracolumbar rotation will be recorded. All parameters will be calculated in degree.
1 Day

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
Anterior Core Musculature Assessment
Time Frame: 1 Day
Trunk anterior flexion test will be used to assess anterior core region endurance. Score will be calculated in seconds.
1 Day
Lateral Core Musculature Assessment
Time Frame: 1 Day
Lateral plank test will be used to determine lateral core muscle endurance. Score will be calculated in seconds.
1 Day
Posterior Core Musculature Assessment
Time Frame: 1 Day
Trunk posterior extensor test will be used to determine endurance of the posterior core musculature. Score will be calculated in seconds.
1 Day
Core Musculature Ratio Assessment
Time Frame: 1 Day
Trunk anterior musculature and trunk posterior musculature ratio, ratio of two sides of lateral core musculature and lateral trunk musculature and extensor trunk musculature will be used.
1 Day
Shoulder Strength Assessment
Time Frame: 1 Day
Isometric and eccentric shoulder external rotation strength will be recorded in Newton unit.
1 Day
Shoulder Strength Ratio Assessment
Time Frame: 1 Day
Ratio between shoulder internal rotation and external rotation strength will be used.
1 Day
Scapular Dyskinesia
Time Frame: 1 Day
Scapular dyskinesia will be recorded with Scapular Dyskinesia Test by using dumbbells which was described by McClure. Scapular dyskinesia will be measure as normal scapular motion, subtle dyskinesis and obvious dyskinesis.
1 Day

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.
Yeditepe University

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

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 (Estimated)

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.
August 10, 2024

Primary Completion (Estimated)

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.
October 1, 2024

Study Completion (Estimated)

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.
December 1, 2024

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).
March 5, 2024

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.
March 16, 2024

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.
March 22, 2024

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.
July 24, 2024

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.
July 23, 2024

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.
July 1, 2024

More Information

Terms related to this study

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.
  • Yeditepe U - Poyraz Tuncer

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

UNDECIDED

IPD Plan Description

Only result and certain characteristics may be shared.

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

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