Kinematics and Muscle Activity During the Tennis Serve and Musculoskeletal Characteristics in Tennis Players With Subacromial Pain Syndrome or History of Shoulder Pain

April 15, 2026 updated by: National Yang Ming Chiao Tung University
Tennis players often suffer from shoulder pain due to the repetitive high-loaded overhead movements during serving, and subacromial pain syndrome is one of the main types of shoulder pain. Previous shoulder injury has been identified as one of the risk factors for shoulder overuse injuries in overhead sports. No research has explored differences in trunk kinematics and shoulder muscle activities among tennis players with and without subacromial pain syndrome or a history of shoulder pain. Furthermore, limited studies have examined shoulder kinematics during tennis serve and musculoskeletal characteristics in tennis players with subacromial pain syndrome or a history of shoulder pain. Therefore, this study aims to investigate shoulder and trunk kinematics and shoulder muscle activity during the tennis serve and musculoskeletal characteristics in tennis players with subacromial pain syndrome or a history of shoulder pain. This study will recruit sixty tennis players with subacromial pain syndrome, a history of shoulder pain, and healthy players. The electromagnetic tracking system will be applied to collect shoulder and trunk kinematics during the tennis serve, and surface electromyography will be simultaneously used for recording shoulder muscle activities. Moreover, we will collect shoulder and trunk rotational joint range of motion, isometric strength and rate of force development of shoulder internal and external rotation, scapulothoracic and glenohumeral joint control capability, upper quarter Y-balance test performance, and posterior shoulder endurance. This study will compare the difference of these measures in tennis players with subacromial pain syndrome or a history of shoulder pain to healthy players.

Study Overview

Status

Status

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

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.

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.
60

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
      • Taipei, Taiwan
        • Recruiting
        • No. 155, Sec. 2, Linong St. Beitou Dist., Taipei City 112304, Taiwan
        • Contact:

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

  • Adult

Accepts Healthy Volunteers

Yes

Sampling Method

Non-Probability Sample

Study Population

Tennis players in Taiwan

Description

Inclusion Criteria:

  • Amateur tennis players
  • National Tennis Rating Program (NTRP) should level ≥ 3.5
  • Training experience: ≥ 3 years, current or former school team players
  • Training volume: ≥ 4 hours/week

Exclusion Criteria:

  • Any current musculoskeletal injuries preventing maximum skill execution at the time of testing
  • Previously had any form of surgery or trauma
  • Patient-reported pain that will inhibit participation in this study

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.
subacromial pain syndrome
(1) Shoulder pain that had lasted for at least 3 months and recurred during flat serves in matches or practice; and (2) positive results in at least 3 of the 5 subacromial impingement tests, including the empty can test, Neer impingement test, Hawkins-Kennedy impingement test, resisted external rotation test, and painful arc during shoulder elevation.
history of shoulder pain
Within 6 months prior to the begin of the experiment, the participant was absent from or had to adjust one practice or competition due to pain in the dominant shoulder joint.
healthy
The healthy group had no neck pain, shoulder pain, or disability on their dominant side within the six months prior to the start of the experiment

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
Degree of the glenohumeral and scapulothoracic joint during serving
Time Frame: Day 1
The kinematics is assessed using an electromagnetic motion tracking system (VIPERTM, Polhemus, USA) and IMU (Inertial Measurement Unit) systems (Noraxon USA, Scottsdale, AZ, USA) to collect the glenohumeral elevation, horizontal abduction/adduction, internal/external rotation, scapulothoracic retraction/protraction, upward/downward rotation, anterior/posterior tilt, and trunk rotation, sidebending, flexion/extension during tennis serve. During the test, participants performed 5 flat serves, with 60 seconds of rest between each trial. Data were analyzed at the end of the arm cocking (maximal shoulder horizontal abduction), at ball-contact (peak of acceleration or perturbation in IMU), and at the end of the arm deceleration (maximal shoulder horizontal adduction). Data will report as mean values for each trial. (unit of measure: degree, °)
Day 1
Amplitude of the activation of glenohumeral and periscapular muscles
Time Frame: Day 1
The muscle activation amplitude of the upper trapezius, lower trapezius, serratus anterior, latissimus dorsi, pectoralis major, biceps brachii, and triceps brachii would be recorded during tennis serve. During the test, participants performed 5 serves, with 60 seconds of rest between each trial. Data were collected in the arm cocking phase (from shoulder elevation over 5 standard deviation form resting to the shoulder maximal horizontal abduction) and the acceleration phase (from maximal shoulder horizontal abduction to the ball-contact), and the deceleration phase (from ball-contact to maximal horizontal adduction). The data will be reported as mean values for each trial. (unit of measure: percentage, %)
Day 1
Shoulder active range of motion
Time Frame: Day 2
Shoulder external rotation and internal rotation range of motion in shoulder flexion 90 degrees in supine. An inclinometer will used for the test. The test will perform 3 times. Data will report as mean values for each trial. (unit of measure: degree, °)
Day 2
Shoulder passive range of motion
Time Frame: Day 2
Shoulder external rotation and internal rotation range of motion in shoulder flexion 90 degrees in supine. An inclinometer will used for the test. The test will perform 3 times. Data will report as mean values for each trial. (unit of measure: degree, °)
Day 2
Trunk rotational range of motion
Time Frame: Day 2
Trunk rotational range of motion would be tested in lumbar locked position. An inclinometer will used for the test, and participants active rotate their trunk to both sides, and 3 times each sides. Data will report as mean values. (unit of measure: degree, °)
Day 2
Isometric strength and rate of force development of shoulder internal and external rotation
Time Frame: Day 2
Subjects supine with the test side positioned at 90° shoulder abduction and 90° elbow flexion in scapular plane. The K-pull Digital Dynamometer (Kinvent, Montpellier, France) will used for trials. Subjects would be asked to hold the digital dynamometer and perform the maximum isometric contraction strength test of shoulder internal and external rotation for 5 seconds at their maximal exertion. Shoulder internal and external rotation will be performed 3 times each, with a 30-second rest interval. The maximum isometric strength of the shoulder internal and external rotation is calculated by dividing the maximum strength by the body weight and multiplying by 100%, and the average of the 3 measurements will be calculated. The shoulder external/internal rotation strength ratio would also be calculated. The force rate data are averaged using the values in the time ranges of 0-50, 0-100, 0-150, 0-200, and 0-300 milliseconds.
Day 2
Scapulothoracic and glenohumeral joint control ability
Time Frame: Day 2
Subjects will supine with the tested side positioned at 90° shoulder abduction and 90° elbow flexion in scapular plane, and then actively perform 60° shoulder internal rotation. The test consist of two parts. The first part observe whether the scapula is excessively anteriorly rotated; if so, one point will be given. The second part observe whether the subject has difficulty breathing, difficulty moving, inability to reach 60° shoulder internal rotation, excessive anterior rotation of the humerus, fatigue, or a need for external feedback and assistance; if so, one point will be given. Each item can be scored as one point. A score of 1 in the first part or more than 3 points in the second part (out of a total of 7 points) is considered a positive test result. Positive or negative result will be recored.
Day 2
Upper quarter Y-balance test performance
Time Frame: Day 2
Subjects will remove their shoes and socks for the test. The test begin with a push-up position with both shoulders flexed at 90°, elbows extended, and both legs shoulder-width apart. The subject will perform maximum movement in each direction from the non-test side (moving end), returning to the starting position in the same motion to complete the test. Participants will be asked to perform the test 3 times each direction, with a 30-second rest between each test.The maximum distance of movement was standardized by dividing by the upper limb length, and the standardized results for each direction are summed and averaged to obtain the overall score. (unit of measure: %)
Day 2
Posterior shoulder endurance
Time Frame: Day 2
After the subject positioned in 90° shoulder flexion position in standing, a Thera band is fixed at the same level as the shoulder, which is the starting position. The endpoint is defined as a position with 90° external rotation and 90° abduction of the shoulder. Male subjects use a green resistance band (2.1 kg), while female subjects use a red resistance band (1.7 kg). The subject is asked to repeat the movement between the starting and endpoint positions until the subject is unable to maintain the rhythm or complete the movement after two verbal reminders. The beat starts at 60 bpm and increases by 30 bpm every 20 seconds, up to a maximum of 150 bpm. (unit of measurement: seconds)
Day 2

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
Degree of shoulder and scapular kinematics during arm elevation
Time Frame: Day 1
The kinematics is assessed using an electromagnetic motion tracking system (VIPERTM, Polhemus, USA) to collect the glenohumeral elevation, horizontal abduction/adduction, internal/external rotation, scapulothoracic retraction/protraction, upward/downward rotation, anterior/posterior tilt during arm elevation. During the test, participants performed 5 arm elevations, with 60 seconds of rest between each trial. Data will report as mean values for each trial. (unit of measure: degree, °)
Day 1
Amplitude of the activation of glenohumeral and periscapular muscles during arm elevation
Time Frame: Day 1
The muscle activation amplitude of the upper trapezius, lower trapezius, serratus anterior, latissimus dorsi, pectoralis major, biceps brachii, and triceps brachii would be recorded during arm elevation. During the test, participants performed 5 arm elevations, with 60 seconds of rest between each trial. The data will be reported as mean values for each trial. (unit of measure: percentage, %)
Day 1

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 Chiao Tung 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.
January 29, 2026

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.
January 29, 2027

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.
January 29, 2027

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 12, 2026

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.
April 15, 2026

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.
April 22, 2026

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.
April 22, 2026

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.
April 15, 2026

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.
February 1, 2026

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.
  • NYCU114005AF

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