The effectiveness of neuromuscular training based exercise program among overhead athletes with shoulder pain

The study aimed to investigate the effectiveness of a neuromuscular training-based exercise program (NEP) applied at the same intensity on pain, shoulder function, kinesiophobia, risk factors specific to shoulder pain, muscle tone and athletic performance in overhead athletes (OA) with shoulder pain (SP). This randomised controlled study involved 28 OA diagnosed with subacromial pain by an orthopaedic surgeon, and the subjects were randomly assigned to two groups: NEP (Group 1) and Thrower's Ten exercises (TTE) (Group 2). Exercises were conducted in both groups three times a week for eight weeks under the supervision of a physiotherapist. The cases were evaluated both before and after the treatment. Pain was assessed using the Visual Analog Scale (VAS), pressure pain threshold with a digital algometer, shoulder injury-specific risk factors with the Hylygth Screening Program, and athletic performance with the Y Balance Test – Upper Extremity (YBT-UQ), the Closed Kinetic Chain Upper Extremity Stability Test (CKCUES), and the Single Arm Seated Shot Put Test (SSPT). Shoulder functional status, kinesiophobia, and muscle tone were assessed using the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, the Tampa Kinesiophobia Scale (TKS), and Myotonometry, respectively. After treatment, both groups revealed improvement in pain, shoulder functional status, kinesiophobia, shoulder-specific risk factors, muscle tone, and athletic performance (p<0.05). There was a significant difference favouring Group 1 in pain, shoulder flexibility parameters, all strength parameters except internal rotation (IR) and external rotation (ER), and CKCUES test result after treatment (p < 0.05). In conclusion, the effect of NEP on night pain, pressure pain threshold, CKCUES test, shoulder flexibility, strength, and muscle tone parameters is superior compared to the TTE program. This clinical study, which presents the first results in the literature on the application of NEP to OA with SP, has shown that the early use of the low-cost, easy-to-implement, and side-effect-free protocol may recommend advantages in terms of managing pain and risk factors for shoulder injuries.