Combined Effect of Biofeedback and Scapular Stabilization Exercises in Children With Swimmer's Shoulder

Swimmer's shoulder is the most common injury in swimmers and is defined as a painful syndrome that occurs mostly in the anterior region of the shoulder and results from repetitive impingement of the rotator cuff under the coracoacromial arch during the technical gesture of swimming.

Shoulder injuries have been reported in up to 90% of swimmers. The scapula is vital in shoulder function and abnormal scapulothoracic mechanics and scapula-humeral rhythm have been implicated in shoulder pathologies, including glenohumeral impingement and rotator cuff tears.

When weakness or dysfunction is present in the scapular musculature, normal scapular positioning and mechanics may become altered which result in abnormal stresses to the capsular structures, rotator cuff compression and reduced performance.

Knowledge of scapulothoracic movements is regarded as crucial in the development of preventative strategies and treatment programs in athletes with shoulder pathology.

Scapula upward rotation is the dominant scapula action throughout shoulder elevation and has been previously implicated in the development of impingement.

In swimming, an athlete's scapular musculature plays a pivotal role in stabilizing and preventing impingement because its continuous activation is required throughout the swim stroke.

During all movements of the glenohumeral joint especially overhead elevation of the arm, it is of great importance that the scapular- stabilizing musculature should be strong enough to properly position the scapula. The main scapula stabilizers are the Levator Scapulae, Rhomboids major and minor, Serratus anterior, and Trapezii. These muscle groups function through synergistic co- contraction with rotator cuff to control the scapular movement. Scapular stabilization exercise aims to restore scapular position, orientations, motor control of muscles, and movement pattern, thereby attaining stability of scapula for better kinematics of shoulder. Due to lack of research area of scapular stabilization using a pressure biofeedback on swimmer's shoulder in pediatric swimmers, so the purpose of the study is to investigate the combined effect of scapular stabilization and biofeedback in children with swimmer's shoulder.

Inclusion criteria

• Both sexes form 9-13 years old and active in competitive swimming clubs
• Swimming styles will be selected are butterfly and backstroke styles and the swimmers undergone an average minimum of 4 hours of swimming per week.
• All pediatric swimmers have shoulder pain.
• All of them are not allowed to practice swimming during study.

Exclusion criteria

• Pediatric swimmers who practice any sport related to overhead activities.
• Swimmers who had dermatological problems.
• Past history of upper limb fractures or surgeries.
• Swimmers who had any neurological condition (like winging scapula due to nerve damage).
• Swimmers who had dorsal scoliosis (s or c shaped).
• Swimmers who integrate in swimming competitions at the same time of study.