Case Report
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Effects of A Progressive Rehabilitation Program on Shoulder Internal Rotation Range of Motion, Acromiohumeral Distance, And Pain in An Adolescent Female Swimmer with Subacromial Pain (Impingement) Syndrome

Year 2022, Volume: 5 Issue: 1, 56 - 65, 20.06.2022

Sevgi Sevi Yesılyaprak Halime Ezgi Türksan Damla Karabay

https://doi.org/10.33438/ijdshs.1041097
Cited By: 1

Abstract

Shoulder injuries are common in competitive youth swimmers because of sport-specific changes in upper extremity physical characteristics and acromio-humeral distance (AHD). These physical alterations could cause abnormal scapular kinematics and positioning. Subacromial pain syndrome (SPS), scapular dyskinesis, and SLAP lesions require a multiphase approach. A 14-years-old female athlete who has been swimming for 7 years had SPS symptoms for 14 months. She also had scapular dyskinesis and suspected SLAP lesion. She received 15 treatment sessions. We conducted a progressive and comprehensive rehabilitation program consisting of electrotherapy, thermal agent, mobilization techniques, posterior shoulder stretching exercises, upper and lower extremity strengthening, proprioception, scapular stabilization, and core stabilization exercises, rhythmic stabilization exercises, plyometric exercises, and the advanced thrower’s 10 program. Internal rotation range of motion (IRROM) with bubble inclinometer, pain with Visual Analog Scale, and AHD with ultrasonographic imaging were assessed before treatment and at the end of the 9th and 15th treatment sessions. Before treatment, IRROM was 52°, AHD was 10.67 mm, and pain intensity at rest and during swimming was 0 and 3.1 cm, respectively. After 9 treatment sessions, IRROM was 55.6°, AHD was 11.62 mm, pain intensity at rest and during swimming was 3.7 cm and 5.1 cm, respectively. At the end of the treatment, IRROM was 58.33°, AHD was 12.02 mm, pain intensity at rest and during swimming was 0 cm. A progressive and challenging rehabilitation program may positively change the scapular and glenohumeral kinematic patterns leading to an increase in AHD and IRROM, therefore a decrease in pain.

Keywords

Subacromial Pain Syndrome SLAP Lesion Scapular Dyskinesis Swimmer Physical Therapy Rehabilitation Ultrasonography

References

  • Atalar, H., Yilmaz, C., Polat, O., Selek, H., Uraş, I., & Yanik, B. (2009). Restricted scapular mobility during arm abduction: implications for impingement syndrome. Acta Orthop Belg, 75(1), 19-24.
  • Bak, K. (2010). The practical management of swimmer's painful shoulder: etiology, diagnosis, and treatment. Clin J Sport Med, 20(5), 386-390.
  • Bak, K., & Faunø, P. (1997). Clinical findings in competitive swimmers with shoulder pain. Am J Sports Med, 25(2), 254-260.
  • Burkhart, S. S., Morgan, C.D., & Kibler, W. B. (2003). The disabled throwing shoulder: spectrum of pathology Part I: pathoanatomy and biomechanics. Arthroscopy, 19(4), 404-420.
  • Clark, P., Lavielle, P., & Martínez, H. (2003). Learning from pain scales: patient perspective. J Rheumatol, 30(7), 1584-1588.
  • De Martino, I., & Rodeo, S. A. (2018). The Swimmer's Shoulder: Multi-directional Instability. Curr Rev Musculoskelet Med, 11(2), 167-171.
  • Desmeules, F., Minville, L., Riederer, B., Côté, C. H., & Frémont, P. (2004). Acromio-humeral distance variation measured by ultrasonography and its association with the outcome of rehabilitation for shoulder impingement syndrome. Clin J Sport Med, 14(4), 197-205.
  • Harryman, D.T., 2nd, Sidles, J.A., Clark, J. M., McQuade, K.J., Gibb, T.D., & Matsen, F. A., 3rd. (1990). Translation of the humeral head on the glenoid with passive glenohumeral motion. J Bone Joint Surg Am, 72(9), 1334-1343.
  • Harshbarger, N.D., Eppelheimer, B.L., Valovich McLeod, T.C., & Welch McCarty, C. (2013). The effectiveness of shoulder stretching and joint mobilizations on posterior shoulder tightness. J Sport Rehabil, 22(4), 313-319.
  • Hibberd, E.E., Laudner, K., Berkoff, D.J., Kucera, K.L., Yu, B., & Myers, J.B. (2016). Comparison of Upper Extremity Physical Characteristics Between Adolescent Competitive Swimmers and Nonoverhead Athletes. J Athl Train, 51(1), 65-69.
  • Hibberd, E.E., Laudner, K.G., Kucera, K. L., Berkoff, D.J., Yu, B., & Myers, J. B. (2016). Effect of Swim Training on the Physical Characteristics of Competitive Adolescent Swimmers. Am J Sports Med, 44(11), 2813-2819.
  • Jobe, C.M., Coen, M.J., & Screnar, P. (2000). Evaluation of impingement syndromes in the overhead-throwing athlete. J Athl Train, 35(3), 293-299.
  • Kenal, K.A., & Knapp, L.D. (1996). Rehabilitation of injuries in competitive swimmers. Sports Med, 22(5), 337-347.
  • Kibler, W.B., Kuhn, J. E., Wilk, K., Sciascia, A., Moore, S., & Laudner, K. (2013). The disabled throwing shoulder: spectrum of pathology-10-year update. Arthroscopy, 29(1), 141-161.e126.
  • Kibler, W.B., McMullen, J., & Uhl, T. (2001). Shoulder rehabilitation strategies, guidelines, and practice. Orthop Clin North Am, 32(3), 527-538.
  • Kibler, W.B., Sciascia, A., & Thomas, S. J. (2012). Glenohumeral internal rotation deficit: pathogenesis and response to acute throwing. Sports Med Arthrosc Rev, 20(1), 34-38.
  • Kolber, M.J., & Hanney, W.J. (2010). The reliability, minimal detectable change and construct validity of a clinical measurement for identifying posterior shoulder tightness. N Am J Sports Phys Ther, 5(4), 208-219.
  • Ludewig, P.M., & Cook, T.M. (2000). Alterations in shoulder kinematics and associated muscle activity in people with symptoms of shoulder impingement. Phys Ther, 80(3), 276-291.
  • Lukasiewicz, A.C., McClure, P., Michener, L., Pratt, N., & Sennett, B. (1999). Comparison of 3-dimensional scapular position and orientation between subjects with and without shoulder impingement. J Orthop Sports Phys Ther, 29(10), 574-583; discussion 584-576.
  • Luque-Suarez, A., Navarro-Ledesma, S., Petocz, P., Hancock, M.J., & Hush, J. (2013). Short term effects of kinesiotaping on acromiohumeral distance in asymptomatic subjects: a randomised controlled trial. Man Ther, 18(6), 573-577.
  • Maenhout, A., Van Eessel, V., Van Dyck, L., Vanraes, A., & Cools, A. (2012). Quantifying acromiohumeral distance in overhead athletes with glenohumeral internal rotation loss and the influence of a stretching program. Am J Sports Med, 40(9), 2105-2112.
  • Manske, R., Wilk, K.E., Davies, G., Ellenbecker, T., & Reinold, M. (2013). Glenohumeral motion deficits: friend or foe? Int J Sports Phys Ther, 8(5), 537-553.
  • Manske, R.C., Meschke, M., Porter, A., Smith, B., & Reiman, M. (2010). A randomized controlled single-blinded comparison of stretching versus stretching and joint mobilization for posterior shoulder tightness measured by internal rotation motion loss. Sports Health, 2(2), 94-100.
  • McClure, P., Balaicuis, J., Heiland, D., Broersma, M.E., Thorndike, C.K., & Wood, A. (2007). A randomized controlled comparison of stretching procedures for posterior shoulder tightness. J Orthop Sports Phys Ther, 37(3), 108-114.
  • McCreesh, K.M., Purtill, H., Donnelly, A.E., & Lewis, J. S. (2017). Increased supraspinatus tendon thickness following fatigue loading in rotator cuff tendinopathy: potential implications for exercise therapy. BMJ Open Sport Exerc Med, 3(1), e000279.
  • McFarland, E.G., & Wasik, M. (1996). Injuries in female collegiate swimmers due to swimming and cross training. Clin J Sport Med, 6(3), 178-182.
  • Muraki, T., Yamamoto, N., Zhao, K.D., Sperling, J. W., Steinmann, S. P., Cofield, R.H., & An, K.-N. J. J. o. s. (2012). Effects of posterior capsule tightness on subacromial contact behavior during shoulder motions. Journal of shoulder elbow surgery 21(9), 1160-1167.
  • Navarro-Ledesma, S., Struyf, F., Labajos-Manzanares, M.T., Fernandez-Sanchez, M., Morales-Asencio, J. M., & Luque-Suarez, A. (2017). Does the acromiohumeral distance matter in chronic rotator cuff related shoulder pain? Musculoskelet Sci Pract, 29, 38-42.
  • Park, S. W., Chen, Y.T., Thompson, L., Kjoenoe, A., Juul-Kristensen, B., Cavalheri, V., & McKenna, L. (2020). No relationship between the acromiohumeral distance and pain in adults with subacromial pain syndrome: a systematic review and meta-analysis. Sci Rep, 10(1), 20611.
  • Porter, K.N., Blanch, P.D., Walker, H.M., & Shield, A. J. (2020). The effect of previous shoulder pain on supraspinatus tendon thickness changes following swimming practice. Scand J Med Sci Sports, 30(8), 1442-1448.
  • Reagan, K.M., Meister, K., Horodyski, M. B., Werner, D.W., Carruthers, C., & Wilk, K. (2002). Humeral retroversion and its relationship to glenohumeral rotation in the shoulder of college baseball players. Am J Sports Med, 30(3), 354-360.
  • Riley, G.P., Harrall, R.L., Constant, C.R., Chard, M. D., Cawston, T. E., & Hazleman, B. L. (1994). Glycosaminoglycans of human rotator cuff tendons: changes with age and in chronic rotator cuff tendinitis. Ann Rheum Dis, 53(6), 367-376.
  • Sajadi, N., Alizadeh, M.H., Barati, A.H., & Minoonejad, H. (2019). Effect of Selected Corrective Exercises on Glenohumeral Internal Rotation in Female Adolescent Swimmers with Scapular Dyskinesis. J Annals of Military Health Sciences Research, 17(4).
  • Silva, R.T., Hartmann, L.G., Laurino, C.F., & Biló, J.P. (2010). Clinical and ultrasonographic correlation between scapular dyskinesia and subacromial space measurement among junior elite tennis players. Br J Sports Med, 44(6), 407-410.
  • Solem-Bertoft, E., Thuomas, K.A., & Westerberg, C.E. (1993). The influence of scapular retraction and protraction on the width of the subacromial space. An MRI study. Clin Orthop Relat Res(296), 99-103.
  • Su, K.P., Johnson, M.P., Gracely, E.J., & Karduna, A.R. (2004). Scapular rotation in swimmers with and without impingement syndrome: practice effects. Med Sci Sports Exerc, 36(7), 1117-1123.
  • Tahran, Ö., & Yeşilyaprak, S. S. (2020). Effects of Modified Posterior Shoulder Stretching Exercises on Shoulder Mobility, Pain, and Dysfunction in Patients With Subacromial Impingement Syndrome. Sports Health, 12(2), 139-148.
  • Torres, R. R., & Gomes, J. L. (2009). Measurement of glenohumeral internal rotation in asymptomatic tennis players and swimmers. Am J Sports Med, 37(5), 1017-1023.
  • Tyler, T.F., Nicholas, S.J., Roy, T., & Gleim, G. W. (2000). Quantification of posterior capsule tightness and motion loss in patients with shoulder impingement. Am J Sports Med, 28(5), 668-673.
  • Weldon, E.J., 3rd, & Richardson, A.B. (2001). Upper extremity overuse injuries in swimming. A discussion of swimmer's shoulder. Clin Sports Med, 20(3), 423-438.
  • Wilk, K.E., & Arrigo, C. (1993). Current concepts in the rehabilitation of the athletic shoulder. J Orthop Sports Phys Ther, 18(1), 365-378.
  • Wilk, K. E., Hooks, T. R., & Macrina, L.C. (2013). The modified sleeper stretch and modified cross-body stretch to increase shoulder internal rotation range of motion in the overhead throwing athlete. J Orthop Sports Phys Ther, 43(12), 891-894.
  • Wilk, K.E., Yenchak, A.J., Arrigo, C.A., & Andrews, J.R. (2011). The Advanced Throwers Ten Exercise Program: a new exercise series for enhanced dynamic shoulder control in the overhead throwing athlete. Phys Sportsmed, 39(4), 90-97.
  • Yamauchi, T., Hasegawa, S., Nakamura, M., Nishishita, S., Yanase, K., & Fujita, K. (2016). Effects of two stretching methods on shoulder range of motion and muscle stiffness in baseball players with posterior shoulder tightness: a randomized controlled trial. J Shoulder Elbow Surg, 25(9), 1395-1403.
  • Yanai, T., & Hay, J.G. (2000). Shoulder impingement in front-crawl swimming: II. Analysis of stroking technique. Med Sci Sports Exerc, 32(1), 30-40.

Year 2022, Volume: 5 Issue: 1, 56 - 65, 20.06.2022

Sevgi Sevi Yesılyaprak Halime Ezgi Türksan Damla Karabay

https://doi.org/10.33438/ijdshs.1041097
Cited By: 1

Abstract

References

  • Atalar, H., Yilmaz, C., Polat, O., Selek, H., Uraş, I., & Yanik, B. (2009). Restricted scapular mobility during arm abduction: implications for impingement syndrome. Acta Orthop Belg, 75(1), 19-24.
  • Bak, K. (2010). The practical management of swimmer's painful shoulder: etiology, diagnosis, and treatment. Clin J Sport Med, 20(5), 386-390.
  • Bak, K., & Faunø, P. (1997). Clinical findings in competitive swimmers with shoulder pain. Am J Sports Med, 25(2), 254-260.
  • Burkhart, S. S., Morgan, C.D., & Kibler, W. B. (2003). The disabled throwing shoulder: spectrum of pathology Part I: pathoanatomy and biomechanics. Arthroscopy, 19(4), 404-420.
  • Clark, P., Lavielle, P., & Martínez, H. (2003). Learning from pain scales: patient perspective. J Rheumatol, 30(7), 1584-1588.
  • De Martino, I., & Rodeo, S. A. (2018). The Swimmer's Shoulder: Multi-directional Instability. Curr Rev Musculoskelet Med, 11(2), 167-171.
  • Desmeules, F., Minville, L., Riederer, B., Côté, C. H., & Frémont, P. (2004). Acromio-humeral distance variation measured by ultrasonography and its association with the outcome of rehabilitation for shoulder impingement syndrome. Clin J Sport Med, 14(4), 197-205.
  • Harryman, D.T., 2nd, Sidles, J.A., Clark, J. M., McQuade, K.J., Gibb, T.D., & Matsen, F. A., 3rd. (1990). Translation of the humeral head on the glenoid with passive glenohumeral motion. J Bone Joint Surg Am, 72(9), 1334-1343.
  • Harshbarger, N.D., Eppelheimer, B.L., Valovich McLeod, T.C., & Welch McCarty, C. (2013). The effectiveness of shoulder stretching and joint mobilizations on posterior shoulder tightness. J Sport Rehabil, 22(4), 313-319.
  • Hibberd, E.E., Laudner, K., Berkoff, D.J., Kucera, K.L., Yu, B., & Myers, J.B. (2016). Comparison of Upper Extremity Physical Characteristics Between Adolescent Competitive Swimmers and Nonoverhead Athletes. J Athl Train, 51(1), 65-69.
  • Hibberd, E.E., Laudner, K.G., Kucera, K. L., Berkoff, D.J., Yu, B., & Myers, J. B. (2016). Effect of Swim Training on the Physical Characteristics of Competitive Adolescent Swimmers. Am J Sports Med, 44(11), 2813-2819.
  • Jobe, C.M., Coen, M.J., & Screnar, P. (2000). Evaluation of impingement syndromes in the overhead-throwing athlete. J Athl Train, 35(3), 293-299.
  • Kenal, K.A., & Knapp, L.D. (1996). Rehabilitation of injuries in competitive swimmers. Sports Med, 22(5), 337-347.
  • Kibler, W.B., Kuhn, J. E., Wilk, K., Sciascia, A., Moore, S., & Laudner, K. (2013). The disabled throwing shoulder: spectrum of pathology-10-year update. Arthroscopy, 29(1), 141-161.e126.
  • Kibler, W.B., McMullen, J., & Uhl, T. (2001). Shoulder rehabilitation strategies, guidelines, and practice. Orthop Clin North Am, 32(3), 527-538.
  • Kibler, W.B., Sciascia, A., & Thomas, S. J. (2012). Glenohumeral internal rotation deficit: pathogenesis and response to acute throwing. Sports Med Arthrosc Rev, 20(1), 34-38.
  • Kolber, M.J., & Hanney, W.J. (2010). The reliability, minimal detectable change and construct validity of a clinical measurement for identifying posterior shoulder tightness. N Am J Sports Phys Ther, 5(4), 208-219.
  • Ludewig, P.M., & Cook, T.M. (2000). Alterations in shoulder kinematics and associated muscle activity in people with symptoms of shoulder impingement. Phys Ther, 80(3), 276-291.
  • Lukasiewicz, A.C., McClure, P., Michener, L., Pratt, N., & Sennett, B. (1999). Comparison of 3-dimensional scapular position and orientation between subjects with and without shoulder impingement. J Orthop Sports Phys Ther, 29(10), 574-583; discussion 584-576.
  • Luque-Suarez, A., Navarro-Ledesma, S., Petocz, P., Hancock, M.J., & Hush, J. (2013). Short term effects of kinesiotaping on acromiohumeral distance in asymptomatic subjects: a randomised controlled trial. Man Ther, 18(6), 573-577.
  • Maenhout, A., Van Eessel, V., Van Dyck, L., Vanraes, A., & Cools, A. (2012). Quantifying acromiohumeral distance in overhead athletes with glenohumeral internal rotation loss and the influence of a stretching program. Am J Sports Med, 40(9), 2105-2112.
  • Manske, R., Wilk, K.E., Davies, G., Ellenbecker, T., & Reinold, M. (2013). Glenohumeral motion deficits: friend or foe? Int J Sports Phys Ther, 8(5), 537-553.
  • Manske, R.C., Meschke, M., Porter, A., Smith, B., & Reiman, M. (2010). A randomized controlled single-blinded comparison of stretching versus stretching and joint mobilization for posterior shoulder tightness measured by internal rotation motion loss. Sports Health, 2(2), 94-100.
  • McClure, P., Balaicuis, J., Heiland, D., Broersma, M.E., Thorndike, C.K., & Wood, A. (2007). A randomized controlled comparison of stretching procedures for posterior shoulder tightness. J Orthop Sports Phys Ther, 37(3), 108-114.
  • McCreesh, K.M., Purtill, H., Donnelly, A.E., & Lewis, J. S. (2017). Increased supraspinatus tendon thickness following fatigue loading in rotator cuff tendinopathy: potential implications for exercise therapy. BMJ Open Sport Exerc Med, 3(1), e000279.
  • McFarland, E.G., & Wasik, M. (1996). Injuries in female collegiate swimmers due to swimming and cross training. Clin J Sport Med, 6(3), 178-182.
  • Muraki, T., Yamamoto, N., Zhao, K.D., Sperling, J. W., Steinmann, S. P., Cofield, R.H., & An, K.-N. J. J. o. s. (2012). Effects of posterior capsule tightness on subacromial contact behavior during shoulder motions. Journal of shoulder elbow surgery 21(9), 1160-1167.
  • Navarro-Ledesma, S., Struyf, F., Labajos-Manzanares, M.T., Fernandez-Sanchez, M., Morales-Asencio, J. M., & Luque-Suarez, A. (2017). Does the acromiohumeral distance matter in chronic rotator cuff related shoulder pain? Musculoskelet Sci Pract, 29, 38-42.
  • Park, S. W., Chen, Y.T., Thompson, L., Kjoenoe, A., Juul-Kristensen, B., Cavalheri, V., & McKenna, L. (2020). No relationship between the acromiohumeral distance and pain in adults with subacromial pain syndrome: a systematic review and meta-analysis. Sci Rep, 10(1), 20611.
  • Porter, K.N., Blanch, P.D., Walker, H.M., & Shield, A. J. (2020). The effect of previous shoulder pain on supraspinatus tendon thickness changes following swimming practice. Scand J Med Sci Sports, 30(8), 1442-1448.
  • Reagan, K.M., Meister, K., Horodyski, M. B., Werner, D.W., Carruthers, C., & Wilk, K. (2002). Humeral retroversion and its relationship to glenohumeral rotation in the shoulder of college baseball players. Am J Sports Med, 30(3), 354-360.
  • Riley, G.P., Harrall, R.L., Constant, C.R., Chard, M. D., Cawston, T. E., & Hazleman, B. L. (1994). Glycosaminoglycans of human rotator cuff tendons: changes with age and in chronic rotator cuff tendinitis. Ann Rheum Dis, 53(6), 367-376.
  • Sajadi, N., Alizadeh, M.H., Barati, A.H., & Minoonejad, H. (2019). Effect of Selected Corrective Exercises on Glenohumeral Internal Rotation in Female Adolescent Swimmers with Scapular Dyskinesis. J Annals of Military Health Sciences Research, 17(4).
  • Silva, R.T., Hartmann, L.G., Laurino, C.F., & Biló, J.P. (2010). Clinical and ultrasonographic correlation between scapular dyskinesia and subacromial space measurement among junior elite tennis players. Br J Sports Med, 44(6), 407-410.
  • Solem-Bertoft, E., Thuomas, K.A., & Westerberg, C.E. (1993). The influence of scapular retraction and protraction on the width of the subacromial space. An MRI study. Clin Orthop Relat Res(296), 99-103.
  • Su, K.P., Johnson, M.P., Gracely, E.J., & Karduna, A.R. (2004). Scapular rotation in swimmers with and without impingement syndrome: practice effects. Med Sci Sports Exerc, 36(7), 1117-1123.
  • Tahran, Ö., & Yeşilyaprak, S. S. (2020). Effects of Modified Posterior Shoulder Stretching Exercises on Shoulder Mobility, Pain, and Dysfunction in Patients With Subacromial Impingement Syndrome. Sports Health, 12(2), 139-148.
  • Torres, R. R., & Gomes, J. L. (2009). Measurement of glenohumeral internal rotation in asymptomatic tennis players and swimmers. Am J Sports Med, 37(5), 1017-1023.
  • Tyler, T.F., Nicholas, S.J., Roy, T., & Gleim, G. W. (2000). Quantification of posterior capsule tightness and motion loss in patients with shoulder impingement. Am J Sports Med, 28(5), 668-673.
  • Weldon, E.J., 3rd, & Richardson, A.B. (2001). Upper extremity overuse injuries in swimming. A discussion of swimmer's shoulder. Clin Sports Med, 20(3), 423-438.
  • Wilk, K.E., & Arrigo, C. (1993). Current concepts in the rehabilitation of the athletic shoulder. J Orthop Sports Phys Ther, 18(1), 365-378.
  • Wilk, K. E., Hooks, T. R., & Macrina, L.C. (2013). The modified sleeper stretch and modified cross-body stretch to increase shoulder internal rotation range of motion in the overhead throwing athlete. J Orthop Sports Phys Ther, 43(12), 891-894.
  • Wilk, K.E., Yenchak, A.J., Arrigo, C.A., & Andrews, J.R. (2011). The Advanced Throwers Ten Exercise Program: a new exercise series for enhanced dynamic shoulder control in the overhead throwing athlete. Phys Sportsmed, 39(4), 90-97.
  • Yamauchi, T., Hasegawa, S., Nakamura, M., Nishishita, S., Yanase, K., & Fujita, K. (2016). Effects of two stretching methods on shoulder range of motion and muscle stiffness in baseball players with posterior shoulder tightness: a randomized controlled trial. J Shoulder Elbow Surg, 25(9), 1395-1403.
  • Yanai, T., & Hay, J.G. (2000). Shoulder impingement in front-crawl swimming: II. Analysis of stroking technique. Med Sci Sports Exerc, 32(1), 30-40.
There are 45 citations in total.

Details

Primary Language English
Subjects Sports Medicine
Journal Section Case Report
Authors

Sevgi Sevi Yesılyaprak 0000-0002-4592-9812

Halime Ezgi Türksan 0000-0003-0083-2387

Damla Karabay 0000-0003-4782-2549

Publication Date June 20, 2022
Published in Issue Year 2022 Volume: 5 Issue: 1

Cite

APA Yesılyaprak, S. S., Türksan, H. E., & Karabay, D. (2022). Effects of A Progressive Rehabilitation Program on Shoulder Internal Rotation Range of Motion, Acromiohumeral Distance, And Pain in An Adolescent Female Swimmer with Subacromial Pain (Impingement) Syndrome. International Journal of Disabilities Sports and Health Sciences, 5(1), 56-65. https://doi.org/10.33438/ijdshs.1041097
AMA Yesılyaprak SS, Türksan HE, Karabay D. Effects of A Progressive Rehabilitation Program on Shoulder Internal Rotation Range of Motion, Acromiohumeral Distance, And Pain in An Adolescent Female Swimmer with Subacromial Pain (Impingement) Syndrome. International Journal of Disabilities Sports &Health Sciences. June 2022;5(1):56-65. doi:10.33438/ijdshs.1041097
Chicago Yesılyaprak, Sevgi Sevi, Halime Ezgi Türksan, and Damla Karabay. “Effects of A Progressive Rehabilitation Program on Shoulder Internal Rotation Range of Motion, Acromiohumeral Distance, And Pain in An Adolescent Female Swimmer With Subacromial Pain (Impingement) Syndrome”. International Journal of Disabilities Sports and Health Sciences 5, no. 1 (June 2022): 56-65. https://doi.org/10.33438/ijdshs.1041097.
EndNote Yesılyaprak SS, Türksan HE, Karabay D (June 1, 2022) Effects of A Progressive Rehabilitation Program on Shoulder Internal Rotation Range of Motion, Acromiohumeral Distance, And Pain in An Adolescent Female Swimmer with Subacromial Pain (Impingement) Syndrome. International Journal of Disabilities Sports and Health Sciences 5 1 56–65.
IEEE S. S. Yesılyaprak, H. E. Türksan, and D. Karabay, “Effects of A Progressive Rehabilitation Program on Shoulder Internal Rotation Range of Motion, Acromiohumeral Distance, And Pain in An Adolescent Female Swimmer with Subacromial Pain (Impingement) Syndrome”, International Journal of Disabilities Sports &Health Sciences, vol. 5, no. 1, pp. 56–65, 2022, doi: 10.33438/ijdshs.1041097.
ISNAD Yesılyaprak, Sevgi Sevi et al. “Effects of A Progressive Rehabilitation Program on Shoulder Internal Rotation Range of Motion, Acromiohumeral Distance, And Pain in An Adolescent Female Swimmer With Subacromial Pain (Impingement) Syndrome”. International Journal of Disabilities Sports and Health Sciences 5/1 (June 2022), 56-65. https://doi.org/10.33438/ijdshs.1041097.
JAMA Yesılyaprak SS, Türksan HE, Karabay D. Effects of A Progressive Rehabilitation Program on Shoulder Internal Rotation Range of Motion, Acromiohumeral Distance, And Pain in An Adolescent Female Swimmer with Subacromial Pain (Impingement) Syndrome. International Journal of Disabilities Sports &Health Sciences. 2022;5:56–65.
MLA Yesılyaprak, Sevgi Sevi et al. “Effects of A Progressive Rehabilitation Program on Shoulder Internal Rotation Range of Motion, Acromiohumeral Distance, And Pain in An Adolescent Female Swimmer With Subacromial Pain (Impingement) Syndrome”. International Journal of Disabilities Sports and Health Sciences, vol. 5, no. 1, 2022, pp. 56-65, doi:10.33438/ijdshs.1041097.
Vancouver Yesılyaprak SS, Türksan HE, Karabay D. Effects of A Progressive Rehabilitation Program on Shoulder Internal Rotation Range of Motion, Acromiohumeral Distance, And Pain in An Adolescent Female Swimmer with Subacromial Pain (Impingement) Syndrome. International Journal of Disabilities Sports &Health Sciences. 2022;5(1):56-65.

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