Effects of Dynamic Neuromuscular Stabilization (DNS) and Gyrotonic Training on Shoulder Function in Overhead Athletes (DNSGyroSHOA)

Evaluation of Effects of Dynamic Neuromuscular Stabilization Treatments and Other Innovative Methods on Shoulder Problems in Athletes

The goal of this randomized control trial is to evaluate the effect of the Dynamic Neuromuscular Stabilization (DNS) and Gyrotonic training compared to a control group on pain level, functional performance, and shoulder stability in overhead athletes aged 18 to 25 years. The main question is whether these interventions are more effective than usual training in improving clinical and performance related outcomes.

Participants will take part in a supervised rehabilitation program based on these methods three times per week for six weeks.

Assessments were performed at baseline and after 6 weeks of intervention. Outcome measures included pain level, functional performance, and dynamic shoulder stability. Also, core endurance, shoulder mobility, and shoulder muscle strength will be evaluated as a secondary outcomes.

These outcomes will be assessed using Visual Analog Scale (VAS), Kerlan-Jobe Orthopedic Clinic score (KJOC), the Y-Balance Upper Quarter Stability Test (UQYBT), McGill Endurance Test Battery, goniometer and digital dynamometer.

The study was approved by the Ethics Committee of the Sports University of Tirana. All participants involved in this study provided written informed consent.

Study Overview

• Status: Completed
• Conditions: Shoulder Injuries
• Intervention / Treatment: Other: Dynamic Neuromuscular Stabilization (DNS); Other: Gyrotonic Training; Other: Usual Training

Detailed Description

One of the most challenging aspects of orthopedic sports medicine is the rehabilitation of the overhead athletes. Overhead athletes place a lot of load on the shoulder joint, because of the volume of throws, mechanical stress and repetitive movements above shoulder level. During the game these athletes require high levels of mobility and stability at the same time, and neuromuscular control. Rapid motion, poor biomechanics, and weak links in the kinetic chain put this area in high risk of injury in glenohumeral joint and surrounding soft tissues. As a result, those athletes are exposed of developing shoulder pain, functional impairments, overuse injuries, and deficits in strength and mobility.

Recent rehabilitation programs for shoulder injuries in overhead athletes incorporate exercise-based interventions that integrate core activation, coordinated movement, and sport-specific function.

The purpose of this randomized controlled trial was to investigate the effect of structured neuromuscular rehabilitation program based on the Dynamic Neuromuscular Stabilization (DNS) method and Gyrotonic training on shoulder pain, functional performance, and dynamic stability in overhead athletes with shoulder injuries. The study looked for to determine whether these interventions could lead to significant improvements in the variables at baseline and after the interventions.

Participants meeting the inclusion criteria were recruited and were randomly allocated into one of three study groups. The intervention consisted of a supervised rehabilitation program focused on key components of shoulder function, such as neuromuscular control, strength, mobility, and coordination. The DNS program was focused on exercise based on developmental kinesiology, aimed to improve core stability, breathing patterns, and shoulder stabilization in various functional positions. The Gyrotonic program incorporated three-dimensional, spiral movement patterns aimed to improve mobility, coordination, and integrated upper limb function. The athletes involved in the DNS and Gyrotonic group continued also with their usual sports training. Exercise sessions were performed regularly in both intervention groups for a period of six-weeks. Participants in the control group continued with the usual training regime and did not receive any specific rehabilitation intervention.

Outcome assessments were conducted at baseline and after six weeks of intervention. Pain intensity, functional performance, dynamic stability were the main outcomes that were evaluated before and after the intervention period.

In addition, core endurance, mobility and muscle strength of glenohumeral joint was evaluated as a secondary outcome before and after the rehabilitation program. This study design allows the comparison of changes over time within and between groups in order to identify the most effective approach for improving pain, functional performance and stability in overhead athletes with shoulder injuries.

The findings of this study aim to provide clinically relevant evidence for the rehabilitation of overhead athletes with shoulder injuries.

• Study Type: Interventional
• Enrollment (Actual): 90
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Albania
  • Tirana
    • Tirana, Tirana, Albania, 1001
      • Sport University of Tirana

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria:

• Male and female participants
• Had a minimum of two years of sports experience
• Presence of shoulder region injury or pain
• Active participation in sports

Exclusion Criteria:

• Shoulder surgery
• Neurological disorders that can affect the upper limb
• Shoulder dislocation
• Orthopedic condition such as upper or lower limb fractures
• Athletes with less than two years of sports experience

Study Plan

How is the study designed?

Design Details

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

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: DNS Group; Participants involved in DNS group underwent a structured exercise-based intervention aimed to improve mobility, strength, and neuromuscular control. Also, the participants in this group followed the usual training program.	Other: Dynamic Neuromuscular Stabilization (DNS); Dynamic Neuromuscular Stabilization (DNS) The exercise program based on the DNS method was focused on core activation, diaphragmatic breathing, and shoulder stabilization in various positions based on development kinesiology. Sessions were supervised by certificated therapist and were performed three times per week over a period of 6 weeks.
Experimental: Gyrotonic Training Group; Participants in the Gyrotonic group followed an exercise program based on three-dimensional, flowing movement aimed to improve mobility, strength, and neuromuscular control. Also, the participants continued the usual training program.	Other: Gyrotonic Training; A structured rehabilitation program based on the Gyrotonic method were conducted in the second intervention group. Sessions were supervised by certificated therapist and were conducted three times per week for 6 weeks. The program based on this method was focused on shoulder mobility and stability.
Active Comparator: Control Group; Participants included in control group continued their usual sports training routines without additional intervention during the study period.	Other: Usual Training; Participants continued their usual sports training without any additional protocol exercise. The inclusion of the control group allows for the assessment of the additional effect of the interventions beyond usual training.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change from baseline in Shoulder Functional Performance (Kerlan-Jobe Orthopaedic Clinic Shoulder and Elbow Score)	Shoulder functional performance was assessed using the Kerlan-Jobe Orthopedic Clinic Shoulder and Elbow Score Questionnaire (KJOC), a validated 0-100 scale, where higher scores indicate better function. Changes from baseline to post-intervention will be evaluated.	Baseline (pre-intervention) and after 6 weeks of intervention
Change from baseline in Shoulder Pain (Visual Analog Scale)	Shoulder pain was assessed by Visual Analog Scale (VAS), a 0-10 scale, where higher scores indicate greater pain intensity. Changes from baseline to post-intervention will be evaluated.	Baseline (pre-intervention) and 6 weeks after of intervention.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Changes from baseline in Upper Limb Dynamic Stability (Upper Quarter Y Balance Test)	Upper limb dynamic stability was assessed by Upper Quarter Y Balance Test (UQYBT), which evaluates reach distance in multiple directions to assess functional shoulder stability. Results were recorded in centimeters and normalized as a percentage of limb length. Higher scores indicates better dynamic stability.	Baseline (pre-intervention) and after 6 weeks of intervention.
Change from baseline in Trunk Flexor Endurance	Trunk flexor endurance was assessed using the McGill Endurance Battery Test and was recorded in seconds (s). Higher values indicate greater endurance	Baseline (pre-intervention) and after 6 weeks of intervention.
Change from baseline in Trunk Extensor Endurance	Trunk extensor endurance was assessed by McGill Endurance Battery Test, a validated clinical assessment of trunk muscle endurance. Performance is recorded in seconds. Higher values indicate greater muscular endurance.	Baseline (pre-intervention) and after 6 weeks of intervention.
Change from baseline in Shoulder Abduction Range of Motion	Glenohumeral abduction range of motion (ROM) was assessed in both upper limbs, the dominant and non-dominant using a universal goniometer in degrees (◦). Goniometer is a validated instrument for joint angle measurement. Higher values indicate greater joint mobility. Changes from baseline to post intervention will be analyzed.	Baseline (pre-intervention) and after 6 weeks of intervention.
Change from baseline in Shoulder Internal Rotation Range of Motion	Glenohumeral internal rotation range of motion (ROM) was assessed in both upper limbs, the dominant and non-dominant using a universal goniometer in degrees (◦). Goniometer is a validated instrument for joint angle measurement. Higher values indicate greater joint mobility. Changes from baseline to post intervention will be analyzed.	Baseline (pre-intervention) and after 6 weeks of intervention.
Change from baseline in Shoulder External Rotation Range of Motion	Glenohumeral external rotation range of motion (ROM) was assessed in both upper limbs, the dominant and non-dominant using a universal goniometer in degrees (◦). Goniometer is a validated instrument for joint angle measurement. Higher values indicate greater joint mobility. Changes from baseline to post intervention will be analyzed.	Baseline (pre-intervention) and after 6 weeks of intervention.
Change from baseline in Shoulder Internal Rotation Muscle Strength	Shoulder internal rotation muscle strength was assessed using a digital dynamometer, a valid and reliable instrument for isometric muscle strength, and expressed in Newton (N). Higher values indicate greater muscle strength.	Baseline (pre-intervention) and after 6 weeks of intervention.
Change from baseline in Shoulder External Rotation Muscle Strength	Shoulder external rotation muscle strength was assessed using a digital dynamometer, a valid and reliable instrument for isometric muscle strength, and expressed in Newton (N). Higher values indicate greater muscle strength.	Baseline (pre-intervention) and after 6 weeks of intervention.
Change from baseline in Shoulder Abduction Muscle Strength	Shoulder abduction muscle strength was assessed using a digital dynamometer, a valid and reliable instrument for isometric muscle strength, and expressed in Newton (N). Higher values indicate greater muscle strength.	Baseline (pre-intervention) and after 6 weeks of intervention.

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change from baseline in Limb Symmetry Index	Limb symmetry Index (LSI) will be calculated as the ratio of lower performing limb to higher performing limb, multiplied by 100 and expressed as a percentage(%). Values closer to 100% indicate greater inter-limb symmetry.	Baseline (pre-intervention) and after 6 weeks of intervention.
Changes from baseline in Glenohumeral Internal Rotation Deficit (GIRD)	Glenohumeral Internal Rotation Deficit (GIRD) will be calculate as the difference in shoulder internal rotation range of motion between the dominant and non-dominant shoulders, measured in degrees (◦). Higher values indicate greater internal rotation deficit.	Baseline (pre-intervention) and after 6 weeks of intervention.
Change from baseline in shoulder External to Internal Rotation Strength Ratio	The external/internal rotation (ER/IR) strength ratio will be calculated as the ratio of isometric external rotation strength to internal rotation strength measured using a digital dynamometer. The ER/IR ratio is unitless, with values of approximately 0.66-0.75 considered normal; values below 0.66 indicate external rotator strength deficit, while values above 0.75 indicate relative external rotator dominance or adaptation.	Baseline (pre-intervention) and after 6 weeks of intervention.
Change from baseline in Trunk Flexor to Extensor Endurance Ratio	The trunk flexor/extensor endurance ratio will be calculated as flexor endurance time divided by extensor endurance time. The ratio is unitless, with values closer to 1 indicating better muscular balance.	Baseline (pre-intervention) and after 6 weeks of intervention.

Collaborators and Investigators

• Sponsor: Sport University of Tirana

Study record dates

Study Major Dates

• Study Start (Actual): February 17, 2025
• Primary Completion (Actual): March 17, 2025
• Study Completion (Actual): June 20, 2025

Study Registration Dates

• First Submitted: April 23, 2026
• First Submitted That Met QC Criteria: April 30, 2026
• First Posted (Actual): May 7, 2026

Study Record Updates

• Last Update Posted (Actual): May 7, 2026
• Last Update Submitted That Met QC Criteria: April 30, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Keywords: Neuromuscular Training; Functional Performance; Shoulder injury; Overhead athletes; Shoulder Stability; DNS (Dynamic Neuromuscular Stabilization); Gyrotonic training
• Additional Relevant MeSH Terms: Wounds and Injuries; Shoulder Injuries
• Other Study ID Numbers: DNS-Gyro-Study-2025

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: The individual participant data (IPD) will not be shared in order to protect participant confidentiality and privacy. In accordance with institutional regulations and informed consent obtained from participants, only overall results will be reported in publications.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No