Impact of a Cueing Device on Upper Extremity Muscle Strength in Swimmers

Impact of a Cueing Device on Upper Extremity Muscle Strength in Swimmers: A 6-Week Training Protocol Using Scapular Stabilization Exercises.

The goal of this study is to find out if a tool called an external cueing device (ECD) can help young swimmers improve their shoulder function. An ECD is a tool that limits arm movement and gives the swimmer a target to focus on while doing exercises. The main questions this study will answer are:

• Does using an ECD during certain exercises improve muscle strength?
• Does using an ECD while exercising help with shoulder stability?

Participants will:

• Test their shoulder muscle strength and stability at the beginning of the study.
• Complete 8 exercises as part of their regular dry-land training program for 6 weeks.
• Repeat the same tests after 3 weeks and again at the end of the study.

Study Overview

• Status: Completed
• Conditions: Healthy Volunteers Only
• Intervention / Treatment: Other: Exercise; Device: External Cueing Device

• Study Type: Interventional
• Enrollment (Actual): 36
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Alabama
    • Mobile, Alabama, United States, 36603
      • Fredericka G. Evans Cultural Centre

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Healthy Volunteer Adolescent Swimmers
• Member of CMSA

Exclusion Criteria:

• Swimmers under the age of 11 years of age.
• Swimmers that are not registered as athletes through United States Swimming.
• Swimmers that are not enrolled in Age Group III, Senior 1, Senior 2, or Senior 3
• Swimmers not attending practice due to an injury (i.e., shoulder, back, etc.).
• Swimmers currently not participating in a dryland program offered through CMSA.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Shoulder Stabilization Exercise; Protocol contains 8 exercises ("I", "Y", "T", "i", "w", alternating arm "I"/"i", "n", and supine serratus punch) completed for 8 repetitions each for 3 weeks, and in weeks 4-6 completed at 2 sets of 8 repetitions each. Standard group coaching assistance will be provided.	Other: Exercise; Shoulder stabilization exercise protocol contains 8 exercises ("I", "Y", "T", "i", "w", alternating arm "I"/"i", "n", and supine serratus punch) completed for 8 repetitions each for 3 weeks, and in weeks 4-6 completed at 2 sets of 8 repetitions each.
Experimental: Shoulder Stabilization Exercise with External Cueing Device; Protocol contains 8 exercises ("I", "Y", "T", "i", "w", alternating arm "I"/"i", "n", and supine serratus punch) completed for 8 repetitions each for 3 weeks, and in weeks 4-6 completed at 2 sets of 8 repetitions each. External cueing device provides movement pattern constraint and an external target zone for the individual for each exercise. Standard group coaching assistance will be provided.	Other: Exercise; Shoulder stabilization exercise protocol contains 8 exercises ("I", "Y", "T", "i", "w", alternating arm "I"/"i", "n", and supine serratus punch) completed for 8 repetitions each for 3 weeks, and in weeks 4-6 completed at 2 sets of 8 repetitions each.; Device: External Cueing Device; A portable product that provides movement pattern constraints to ensure improved exercise form, and provides a target zone for exercise effort

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change from baseline in isometric muscle torque production at 180 degrees shoulder abduction	Handheld dynamometer assessment of force production times lever arm distance (Newton.meters) of prone shoulder elevation in 180 degrees of abduction completed at baseline, after 3 and 6 weeks of the training program.	Baseline, 3 weeks, 6 weeks.
Change from baseline in isometric muscle torque production at 135 degrees shoulder abduction	Handheld dynamometer assessment of force production times lever arm distance (Newton.meters) of prone shoulder elevation in 135 degrees of abduction completed at baseline, after 3 and 6 weeks of the training program.	Baseline, 3 weeks, 6 weeks.
Change from baseline in isometric muscle torque production at 90 degrees shoulder abduction	Handheld dynamometer assessment of force production times lever arm distance (Newton.meters) of prone shoulder elevation in 90 degrees of abduction completed at baseline, after 3 and 6 weeks of the training program.	Baseline, 3 weeks, 6 weeks.
Change from baseline in modified Athletic Shoulder Test at 180 degrees shoulder abduction	Maximum isometric force production with lying prone into a handheld dynamometer at a given lever arm distance results in muscle torque (Newton.meters) reading. This portion of the test is conducted at 180 degrees of abduction.	Baseline, 3 weeks, 6 weeks.
Change from baseline in modified Athletic Shoulder Test at 135 degrees shoulder abduction	Maximum isometric force production with lying prone into a handheld dynamometer at a given lever arm distance results in muscle torque (Newton.meters) reading. This portion of the test is conducted at 135 degrees of abduction.	Baseline, 3 weeks, 6 weeks.
Change from baseline in modified Athletic Shoulder Test at 90 degrees shoulder abduction	Maximum isometric force production with lying prone into a handheld dynamometer at a given lever arm distance results in muscle torque (Newton.meters) reading. This portion of the test is conducted at 90 degrees of abduction.	Baseline, 3 weeks, 6 weeks.
Closed Kinetic Chain Upper Extremity Stability Test Power Score	Two strips of tape are placed 36 inches apart. Participants assume a push up position (male) or pushup on knees (Female) and are instructed to reach across and touch the opposing hand alternating arms. Maximum number of touches in 15 seconds is recorded. Normalization is made by multiplying the raw touch score by 0.68 x Subject weight in Kg (representing the mass on the head arms and trunk) and dividing by the 15 seconds. Higher number indicates increased shoulder stability.	Baseline, 6 weeks.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Closed Kinetic Chain Upper Extremity Stability Test Raw Touch Score	Two strips of tape are placed 36 inches apart. Participants assume a push up position (male) or pushup on knees (Female) and are instructed to reach across and touch the opposing hand alternating arms. Maximum number of touches in 15 seconds is recorded. Higher number of touches indicates increased shoulder stability	Baseline, 6 weeks.
Closed Kinetic Chain Upper Extremity Stability Test Touch Score	Two strips of tape are placed 36 inches apart. Participants assume a push up position (male) or pushup on knees (Female) and are instructed to reach across and touch the opposing hand alternating arms. Maximum number of touches in 15 seconds is recorded. Touches are adjusted for subject height by dividing raw touch by subject height (in inches based on prior literature). Higher number of touches indicates increased shoulder stability	Baseline, 6 weeks.
Maximal Prone Arm Elevation at 180 degrees abduction	Distance from floor to wrist crease, measured in cm.	Baseline, 3 weeks, 6 weeks.
Maximal Prone Arm Elevation at 135 degrees abduction	Distance from floor to wrist crease, measured in cm.	Baseline, 3 weeks, 6 weeks.
Maximal Prone Arm Elevation at 90 degrees abduction	Distance from floor to wrist crease, measured in cm.	Baseline, 3 weeks, 6 weeks.

Collaborators and Investigators

• Sponsor: University of South Alabama

Publications and helpful links

General Publications

• de Oliveira VM, Pitangui AC, Nascimento VY, da Silva HA, Dos Passos MH, de Araujo RC. TEST-RETEST RELIABILITY OF THE CLOSED KINETIC CHAIN UPPER EXTREMITY STABILITY TEST (CKCUEST) IN ADOLESCENTS: RELIABILITY OF CKCUEST IN ADOLESCENTS. Int J Sports Phys Ther. 2017 Feb;12(1):125-132.
• Tooth C, Forthomme B, Croisier JL, Gofflot A, Bornheim S, Schwartz C. The Modified-Athletic Shoulder Test: Reliability and validity of a new on-field assessment tool. Phys Ther Sport. 2022 Nov;58:8-15. doi: 10.1016/j.ptsp.2022.08.003. Epub 2022 Aug 30.

Study record dates

Study Major Dates

• Study Start (Actual): April 20, 2025
• Primary Completion (Actual): July 25, 2025
• Study Completion (Actual): July 25, 2025

Study Registration Dates

• First Submitted: March 29, 2025
• First Submitted That Met QC Criteria: April 4, 2025
• First Posted (Actual): April 11, 2025

Study Record Updates

• Last Update Posted (Actual): April 13, 2026
• Last Update Submitted That Met QC Criteria: April 7, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Keywords: External cue; Shoulder Stability; Strength Exercise; Adolescent Swimmer
• Additional Relevant MeSH Terms: Motor Activity; Movement; Musculoskeletal Physiological Phenomena; Musculoskeletal and Neural Physiological Phenomena; Exercise
• Other Study ID Numbers: 2305310-1/2304240-1

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No