Pain, ShoulderNCT06385743
The Effectiveness of Neuromuscular Training-Based Exercise Program
A study testing Neuromuscular Training-based Exercise Program and ''Thrower's Ten'' Exercise Program in people with Pain, Shoulder and Sports Physical Therapy, run by Yeditepe University at 1 site in Turkey (Türkiye).
Trial summary
This randomised controlled study aimed to investigate the effectiveness of a neuromuscular training-based exercise program on pain, function, risk factors specific to shoulder injuries and performance in overhead athletes with shoulder pain. Read more about this study
- Who is it for?
- Ages 18 to 35 years
- Conditions the study is for
- Pain, Shoulder, Sports Physical Therapy
- What is being tested?
- Neuromuscular Training-based Exercise Program and ''Thrower's Ten'' Exercise Program
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 28 participants
- Where
- 1 siteTurkey (Türkiye)
- Study dates
- 17 Apr 2023to 31 May 2025
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 to 35 years
- All sexes
- No healthy volunteers
- Adult
Who may be able to join
- Giving consent to be a volunteer for participating
- 18-35 years of age
- Athletes playing overhead sports like volleyball, water polo, tennis, baseball, cricket, swimming, badminton, and basketball for at least 2 days a week (Unilateral sports).
- Patients with unilateral shoulder pain lasting >6 weeks.
- Suitable and referred for conservative treatment by an orthopedist (non-surgical patients)
- Having one positive sign in the following 3 categories; the painful arc of movement, Neer or Hawkins-Kennedy impingement signs and pain during resisted external rotation, abduction, or empty can test performed by the orthopedist.
- Participating in regular training with the team for at least 3 years of experience in overhead sports
Who cannot join
- Bilateral shoulder pain
- Having an acute shoulder pain
- Having a non-specific shoulder pain
- Reflected pain
- Having some severe shoulder patholojies such as adhesive capsulitis, osteoarthritis, rheumatoid arthritis, fracture, dislocation and instability
- Shoulder pain originating from non-musculoskeletal system
Show all 16Show fewer
- Having the shoulder and neck surgery and non-traumatic injuries within the last six months
- Having severe pathologies during the rehabilitation program (cardiac, diabetes mellitus and neuropsychiatric problems)
- Presence of diagnosed significant comorbidity (neurological and systemic disorders)
- Current and past carcinoma
- Type 3 acromion
- Avulsion fracture
- Non-compliance with treatment
- Symptomatic cervical spine pathology
- Antidepressant usage
- Clinical signs of full-thickness rotator cuff tears (positive lag signs)
Trial locations and contacts
1 site in 1 country.
About this study
Official title: The Effectiveness of Neuromuscular Training-Based Exercise Program Among Overhead Athletes With Shoulder Pain
This randomised controlled study aimed to investigate the effectiveness of a neuromuscular training-based exercise program on pain, function, risk factors specific to shoulder injuries and performance in overhead athletes with shoulder pain.
The main hypothesis is;
Read more
H0: There is no difference between the "Thrower's Ten" exercise program and the neuromuscular training-based exercise program applied to overhead athletes with shoulder pain, on pain, function, risk factors specific to shoulder injuries, and performance.
H1: The effects of a neuromuscular training-based exercise program on pain, function, risk factors specific to shoulder injuries and performance in overhead athletes with shoulder pain are superior to the effects of "Thrower's Ten" exercise program
Read the detailed description
Overhead athletes with shoulder pain who met the inclusion criteria applied to Yeditepe University Hospital Orthopedics and Traumatology Clinic for a randomized controlled study will be included to demonstrate the effectiveness of a neuromuscular training-based exercise program in overhead athletes with shoulder pain.
Athletes will be included in two different exercise programs (Thrower's Ten and Neuromuscular Training Based groups) by simple randomization.
Athletes evaluated by the orthopaedic surgeon will be included in the study if willing to participate in the rehabilitation program. The treatment program to be applied, hands-off treatment, was determined as exercise therapy. In our study, the athletes participating in the Neuromuscular Training-Based Exercise Program (Group 1) and the ''Thrower's Ten'' Exercise Program (Group 2) will participate in 24 physiotherapy sessions, three days a week, for eight weeks.
Before starting the treatment program, the participants' sociodemographic characteristics, comorbidities, dominant sides, sports histories, training routine (frequency/week, duration, etc.), and previous injury histories will be questioned with a structured evaluation form. Before randomization, a clinical examination for shoulder pain will be done by the orthopaedic surgeon. Pain intensity, pressure pain threshold, muscle tone, shoulder functional status, risk factors specific to shoulder injuries, sportive performance and kinesiophobia will be evaluated before treatment, at the end of the eight-week exercise program,
- Conditions
- Pain, Shoulder, Sports Physical Therapy
- Being tested
- Neuromuscular Training-based Exercise Program, ''Thrower's Ten'' Exercise Program
- Keywords
- Overhead Athletes, Neuromuscular training, Shoulder funtions, Shoulder pain, performance
- Medical subject headings
- Shoulder Pain
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Neuromuscular Training-based Exercise ProgramOther
Neuromuscular training has been accepted as an effective treatment modality to improve the neurophysiological states of the joints for coordinated work. In addition to shoulder strength, stabilization and kinetic chain exercises, this program includes internal and external focus (sound, touch, light, dual task, etc.), sport-specific exercises and plyometric exercises (speed, agility). All athletes with shoulder pain will include in the baseline evaluation at the beginning of the season and all parameters will be followed throughout the season for 8 weeks. All athletes in this group will participate in a total of 24 physiotherapy sessions, 3 days a week, for eight weeks.
''Thrower's Ten'' Exercise ProgramOther
''Thrower's Ten'' Exercise Program includes 10 different shoulder strengthening and shoulder stabilization exercises in a diagonal pattern. "Advanced Thrower's Ten" exercises that include kinetic chain exercises (covering more than one joint) in addition to shoulder exercises planned to be used in the late stages of rehabilitation into the program, progression is considered after the 3rd week will be added. All athletes with shoulder pain will include in the baseline evaluation at the beginning of the season and all parameters will be followed throughout the season for 8 weeks. All athletes in this group will participate in a total of 24 physiotherapy sessions, 3 days a week, for eight weeks.
| Study group | Role | What they receive |
|---|---|---|
| Neuromuscular Training-based Exercise Program Group | Experimental | Patient Education: Both groups will be given patient education on pain mechanism, posture/posture, exercise training, the role of the shoulder joint in shooting mechanics, situations, and positions to be avoided.
Neuromuscular Training-based Exercise Program: This group will be given a neuromuscular training-based exercise program in a total of 24 physiotherapy sessions, 3 days a week, for eight weeks. In addition to shoulder strength, stabilization and kinetic chain exercises, this program includes internal and external focus (sound, touch, light, dual task, etc.), sport-specific exercises and plyometric exercises (speed, agility). Receives: Other: Neuromuscular Training-based Exercise Program |
| Thrower's Ten Exercise Program Group | Active comparator | Patient Education: Both groups will be given patient education on pain mechanism, posture/posture, exercise training, the role of the shoulder joint in shooting mechanics, situations, and positions to be avoided.
Thrower's Ten Exercise Program: This group will be given include Thrower's Ten Exercise Program in a total of 24 physiotherapy sessions, 3 days a week, for eight weeks. This program includes 10 different shoulder strengthening and shoulder stabilization exercises in a diagonal pattern. "Advanced Thrower's Ten" exercises that include kinetic chain exercises (covering more than one joint) in addition to shoulder exercises planned to be used in the late stages of rehabilitation into the program, progression is considered after the 3rd week will be added. Receives: Other: ''Thrower's Ten'' Exercise Program |
What is being measured
The primary outcome is the main question the study is designed to answer.
Pain Assessment
Visual Analogue Scale will be used to evaluate the severity of pain felt around the shoulder joint. The location of the pain and the severity of the pain will be questioned. Participants will be asked to indicate pain severiy they felt (rest, activity and night) on a 10 cm horizontal line, ranging from 0 to 10. Zero shows no pain and 0 is intolerable pain. Pain intensity will be recorded by measuring the value of the marked place in cm. Higher values indicate more severe pain.
Measured: 8 weeks
Disabilities of the Arm, Shoulder and Hand (DASH)
The Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire was used to evaluate status of shoulder function. It is a questionnaire that evaluates all upper extremity functions and consists of a total of thirty questions. 21 of the questions of the questionnaire question the ability to perform functional activities, 5 of them about pain and 4 of them about the psychosocial effects of the disease. Each question is scored using a 5-point Likert scale with a range of 1-5. The total score of the questionnaire varies between 0-100 points, higher scores indicate better functional status. DASH, which has a short completion time and moderate scoring ease, is a questionnaire that can be used in patients between the ages of 18-64.
Measured: 8 weeks
Secondary outcomes (5)
Tampa Kinesiophobia Scale
Tampa Kinesiophobia Scale (Tampa Kinesiophobia Scale, TKS) was used for kinesiophobia. TKS is a 17-item scale consisting of questions about re-injury anxiety, pain, anxiety, and fear-avoidance behaviors. This questionnaire is used for diseases associated with chronic and acute pain, musculoskeletal injuries and fibromyalgia. This scale utilizies a 4-point Likert score with 1-4 intervals (1= Strongly disagree, 4 = Strongly agree).
Measured: 8 weeks
Hylyght Injury Prevention and Return to the Sports Screening Program (
This program will be used to evaluate risk factors specific to shoulder pain in overhead athletes. The physiotherapist will evaluate each athlete using these specific shoulder injury risk factors tests, and the results will be recorded in the system. These risk factors include parameters for the shoulder (flexibility, strength, range of motion, core stability). The application will automatically generate an individual risk profile map showing risk levels in red, yellow, and green based on AI according to the category of the entered value. Database will be determined pain specific risk factors according to prospective studies. Each participant's individual risk profile will be formed.Both groups' risk profile map changes before and after treatment will be evaluated.
Measured: 8 weeks
Y Balance Test- Upper Quarter
Upper Quarter Y-Balance Test (UQYBT) which is a functional performance test will be used to evaluate kinetic chain, mobility, and stability the components of upper extremity in a closed kinetic chain. The YBT-UQ which is called a closed kinetic chain functional screening tool with using the Y Balance Test kit (Move2Perform, Evansville, IN, USA). Participants will be positioned push-up position with the center of one hand on the grid. Participants will reach out as far as possible in the tested direction. Physiotherapist will measure the reach distance expressed in refrence to the stance limb which is tested side.
Measured: 8 weeks
Closed Kinetic Chain Extremity Stability Test
Closed Kinetic Chain Extremity Stability (CKCUES) Test was applied to participants with shoulder dysfunctions and to assess shoulder performance. Athletes will be positioned in push- ups position between tapes. Athletes will move their hands back and forth, touching each tape. The physiotherapist will count the athlete's touch number within 15 seconds.
Measured: 8 weeks
Single Arm Seated Shot Put Test
The Single Arm Seated Shot Put Test (SSPT) is defined as an upper extremity functional performance test used in the clinical setting. In the test, a weighted ball is asked to be pushed forward during a shooting motion. Few pieces of equipment are requaried for this test. Physiotherapists will be positioned athletes to sit upright with the back, pelvis, shoulders, and head against the wall. Other hand will be resting on the floor or on the lap. Athletes will shot- put the ball as far as possible without moving away from the wall. The physiotherapist will measure where the ball first struck the ground for all three attempts in centime.
Measured: 8 weeks
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted26 Apr 2024
- Study start17 Apr 2023
- Primary completion15 Apr 2025
- Study completion31 May 2025
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Pain, ShoulderStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Double blind
- Who is masked
- Participant, Outcomes assessor
- Enrolment
- 28 participants (actual)
Sponsor and investigators
- Lead sponsor
- Yeditepe University
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Asli Yeral, Yeditepe University
- Investigators
- Aslı Yeral, MSc, Principal investigator, Yeditepe University
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT06385743
- Sponsor's protocol ID
- yeditepe15
- Status last verified
- Jan 2026
- First submitted
- 10 Apr 2023
- Last updated
- 4 Feb 2026
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
Study at a glance
From the registry record, last updated by the sponsor on 4 Feb 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- The Effectiveness of Neuromuscular Training-Based Exercise Program Among Overhead Athletes With Shoulder Pain
- ClinicalTrials.gov ID
- NCT06385743
- Acronym / sponsor ID
- yeditepe15
- Conditions
- Pain, Shoulder, Sports Physical Therapy
- Keywords
- Overhead Athletes, Neuromuscular training, Shoulder funtions, Shoulder pain, performance
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 28 participants (actual)
- Lead sponsor
- Yeditepe UniversityUniversity, hospital or other
- Study start
- 17 Apr 2023 (actual)
- Primary completion
- 15 Apr 2025 (actual)
- Study completion
- 31 May 2025 (actual)
- First posted
- 26 Apr 2024 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
This randomised controlled study aimed to investigate the effectiveness of a neuromuscular training-based exercise program on pain, function, risk factors specific to shoulder injuries and performance in overhead athletes with shoulder pain.
The main hypothesis is;
H0: There is no difference between the "Thrower's Ten" exercise program and the neuromuscular training-based exercise program applied to overhead athletes with shoulder pain, on pain, function, risk factors specific to shoulder injuries, and performance.
H1: The effects of a neuromuscular training-based exercise program on pain, function, risk factors specific to shoulder injuries and performance in overhead athletes with shoulder pain are superior to the effects of "Thrower's Ten" exercise program
Detailed description
Overhead athletes with shoulder pain who met the inclusion criteria applied to Yeditepe University Hospital Orthopedics and Traumatology Clinic for a randomized controlled study will be included to demonstrate the effectiveness of a neuromuscular training-based exercise program in overhead athletes with shoulder pain.
Athletes will be included in two different exercise programs (Thrower's Ten and Neuromuscular Training Based groups) by simple randomization.
Athletes evaluated by the orthopaedic surgeon will be included in the study if willing to participate in the rehabilitation program. The treatment program to be applied, hands-off treatment, was determined as exercise therapy. In our study, the athletes participating in the Neuromuscular Training-Based Exercise Program (Group 1) and the ''Thrower's Ten'' Exercise Program (Group 2) will participate in 24 physiotherapy sessions, three days a week, for eight weeks.
Before starting the treatment program, the participants' sociodemographic characteristics, comorbidities, dominant sides, sports histories, training routine (frequency/week, duration, etc.), and previous injury histories will be questioned with a structured evaluation form. Before randomization, a clinical examination for shoulder pain will be done by the orthopaedic surgeon. Pain intensity, pressure pain threshold, muscle tone, shoulder functional status, risk factors specific to shoulder injuries, sportive performance and kinesiophobia will be evaluated before treatment, at the end of the eight-week exercise program,
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Double blind (participant, outcomes assessor)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Neuromuscular Training-based Exercise Program Group | Experimental | Other: Neuromuscular Training-based Exercise ProgramPatient Education: Both groups will be given patient education on pain mechanism, posture/posture, exercise training, the role of the shoulder joint in shooting mechanics, situations, and positions to be avoided. Neuromuscular Training-based Exercise Program: This group will be given a neuromuscular training-based exercise program in a total of 24 physiotherapy sessions, 3 days a week, for eight weeks. In addition to shoulder strength, stabilization and kinetic chain exercises, this program includes internal and external focus (sound, touch, light, dual task, etc.), sport-specific exercises and plyometric exercises (speed, agility). |
| Thrower's Ten Exercise Program Group | Active comparator | Other: ''Thrower's Ten'' Exercise ProgramPatient Education: Both groups will be given patient education on pain mechanism, posture/posture, exercise training, the role of the shoulder joint in shooting mechanics, situations, and positions to be avoided. Thrower's Ten Exercise Program: This group will be given include Thrower's Ten Exercise Program in a total of 24 physiotherapy sessions, 3 days a week, for eight weeks. This program includes 10 different shoulder strengthening and shoulder stabilization exercises in a diagonal pattern. "Advanced Thrower's Ten" exercises that include kinetic chain exercises (covering more than one joint) in addition to shoulder exercises planned to be used in the late stages of rehabilitation into the program, progression is considered after the 3rd week will be added. |
Who may qualify
- Ages
- 18 to 35 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult
Key inclusion criteria (7 listed)
- Giving consent to be a volunteer for participating
- 18-35 years of age
- Athletes playing overhead sports like volleyball, water polo, tennis, baseball, cricket, swimming, badminton, and basketball for at least 2 days a week (Unilateral sports).
- Patients with unilateral shoulder pain lasting >6 weeks.
- Suitable and referred for conservative treatment by an orthopedist (non-surgical patients)
Key exclusion criteria (16 listed)
- Bilateral shoulder pain
- Having an acute shoulder pain
- Having a non-specific shoulder pain
- Reflected pain
- Having some severe shoulder patholojies such as adhesive capsulitis, osteoarthritis, rheumatoid arthritis, fracture, dislocation and instability
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Neuromuscular Training-based Exercise ProgramNeuromuscular training has been accepted as an effective treatment modality to improve the neurophysiological states of the joints for coordinated work. In addition to shoulder strength, stabilization and kinetic chain exercises, this program includes internal and external focus (sound, touch, light, dual task, etc.), sport-specific exercises and plyometric exercises (speed, agility). All athletes with shoulder pain will include in the baseline evaluation at the beginning of the season and all parameters will be followed throughout the season for 8 weeks. All athletes in this group will participate in a total of 24 physiotherapy sessions, 3 days a week, for eight weeks. | Other | Neuromuscular Training-based Exercise Program Group |
| ''Thrower's Ten'' Exercise Program''Thrower's Ten'' Exercise Program includes 10 different shoulder strengthening and shoulder stabilization exercises in a diagonal pattern. "Advanced Thrower's Ten" exercises that include kinetic chain exercises (covering more than one joint) in addition to shoulder exercises planned to be used in the late stages of rehabilitation into the program, progression is considered after the 3rd week will be added. All athletes with shoulder pain will include in the baseline evaluation at the beginning of the season and all parameters will be followed throughout the season for 8 weeks. All athletes in this group will participate in a total of 24 physiotherapy sessions, 3 days a week, for eight weeks. | Other | Thrower's Ten Exercise Program Group |
Primary outcome
Pain Assessment
Time frame: 8 weeks
Visual Analogue Scale will be used to evaluate the severity of pain felt around the shoulder joint. The location of the pain and the severity of the pain will be questioned. Participants will be asked to indicate pain severiy they felt (rest, activity and night) on a 10 cm horizontal line, ranging from 0 to 10. Zero shows no pain and 0 is intolerable pain. Pain intensity will be recorded by measuring the value of the marked place in cm. Higher values indicate more severe pain.
Disabilities of the Arm, Shoulder and Hand (DASH)
Time frame: 8 weeks
The Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire was used to evaluate status of shoulder function. It is a questionnaire that evaluates all upper extremity functions and consists of a total of thirty questions. 21 of the questions of the questionnaire question the ability to perform functional activities, 5 of them about pain and 4 of them about the psychosocial effects of the disease. Each question is scored using a 5-point Likert scale with a range of 1-5. The total score of the questionnaire varies between 0-100 points, higher scores indicate better functional status. DASH, which has a short completion time and moderate scoring ease, is a questionnaire that can be used in patients between the ages of 18-64.
5 secondary outcomes
Tampa Kinesiophobia Scale
Time frame: 8 weeks
Hylyght Injury Prevention and Return to the Sports Screening Program (
Time frame: 8 weeks
Y Balance Test- Upper Quarter
Time frame: 8 weeks
Closed Kinetic Chain Extremity Stability Test
Time frame: 8 weeks
Single Arm Seated Shot Put Test
Time frame: 8 weeks
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 4 Feb 2026.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Aslı Yeral, MSc principal investigator
Yeditepe University
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Neuromuscular Training-based Exercise Program and ''Thrower's Ten'' Exercise Program in people with Pain, Shoulder and Sports Physical Therapy, run by Yeditepe University at 1 site in Turkey (Türkiye).
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 7 inclusion and 16 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 4 Feb 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Turkey (Türkiye). Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Pain Assessment (time frame: 8 weeks). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 4 Feb 2026.