]>
IRCT20180711040419N4 IRCT 2026-06-14 Shiraz University of Medical Sciences The Effect of Standardized Corrective Exercise on Shoulder Joint Proprioception in Overhead Athletes with Scapular Dyskinesis: A Randomized Controlled Trial - Investigation and Comparison of the Efficacy of Standard Corrective Exercises versus Sensorimotor Exercises on Improving Shoulder Proprioception in Overhead Athletes with Scapular Dyskinesis. 2026-06-22 anticipated 24 Pending https://irct.ir/trial/90197 interventional Randomization: Randomized, Blinding: Single blinded, Placebo: Not used, Assignment: Parallel, Purpose: Other, Randomization description: Participants will be randomly allocated to one of two groups using block randomization. A block size of 4 and a total of 6 blocks will be used, Blinding description: The random sequence will be generated prior to the start of the study by an independent individual, and opaque sealed envelopes will be used for allocation concealment. After each participant is enrolled, the corresponding envelope will be opened and the intervention group will be assigned. Data analysts will also be blinded to participant group assignment through coding in order to minimize the risk of bias. N/A Scapular Dyskinesis. Intervention 1: Intervention group: Participants in the intervention group will only undergo standard corrective exercises for scapular dyskinesis. This combined protocol is based on the clinical guideline provided by Seitz at the Denver Shoulder Specialty Clinic, which has demonstrated effectiveness in correcting shoulder position and movement. The intervention will last for 4 weeks, with 3 sessions per week. Each treatment session will last between 40 to 50 minutes (warming-up, corrective exercises, cooling down), and to maintain exercise quality and prevent early muscle fatigue, rest periods of 45 to 60 seconds will be allocated between sets or exercises. Throughout all sessions, the number of repetitions will be kept constant to preserve the quality of each movement. During the treatment, participant body positions (including head, neck, shoulder, and scapula posture) will be monitored and corrected in sitting and standing positions. The exercises in this group follow three main axes: stretching shortened muscles, strengthening weak muscles, and motor control exercises to correct scapular functional patterns. Exercises will start with low intensity and progress gradually according to the principle of overload. The weekly progression pattern of the exercises is as follows: in the first week, focus is on correcting posture, reducing movement constraints, and initial activation of stabilizer muscles, with exercises performed at an easy and manageable level. In the second week, range of motion and motor control are increased, and light resistance with elastic bands is added. In the third week, participants will engage in more functional and multi-joint exercises (such as Push-up Plus), with increased bodyweight challenges. In the fourth week, exercise intensity is increased by adding more resistance, including advanced exercises like Shoulder Press, as well as strengthening core muscles to stabilize the thorax and improve scapular control. Complete description of standard corrective exercises: __ Week 1: Exercises: Chin Tucks, Scapular Retraction, Arm Swing, Wall Slides Posture: Sitting / Standing Repetitions/Sets: 2–3 sets of 10–12 repetitions or 2–3 sets lasting 1–2 minutes __ Week 2: Exercises: Wall Slides + Serratus Punch, Scapular Clock, Prone Y Raise, Scapular Retraction with light resistance band Posture: Prone / Sitting / Standing Repetitions/Sets: 2–3 sets of 10–12 repetitions __ Week 3: Exercises: Pectoralis Minor stretch, Dynamic Hug, Push-Up Plus, Scapular Wall Push-Ups Posture: Standing / Functional Repetitions/Sets: 2–3 sets of 10–12 repetitions or 20–30 seconds holds __ Week 4: Exercises: External shoulder rotation with band, Lat Pull-Downs with band, Functional exercises (Shoulder Presses), Core strengthening exercises (Plank and Side Plank) Posture: Standing / Functional Repetitions/Sets: 2–3 sets of 10–12 repetitions. Intervention 2: Control group: Participants in the control group will undergo sensorimotor exercises designed to improve proprioception, glenohumeral joint stability, and neuromuscular control of the shoulder girdle in overhead athletes with scapular dyskinesis. This intervention will be implemented over 4 weeks, with 3 sessions per week. Each treatment session will last approximately 30 to 40 minutes (warm-up, sensorimotor exercises, and cool-down), and rest periods of 45 to 60 seconds will be allocated between sets or exercises to maintain movement quality and prevent early fatigue of the stabilizer muscles. To ensure the effectiveness of the intervention, the correct execution and quality of the exercises will be supervised and corrected by a specialized physical therapist in all sessions. Furthermore, the structure of this protocol is based on progressive advancement from stable to unstable surfaces to incrementally enhance sensorimotor stimulation, neuromuscular coordination, and reactive shoulder control. In the first week, the focus is on performing exercises on stable surfaces, establishing controlled hand contact with the surface, and enhancing joint position perception. Gradually, in the second week, the exercises shift to semi-unstable surfaces, and simple, unidirectional movements are initiated. In the third week, the level of surface instability increases, and the athlete is challenged with multi-directional movements, greater movement variability, and higher weight-bearing on the upper extremity. Finally, in the fourth week, the exercises continue with more advanced challenges, such as stabilization on a ball, rapid changes in direction, and the addition of rotational and combined shoulder patterns, so that the neuromuscular system trains for faster and more precise responsiveness. Complete description of sensorimotor exercises: __ Week 1: Maintaining balance with both hands on the floor (3 sets × 30–40 seconds hold), Maintaining one, handed balance with circular movements on the wall (3 sets × 12–15 revolutions). __ Week 2: Maintaining hand balance on a balance board in a kneeling position, forward-backward movement (3 sets × 12–15 repetitions), Dynamic stabilization on a ball or single-handed (3 sets × 30–40 seconds hold). __ Week 3: Hand balance on a balance board in a kneeling position (movement in four directions0 (3 sets × 12–15 repetitions per direction), Single-handed stabilization on the floor (3 sets × 30–40 seconds hold). __ Week 4: Dynamic single-handed stabilization on a ball (3 sets × 15 repetitions), Catching a ball in a 90° abduction and 90° flexion position + performing internal-external rotation (3 sets × 15 repetitions). Yes - There is a plan to make this available What will be shared: Information collection, informed consent form and SPSS file When: After publication the results of the study To whom: Researchers working in academic and scientific institutions Conditions: Only for recording information in scientific databases Where to obtain: Correspondence with the project manager by email. rezaeik@sums.ac.ir How to obtain: Maximum one month after sending the request by email Comments:
public Katayoon Rezaei
Sadra City - After Amir Al-Momenin Burns Hospital - Shahid Doran Campus - Faculty of Rehabilitation Sciences
Shiraz Iran (Islamic Republic of) 7198754361 +98 71 3212 2600 RezaeiK@Sums.ac.ir Shiraz University of Medical Sciences scientific Katayoon Rezaei
Sadra City - After Amir Al-Momenin Burns Hospital - Shahid Doran Campus - Faculty of Rehabilitation Sciences
Shiraz Iran (Islamic Republic of) 7198754361 +98 71 3212 2600 rezaeik@sums.ac.ir Shiraz University of Medical Sciences Iran (Islamic Republic of) Age between 18 and 45 years. Athletes in overhead sports (e.g., volleyball, basketball, handball) with at least 3 years of regular training experience. Presence of scapular dyskinesis in the dominant limb. Ability to perform shoulder abduction and flexion without severe limitations or functional impairment (i.e., defined as the inability to perform at least 90 degrees of flexion or abduction, or the presence of severe pain (VAS > 7)). No participation in similar training programs within the past 3 months. Body Mass Index (BMI) between 18.5 and 26.9. 18 years 45 years Both History of structural injuries to the shoulder or upper extremity within the past 6 months (e.g., fracture, dislocation, rotator cuff tear, or labral tear). History of surgery involving the shoulder, upper extremity or spine. Neuromuscular, rheumatologic, or systemic diseases affecting proprioception (e.g., diabetes, rheumatoid arthritis, thoracic outlet syndrome, cervical radiculopathy, etc.). Presence of acute and active pain in the shoulder, elbow or wrist at the time of testing or during activities of daily living. Evident structural abnormalities of the spine or thoracic cage, such as kyphosis or scoliosis, that may influence shoulder movement patterns. Pregnancy or breastfeeding in female athletes. Rehabilitation Rehabilitation Intervention group: Participants in the intervention group will only undergo standard corrective exercises for scapular dyskinesis. This combined protocol is based on the clinical guideline provided by Seitz at the Denver Shoulder Specialty Clinic, which has demonstrated effectiveness in correcting shoulder position and movement. The intervention will last for 4 weeks, with 3 sessions per week. Each treatment session will last between 40 to 50 minutes (warming-up, corrective exercises, cooling down), and to maintain exercise quality and prevent early muscle fatigue, rest periods of 45 to 60 seconds will be allocated between sets or exercises. Throughout all sessions, the number of repetitions will be kept constant to preserve the quality of each movement. During the treatment, participant body positions (including head, neck, shoulder, and scapula posture) will be monitored and corrected in sitting and standing positions. The exercises in this group follow three main axes: stretching shortened muscles, strengthening weak muscles, and motor control exercises to correct scapular functional patterns. Exercises will start with low intensity and progress gradually according to the principle of overload. The weekly progression pattern of the exercises is as follows: in the first week, focus is on correcting posture, reducing movement constraints, and initial activation of stabilizer muscles, with exercises performed at an easy and manageable level. In the second week, range of motion and motor control are increased, and light resistance with elastic bands is added. In the third week, participants will engage in more functional and multi-joint exercises (such as Push-up Plus), with increased bodyweight challenges. In the fourth week, exercise intensity is increased by adding more resistance, including advanced exercises like Shoulder Press, as well as strengthening core muscles to stabilize the thorax and improve scapular control. Complete description of standard corrective exercises: __ Week 1: Exercises: Chin Tucks, Scapular Retraction, Arm Swing, Wall Slides Posture: Sitting / Standing Repetitions/Sets: 2–3 sets of 10–12 repetitions or 2–3 sets lasting 1–2 minutes __ Week 2: Exercises: Wall Slides + Serratus Punch, Scapular Clock, Prone Y Raise, Scapular Retraction with light resistance band Posture: Prone / Sitting / Standing Repetitions/Sets: 2–3 sets of 10–12 repetitions __ Week 3: Exercises: Pectoralis Minor stretch, Dynamic Hug, Push-Up Plus, Scapular Wall Push-Ups Posture: Standing / Functional Repetitions/Sets: 2–3 sets of 10–12 repetitions or 20–30 seconds holds __ Week 4: Exercises: External shoulder rotation with band, Lat Pull-Downs with band, Functional exercises (Shoulder Presses), Core strengthening exercises (Plank and Side Plank) Posture: Standing / Functional Repetitions/Sets: 2–3 sets of 10–12 repetitions Control group: Participants in the control group will undergo sensorimotor exercises designed to improve proprioception, glenohumeral joint stability, and neuromuscular control of the shoulder girdle in overhead athletes with scapular dyskinesis. This intervention will be implemented over 4 weeks, with 3 sessions per week. Each treatment session will last approximately 30 to 40 minutes (warm-up, sensorimotor exercises, and cool-down), and rest periods of 45 to 60 seconds will be allocated between sets or exercises to maintain movement quality and prevent early fatigue of the stabilizer muscles. To ensure the effectiveness of the intervention, the correct execution and quality of the exercises will be supervised and corrected by a specialized physical therapist in all sessions. Furthermore, the structure of this protocol is based on progressive advancement from stable to unstable surfaces to incrementally enhance sensorimotor stimulation, neuromuscular coordination, and reactive shoulder control. In the first week, the focus is on performing exercises on stable surfaces, establishing controlled hand contact with the surface, and enhancing joint position perception. Gradually, in the second week, the exercises shift to semi-unstable surfaces, and simple, unidirectional movements are initiated. In the third week, the level of surface instability increases, and the athlete is challenged with multi-directional movements, greater movement variability, and higher weight-bearing on the upper extremity. Finally, in the fourth week, the exercises continue with more advanced challenges, such as stabilization on a ball, rapid changes in direction, and the addition of rotational and combined shoulder patterns, so that the neuromuscular system trains for faster and more precise responsiveness. Complete description of sensorimotor exercises: __ Week 1: Maintaining balance with both hands on the floor (3 sets × 30–40 seconds hold), Maintaining one, handed balance with circular movements on the wall (3 sets × 12–15 revolutions). __ Week 2: Maintaining hand balance on a balance board in a kneeling position, forward-backward movement (3 sets × 12–15 repetitions), Dynamic stabilization on a ball or single-handed (3 sets × 30–40 seconds hold). __ Week 3: Hand balance on a balance board in a kneeling position (movement in four directions0 (3 sets × 12–15 repetitions per direction), Single-handed stabilization on the floor (3 sets × 30–40 seconds hold). __ Week 4: Dynamic single-handed stabilization on a ball (3 sets × 15 repetitions), Catching a ball in a 90° abduction and 90° flexion position + performing internal-external rotation (3 sets × 15 repetitions). Shoulder Joint Proprioception. Timepoint: The absolute Angular Error of active shoulder joint reconstruction is measured before and after the exercises in both groups. Method of measurement: The absolute Angular Error of active regeneration of the dominant shoulder joint is measured using an isokinetic device in three movements of internal and external rotation (45 °) and flexion (90 °). Upper extremity performance. Timepoint: The mean scores of upper extremity performance are measured before and after the exercises in both groups. Method of measurement: Quick-Disabilities of the Arm, Shoulder and Hand questionnaire includes 11 questions. Scoring 1 to 5, calculated as (average × 25). Scapular Dyskinesis. Timepoint: The mean scores of the scapular movement pattern are measured in the scapular Dyskinesis test before and after the exercises in both groups. Method of measurement: Scapular Dyskinesis Test. Shiraz University of Medical Sciences Approved 2026-05-12 Ethics committee of Shiraz University of Medical Sciences Zand St., Imam Hossein Square, Shiraz Medical School, Building No. 3, Third Floor, Vice Chancellor for Research, Medical School Shiraz Fars Iran (Islamic Republic of)