A Novel Rehabilitation Program Using Neuromuscular Electrical Stimulation (NMES) and Taping for Shoulder Pain in Swimmers: A Protocol and Case Example

Effect of plyometric training and neuromuscular electrical stimulation assisted strength training on muscular, sprint, and functional performances in collegiate male football players

Background

The study's objective was to analyze the influence of an 8-week neuromuscular electrical stimulation (NMES) with a plyometric (PT) and strength training (ST) program on muscular, sprint, and functional performances in collegiate male football players.

Methods

Sixty collegiate male football players participated in this randomized controlled trial single-blind study. All the participants were randomly divided into two groups: (1) NMES group (Experimental, n = 30) who received NMES assisted ST and (2) sham NMES group (Control, n = 30) who received sham NMES assisted ST. In addition, participants from both groups received a PT program; both groups received intervention on three days a week for 8-weeks. The study's outcomes, such as muscular, sprint, and functional performances, were assessed using a strength test (STN) for quadriceps muscle, sprint test (ST), and single-leg triple hop test (SLTHT), respectively, at baseline pre-intervention and 8-week post-intervention. The interaction between group and time was identified using a mixed design (2 × 2) ANOVA.

Results

Significant difference found across the two time points for the scores of STN: F (1.58) = 5,479.70, p < 0.05; SLTHT: F (1.58) = 118.17, p < 0.05; and ST: F (1.58) = 201.63, p < 0.05. Similarly, the significant differences were found between groups averaged across time for the scores of STN: F (1.58) = 759.62, p < 0.05 and ST: F (1.58) = 10.08, p < 0.05. In addition, after 8-week of training, Cohen's d observed between two groups a large to medium treatment's effect size for the outcome STN (d = 10.84) and ST (d = 1.31). However, a small effect size was observed only for the SLTHT (d = 0.613).

Conclusions

Findings suggest that the effect of PT and ST with either NMES or sham NMES are equally capable of enhancing muscular, sprint, and functional performances in collegiate male football players. However, PT and ST with NMES have shown an advantage over PT and ST with sham NMES in improving muscular performance and sprint performance among the same participants.

The Effect of Exercise Therapy Interventions on Shoulder Pain and Musculoskeletal Risk Factors for Shoulder Pain in Competitive Swimmers: A Scoping Review

CONTEXT

Shoulder pain is the main cause of missed or modified training in competitive swimmers. Exercise therapy can improve the outcomes, yet uncertainty exists regarding the characteristics of these interventions.

OBJECTIVES

The primary aim was to describe the evidence base relating to the effectiveness of exercise therapy interventions on shoulder pain and shoulder musculoskeletal risk factors for shoulder pain in swimmers. The secondary aim was to identify gaps in the literature and provide recommendations for future research and practice.

EVIDENCE ACQUISITION

A scoping review methodology was applied through the search of MEDLINE, PubMed, Scopus, Web of Science, and CINAHL databases. The authors included any research studies (except clinical commentaries and conference papers) that assess the effect of exercise therapy on shoulder pain and musculoskeletal risk factors for shoulder pain in swimmers. The literature was critically appraised using the Modified Down and Black checklist.

EVIDENCE SYNTHESIS

From 452 papers identified, 14 studies were included in this review. An exercise program of 6 to 8 weeks, including strengthening exercises (shoulder external rotator and scapula retractor muscles) and stretches (pectoral muscles), can decrease the incidence of shoulder pain in swimmers. Furthermore, a combination of exercises and stretches with manual therapy techniques can help to decrease shoulder pain in injured swimmers. Regarding risk factors, a strengthening program of more than 12 weeks increased shoulder external rotation peak force, endurance, and external rotation/internal rotation ratio; however, this was not associated to decreases in pain. Finally, open kinetic chain exercises and a dry-land program are superior to close kinetic exercises and water training for improving shoulder external rotation strength and endurance.

CONCLUSIONS

Exercise therapy has positive effects on reducing the incidence of shoulder pain, the management of shoulder pain, and improving shoulder musculoskeletal risk factors in competitive swimmers. However, due to methodological limitations of the studies, caution must be used when applying these results in practice. Future research should focus on high-quality randomized controlled trials for prevention and management of shoulder pain in swimmers.