Shoulder InjurieswaterpoloNCT04202744

Are Alterations in Shoulder Rotations and Core Stability Effective for Water Polo Shoulder Problems?

An observational study of Shoulder Injuries and Sport Injury, run by Yeditepe University at 1 site in Turkey (Türkiye).

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Trial summary

Hypothesis of the clinical study: There are differences between the Water Polo Group and the Non-Water Polo Group in terms of shoulder parameters and core (lumbopelvic) parameters and there are differences between the throwing and non-throwing sides in terms of shoulder parameters in Water Polo Group. Read more about this study

Who is it for?: Ages 10 to 30 years, men only
Conditions the study is for: Shoulder Injuries, Sport Injury, Sports Physical Therapy
What is being tested?: Shoulder and core evaluations
Type of treatment: Pill or oral medicine
How many people: 82 participants
Where: 1 siteTurkey (Türkiye)
Study dates: 12 Mar 2019to 12 Jan 2020
Phase: Observational
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 10 to 30 years
Men only
Child, Adult

Study population: The study is comprised of 82 male participants: 43 of them were Water Polo players and the remaining 39 participants served as controls (non-Water Polo players).

Who may be able to join

Participating to the study in a voluntary basis.
Participant in ages between 10-30 years of age.
Parent permission for participants younger than 18
Giving consent for older than 18

Who cannot join

Having a history of orthopaedic surgery in the shoulder girdle within the last 6 months
Having a history of fracture within the shoulder girdle complex
Having a shoulder problem within the last 6 months continuing more than 3 months
Having a history of pathology in lumbar area within the last 6 months

Trial locations and contacts

1 site in 1 country.

Turkey (Türkiye)1 site

Yeditepe University
Istanbul

Other trials in Turkey (Türkiye)

About this study

Conditions: Shoulder Injuries, Sport Injury, Sports Physical Therapy
Being tested: Shoulder and core evaluations
Medical subject headings: Shoulder Injuries

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

Shoulder and core evaluationsOther
Five main parameters of the shoulder were assessed: the flexibility of pectoralis minor muscle, tightness of the posterior shoulder capsule, glenohumeral range of motion of internal and external rotation (sum of internal and external rotation: total range of motion), the strength of rotator cuff muscles and scapula position. As core parameters, trunk muscle endurance (flexor, extensor, and laterals) and core stability were evaluated.

Study groups in NCT04202744
Study group	Role	What they receive
Water Polo Group		Participants were active water polo players who train regularly with ages in between 10-30 years. Five main parameters of the shoulder were assessed: the flexibility of pectoralis minor muscle, tightness of the posterior shoulder capsule, glenohumeral range of motion of internal and external rotation (sum of internal and external rotation: total range of motion), the strength of rotator cuff muscles and scapula position. As core parameters, trunk muscle endurance (flexor, extensor, and laterals) and core stability were evaluated. Receives: Other: Shoulder and core evaluations
Non-Water Polo Group		Participants who do not engage in overhead sports with ages in between 10-30 years. Five main parameters of the shoulder were assessed: the flexibility of pectoralis minor muscle, tightness of the posterior shoulder capsule, glenohumeral range of motion of internal and external rotation (sum of internal and external rotation: total range of motion), the strength of rotator cuff muscles and scapula position. As core parameters, trunk muscle endurance (flexor, extensor, and laterals) and core stability were evaluated. Receives: Other: Shoulder and core evaluations

What is being measured

The primary outcome is the main question the study is designed to answer.

Shoulder Internal and External Rotation Range of Motion Measurement
Glenohumeral rotations were assessed with the subject lying supine with their shoulder in 90° abduction, 90° elbow flexion and the forearm pronated. Shoulder and elbow alignment were provided with the help of the towel. For external rotation, the goniometer's axis was placed on olecranon process of ulna, the stationary arm was placed perpendicular to the floor and moving arm was placed on ulnar border of forearm toward ulnar styloid process. For internal rotation, the goniometer's axis was positioned on the same area. Then, its stationary arm was positioned perpendicular to the floor and the moving arm was placed on ulnar border of forearm toward ulnar styloid process. The angle was recorded in degrees, three trials were performed and the average taken. Subjects were evaluated by the same physiotherapist to control measurement error.
Measured: 5 minutes
Posterior Shoulder Capsule Tightness
Goniometer measurement of horizontal adduction (Add) angle was used for Posterior shoulder tightness (PST). Shoulder was 90° of abduction (Abd) and elbow was flexed 90° of flexion in supine position. The scapula was stabilized using the thenar part of hand on the lateral edge of the scapula and the other hand was used to move the arm in horizontal Add. The goniometer's axis was placed on Acromioclavicular joint (ACJ), the stationary arm was directed parallel to the ground and the goniometer's mobile arm was placed on lateral epicondyle of the humerus. No scapular protraction and elevation were allowed. Shoulders with a smaller horizontal abduction angle showed a stiffness of posterior capsule.
Measured: 5 minutes
Shoulder Strength Assessment
Maximum isometric shoulder rotation strengths were evaluated using a hand-held dynamometer (HHD) with all measurements recorded in newton meter. The arm was positioned at 45° of abduction, elbow was flexed to 90° and shoulder was at 30° of horizontal adduction. For evaluation of internal rotation strength, the HHD was located on the volar side of the wrist 2 cm proximal to the radial styloid and on the dorsal aspect for testing of external rotation strength. To evaluate external rotation strength, the subject was instructed to externally rotate the examining shoulder against HHD while the humerus was stabilized; under same circumstances to measure internal rotation strength the subject was instructed to internally rotated. Subjects were instructed to perform isometric contraction for 5 seconds during the test. Between maximal isometric contractions, 30 seconds of resting intervals were given. The average values of the three trials were taken.
Measured: 10 minutes
Trunk Muscles Endurance Test - (McGill Trunk Endurance Test)
For endurance of the trunk extensors, subjects were positioned in prone lying with spina iliaca anterior superior level over the edge of the treatment table and their body were stabilized by straps. The upper body was supported by hands before initiation of the test. With the initiation of the test, hands were crossed across their chest and start to keep their upper body parallel to the ground. During the test, participants were instructed to maintain the horizontal position as long as possible. For trunk lateral flexors, subjects were side-lying position on the exercise mat with extended legs and arm must be in full contact with the body. As soon as the participants lift the hips, the test was initiated. Subjects were instructed to maintain a straight line along with the vertebrae by controlling lateral flexor muscles of the trunk as long as possible. The lateral flexors were assessed on both sides.
Measured: 15 minutes

Secondary outcomes (2)

Shoulder Pectoralis Minor Muscle Length
Pectoralis Minor muscle flexibility decision was measuring distance between the acromion of the scapula and examination table by tape in supine, when both shoulders were in loose position. Elbow flexion was obtained by using a towel for reducing the activity of Biceps Brachii and the Coracobrachialis muscles. The absence of anterior tilt of the shoulder was considered as normal.
Measured: 5 minutes
Sahrmann Core Stability Test
Pressure Biofeedback Unit was positioned on under lumbar spine (level of L2 and L3 vertebrae) and the pressure level of the bio-feedback unit was inflated to 40 mm-Hg. Subjects were instructed to maintain pressure 40 mm Hg ±10 during the all test levels. The test consists of 5 levels and increasingly difficult with each level. The scoring of the test was performed in proportional increments of the test levels. To progress through the levels, core stability must be sustained with no more than a 10 mm Hg increase or decrease in pressure.
Measured: 10 minutes

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

12 Mar 201912 Jan 2020

First posted18 Dec 2019
Study start12 Mar 2019
Primary completion12 Jul 2019
Study completion12 Jan 2020

Resources

Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
Publications (19)Papers the sponsor has linked to this study.
Other trials for Shoulder InjuriesStudies 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: Observational
Observational model: Case-control
Time perspective: Cross-sectional
Enrolment: 82 participants (actual)

IDs, dates and publications

ClinicalTrials.gov ID: NCT04202744
Sponsor's protocol ID: Yeditepe
Acronym: waterpolo
Status last verified: Jul 2026
First submitted: 15 Dec 2019
Last updated: 14 Jul 2026
Results posted: No
Data monitoring committee: No
FDA-regulated drug: No
FDA-regulated device: No
Individual data sharing: No

Publications

Mosler A, Whiteley R. Keeping the water polo player out of the clinic and in the water. Sport Med. 2000:434-439.
Snyder P. Water polo for players: teachers of aquatics. USA: LA84 Foundation; 2008.
Egan T. Water polo: rules, tips, strategy, and safety. New York, NY: The Rosen Publishing Group; 2004.
Giannouris Y. 150 years of Water Polo. https://www.fina.org/ Accessed May 5, 2019.
Miller AH, Evans K, Adams R, Waddington G, Witchalls J. Shoulder injury in water polo: A systematic review of incidence and intrinsic risk factors. J Sci Med Sport. 2018 Apr;21(4):368-377. doi: 10.1016/j.jsams.2017.08.015. Epub 2017 Aug 31.
PubMed 28919494
Benjamin N. The injury and posture profiles of male high school of male high school water polo players in Johannesburg. African J Phys Heal Educ Recreat Danc. 2014;20(1): 179-188.
Spittler J, Keeling J. Water Polo Injuries and Training Methods. Curr Sports Med Rep. 2016 Nov/Dec;15(6):410-416. doi: 10.1249/JSR.0000000000000305.
PubMed 27841812
Sanders RH. Analysis of the eggbeater kick used to maintain height in water polo. J Appl Biomech. 1999;15(3):284-291.
Webster MJ, Morris ME, Galna B. Shoulder pain in water polo: a systematic review of the literature. J Sci Med Sport. 2009 Jan;12(1):3-11. doi: 10.1016/j.jsams.2007.05.014. Epub 2007 Sep 21.
PubMed 17889614
Colville JM, Markman BS. Competitive water polo. Upper extremity injuries. Clin Sports Med. 1999 Apr;18(2):305-12, vi. doi: 10.1016/s0278-5919(05)70146-0.
PubMed 10230566
Pogetti LS, Nakagawa TH, Contecote GP, Camargo PR. Core stability, shoulder peak torque and function in throwing athletes with and without shoulder pain. Phys Ther Sport. 2018 Nov;34:36-42. doi: 10.1016/j.ptsp.2018.08.008. Epub 2018 Aug 17.
PubMed 30145541
Kibler WB, Press J, Sciascia A. The role of core stability in athletic function. Sports Med. 2006;36(3):189-98. doi: 10.2165/00007256-200636030-00001.
PubMed 16526831
Huxel Bliven KC, Anderson BE. Core stability training for injury prevention. Sports Health. 2013 Nov;5(6):514-22. doi: 10.1177/1941738113481200.
PubMed 24427426
Hibbs AE, Thompson KG, French D, Wrigley A, Spears I. Optimizing performance by improving core stability and core strength. Sports Med. 2008;38(12):995-1008. doi: 10.2165/00007256-200838120-00004.
PubMed 19026017
Marcondes FB, de Jesus JF, Bryk FF, de Vasconcelos RA, Fukuda TY. Posterior shoulder tightness and rotator cuff strength assessments in painful shoulders of amateur tennis players. Braz J Phys Ther. 2013 Mar-Apr;17(2):185-94. doi: 10.1590/S1413-35552012005000079.
PubMed 23778770

Want to know more?

The sponsor has not listed a contact. The official record may have more details.

Talk to your doctor first and take this page with you. Only the study team can confirm whether you can join.

Questions to ask the study team

What is the study trying to find out?
What would I need to do, and how often would I visit?
Could I receive a placebo instead of the treatment?
What are the possible risks and benefits for me?
Will it cost me anything? Are travel or time paid for?
Can I keep seeing my own doctor during the study?
What happens when the study ends?

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All Shoulder Injuries trials

Study at a glance

From the registry record, last updated by the sponsor on 14 Jul 2026. Recruitment status is as the sponsor reported it: confirm with the study team.

Official title: Are Alterations in Shoulder Rotations and Core Stability Effective for Water Polo Shoulder Problems?
ClinicalTrials.gov ID: NCT04202744
Acronym / sponsor ID: waterpolo / Yeditepe
Conditions: Shoulder Injuries, Sport Injury, Sports Physical Therapy
Study type: Observational
Recruitment status: Completed
Enrolment: 82 participants (actual)
Lead sponsor: Yeditepe UniversityUniversity, hospital or other
Collaborators: Yeditepe University Hospital
Study start: 12 Mar 2019 (actual)
Primary completion: 12 Jul 2019 (actual)
Study completion: 12 Jan 2020 (actual)
First posted: 18 Dec 2019 (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.

Study design

Observational model: Case-control
Time perspective: Cross-sectional
Number of arms: 2

Arm	Type	Receives
Water Polo Group	–	Other: Shoulder and core evaluationsParticipants were active water polo players who train regularly with ages in between 10-30 years. Five main parameters of the shoulder were assessed: the flexibility of pectoralis minor muscle, tightness of the posterior shoulder capsule, glenohumeral range of motion of internal and external rotation (sum of internal and external rotation: total range of motion), the strength of rotator cuff muscles and scapula position. As core parameters, trunk muscle endurance (flexor, extensor, and laterals) and core stability were evaluated.
Non-Water Polo Group	–	Other: Shoulder and core evaluationsParticipants who do not engage in overhead sports with ages in between 10-30 years. Five main parameters of the shoulder were assessed: the flexibility of pectoralis minor muscle, tightness of the posterior shoulder capsule, glenohumeral range of motion of internal and external rotation (sum of internal and external rotation: total range of motion), the strength of rotator cuff muscles and scapula position. As core parameters, trunk muscle endurance (flexor, extensor, and laterals) and core stability were evaluated.

Who may qualify

Ages: 10 to 30 years
Sex: Male only
Age groups: Child, Adult
Study population: The study is comprised of 82 male participants: 43 of them were Water Polo players and the remaining 39 participants served as controls (non-Water Polo players).

Key inclusion criteria (4 listed)

Participating to the study in a voluntary basis.
Participant in ages between 10-30 years of age.
Parent permission for participants younger than 18
Giving consent for older than 18

Key exclusion criteria (4 listed)

Having a history of orthopaedic surgery in the shoulder girdle within the last 6 months
Having a history of fracture within the shoulder girdle complex
Having a shoulder problem within the last 6 months continuing more than 3 months
Having a history of pathology in lumbar area within the last 6 months

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
Shoulder and core evaluationsFive main parameters of the shoulder were assessed: the flexibility of pectoralis minor muscle, tightness of the posterior shoulder capsule, glenohumeral range of motion of internal and external rotation (sum of internal and external rotation: total range of motion), the strength of rotator cuff muscles and scapula position. As core parameters, trunk muscle endurance (flexor, extensor, and laterals) and core stability were evaluated.	Other	Non-Water Polo Group, Water Polo Group

Primary outcome

Shoulder Internal and External Rotation Range of Motion Measurement
Time frame: 5 minutes
Glenohumeral rotations were assessed with the subject lying supine with their shoulder in 90° abduction, 90° elbow flexion and the forearm pronated. Shoulder and elbow alignment were provided with the help of the towel. For external rotation, the goniometer's axis was placed on olecranon process of ulna, the stationary arm was placed perpendicular to the floor and moving arm was placed on ulnar border of forearm toward ulnar styloid process. For internal rotation, the goniometer's axis was positioned on the same area. Then, its stationary arm was positioned perpendicular to the floor and the moving arm was placed on ulnar border of forearm toward ulnar styloid process. The angle was recorded in degrees, three trials were performed and the average taken. Subjects were evaluated by the same physiotherapist to control measurement error.
Posterior Shoulder Capsule Tightness
Time frame: 5 minutes
Goniometer measurement of horizontal adduction (Add) angle was used for Posterior shoulder tightness (PST). Shoulder was 90° of abduction (Abd) and elbow was flexed 90° of flexion in supine position. The scapula was stabilized using the thenar part of hand on the lateral edge of the scapula and the other hand was used to move the arm in horizontal Add. The goniometer's axis was placed on Acromioclavicular joint (ACJ), the stationary arm was directed parallel to the ground and the goniometer's mobile arm was placed on lateral epicondyle of the humerus. No scapular protraction and elevation were allowed. Shoulders with a smaller horizontal abduction angle showed a stiffness of posterior capsule.
Shoulder Strength Assessment
Time frame: 10 minutes
Maximum isometric shoulder rotation strengths were evaluated using a hand-held dynamometer (HHD) with all measurements recorded in newton meter. The arm was positioned at 45° of abduction, elbow was flexed to 90° and shoulder was at 30° of horizontal adduction. For evaluation of internal rotation strength, the HHD was located on the volar side of the wrist 2 cm proximal to the radial styloid and on the dorsal aspect for testing of external rotation strength. To evaluate external rotation strength, the subject was instructed to externally rotate the examining shoulder against HHD while the humerus was stabilized; under same circumstances to measure internal rotation strength the subject was instructed to internally rotated. Subjects were instructed to perform isometric contraction for 5 seconds during the test. Between maximal isometric contractions, 30 seconds of resting intervals were given. The average values of the three trials were taken.
Trunk Muscles Endurance Test - (McGill Trunk Endurance Test)
Time frame: 15 minutes
For endurance of the trunk extensors, subjects were positioned in prone lying with spina iliaca anterior superior level over the edge of the treatment table and their body were stabilized by straps. The upper body was supported by hands before initiation of the test. With the initiation of the test, hands were crossed across their chest and start to keep their upper body parallel to the ground. During the test, participants were instructed to maintain the horizontal position as long as possible. For trunk lateral flexors, subjects were side-lying position on the exercise mat with extended legs and arm must be in full contact with the body. As soon as the participants lift the hips, the test was initiated. Subjects were instructed to maintain a straight line along with the vertebrae by controlling lateral flexor muscles of the trunk as long as possible. The lateral flexors were assessed on both sides.

2 secondary outcomes

Shoulder Pectoralis Minor Muscle Length
Time frame: 5 minutes
Sahrmann Core Stability Test
Time frame: 10 minutes

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 14 Jul 2026.
BackgroundMosler A, Whiteley R. Keeping the water polo player out of the clinic and in the water. Sport Med. 2000:434-439.
BackgroundSnyder P. Water polo for players: teachers of aquatics. USA: LA84 Foundation; 2008.
BackgroundEgan T. Water polo: rules, tips, strategy, and safety. New York, NY: The Rosen Publishing Group; 2004.
BackgroundGiannouris Y. 150 years of Water Polo. https://www.fina.org/ Accessed May 5, 2019.
Background: PubMed 28919494Miller AH, Evans K, Adams R, Waddington G, Witchalls J. Shoulder injury in water polo: A systematic review of incidence and intrinsic risk factors. J Sci Med Sport. 2018 Apr;21(4):368-377. doi: 10.1016/j.jsams.2017.08.015. Epub 2017 Aug 31.
BackgroundBenjamin N. The injury and posture profiles of male high school of male high school water polo players in Johannesburg. African J Phys Heal Educ Recreat Danc. 2014;20(1): 179-188.
Background: PubMed 27841812Spittler J, Keeling J. Water Polo Injuries and Training Methods. Curr Sports Med Rep. 2016 Nov/Dec;15(6):410-416. doi: 10.1249/JSR.0000000000000305.
BackgroundSanders RH. Analysis of the eggbeater kick used to maintain height in water polo. J Appl Biomech. 1999;15(3):284-291.
Background: PubMed 17889614Webster MJ, Morris ME, Galna B. Shoulder pain in water polo: a systematic review of the literature. J Sci Med Sport. 2009 Jan;12(1):3-11. doi: 10.1016/j.jsams.2007.05.014. Epub 2007 Sep 21.
Background: PubMed 10230566Colville JM, Markman BS. Competitive water polo. Upper extremity injuries. Clin Sports Med. 1999 Apr;18(2):305-12, vi. doi: 10.1016/s0278-5919(05)70146-0.
Background: PubMed 30145541Pogetti LS, Nakagawa TH, Contecote GP, Camargo PR. Core stability, shoulder peak torque and function in throwing athletes with and without shoulder pain. Phys Ther Sport. 2018 Nov;34:36-42. doi: 10.1016/j.ptsp.2018.08.008. Epub 2018 Aug 17.
Background: PubMed 16526831Kibler WB, Press J, Sciascia A. The role of core stability in athletic function. Sports Med. 2006;36(3):189-98. doi: 10.2165/00007256-200636030-00001.
Individual participant dataSharing planned: No

Related trials for Shoulder Injuries

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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.

The record lists no contact. Use the official record to reach the sponsor.

1 site in 1 country: see every site and its status.

Questions about this trial

What is this clinical trial studying?

An observational study of Shoulder Injuries and Sport Injury, 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 4 inclusion and 4 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 14 Jul 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?

Shoulder Internal and External Rotation Range of Motion Measurement (time frame: 5 minutes). The study lists 4 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT04202744, which also lists 19 linked publications.

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 14 Jul 2026; AzTrials last refreshed its copy on 26 Oct 2026.