Scapular Stabilization Versus Elbow Strengthening in Athletes with Lateral Epicondylitis
-
Seyed Mohamad Mahdi Ghiami
,
Hooman Minoonejad
,
Elham shirzad Araghi
,
Yousef Moghadas Tabrizi
,
Seyed Abbas Farjad Pezeshk
Abstract
Introduction: Lateral elbow tendinopathy is not merely a localized elbow condition and is often associated with proximal movement impairments, such as scapular dyskinesis, which may contribute to persistent pain and functional limitations in racket-sport athletes. This study aimed to compare the effects of scapular stabilization and elbow strengthening exercises on pain, disability, and functional performance in racket-sport athletes with lateral elbow tendinopathy accompanied by scapular dyskinesis.
Materials and Methods: In this single-blind randomized controlled trial with a pre-test–post-test control group design, 49 racket sport athletes aged 18–25 years and diagnosed with lateral elbow tendinopathy and scapular dyskinesis were randomly assigned to elbow strengthening exercises, combined training (elbow strengthening plus scapular stabilization), or a control group. Interventions were conducted over eight weeks, three sessions per week. Outcome measures included pain intensity, upper-limb disability, muscle strength, dynamic balance (YBT), upper-limb power, and functional movement performance.
Results: Both intervention groups showed reductions in pain and disability and improvements in functional performance, with greater and clinically meaningful improvements observed in the combined training group.
Conclusion: Incorporating scapular stabilization exercises into elbow strengthening programs leads to superior clinical and functional outcomes and supports a kinetic chain–based rehabilitation approach for racket sport athletes with lateral elbow tendinopathy.
Bateman M, Skeggs A, Whitby E, Fletcher-Barrett V, Stephens G, Dawes M, et al. Optimising physiotherapy for people with lateral elbow tendinopathy-Results of a mixed-methods pilot and feasibility randomised controlled trial (OPTimisE). Musculoskeletal Science & Practice. 2024; 69:102905.doi: [DOI:10.1016/j.msksp.2023.102905] [PMID] [PMCID]
Ahmed F, Hassan N, Islam W, Uddin K, Ahmed S, Islam A. Effectiveness of Physiotherapy Intervention for Elderly People with Diabetic Neuropathy: A Review Study. Journal of Modern Rehabilitation. 2024; 18(2):144-51. [DOI:10.18502/jmr.v18i2.15970]
Landesa-Pineiro L, Leirós-Rodríguez R. Physiotherapy treatment of lateral epicondylitis: A systematic review. Journal of Back and Musculoskeletal Rehabilitation. 2022; 35(3):463-77. [DOI:10.3233/BMR-210053] [PMID]
Day JM, Lucado AM, Dale RB, Merriman H, Marker CD, Uhl TL. The effect of scapular muscle strengthening on functional recovery in patients with lateral elbow tendinopathy: A pilot randomized controlled trial. Journal of Sport Rehabilitation. 2021; 30(5):744-53. [DOI:10.1123/jsr.2020-0203] [PMID]
Day JM, Bush H, Nitz AJ, Uhl TL. Scapular muscle performance in individuals with lateral epicondylalgia. Journal of Orthopaedic & Sports Physical Therapy. 2015; 45(5):414-24. [DOI:10.2519/jospt.2015.5290] [PMID]
Reyhani F, Meftahi N, Rojhani-Shirazi Z. Comparing shoulder proprioception, upper extremity dynamic stability, and hand grip strength in overhead athletes with and without scapular dyskinesis. Journal of Bodywork and Movement Therapies. 2024; 39:304-10. [DOI:10.1016/j.jbmt.2024.03.001] [PMID]
Burn MB, McCulloch PC, Lintner DM, Liberman SR, Harris JD. Prevalence of scapular dyskinesis in overhead and nonoverhead athletes: A systematic review. Orthopaedic Journal of Sports Medicine. 2016; 4(2):2325967115627608. [DOI:10.1177/2325967115627608] [PMID] [PMCID]
Eyvazi Hezebaran A, Ghani Zadeh Hesar N, Mohammad Ali Nasab Firouzjah E, Roshani S. Effect of eight weeks scapular stabilization exercises on shoulder pain of archer men with scapular dyskinesis: A clinical trial study. Journal of Gorgan University of Medical Sciences. 2021; 23(3):24-31. [Link]
Kibler WB, Sciascia A, Wilkes T. Scapular dyskinesis and its relation to shoulder injury. The Journal of the American Academy of Orthopaedic Surgeons. 2012; 20(6):364-72. [DOI:10.5435/JAAOS-20-06-364] [PMID]
Salamh PA, Hanney WJ, Boles T, Holmes D, McMillan A, Wagner A, et al. Is it time to normalize scapular dyskinesis? The incidence of scapular dyskinesis in those with and without symptoms: A systematic review. International Journal of Sports Physical Therapy. 2023; 18(3):558. [DOI:10.26603/001c.74388] [PMID] [PMCID]
Sciascia A, Kibler WB. Current views of scapular dyskinesis and its possible clinical relevance. International Journal of Sports Physical Therapy. 2022; 17(2):117. [DOI:10.26603/001c.31727]
Hogan C, Corbett J-A, Ashton S, Perraton L, Frame R, Dakic J. Scapular dyskinesis is not an isolated risk factor for shoulder injury in athletes: A systematic review and meta-analysis.The American Journal of Sports Medicine. 2021; 49(10):2843-53. [DOI:10.1177/0363546520968508] [PMID]
Kibler WB, Sciascia A. Current concepts: Scapular dyskinesis. British Journal of Sports Medicine. 2019; 53(12):705-12. [DOI:10.1136/bjsports-2018-099784] [PMID]
Cools AM, Struyf F, De Mey K, Maenhout A, Castelein B, Cagnie B. Rehabilitation of scapular dyskinesis: From the office worker to the elite overhead athlete. British Journal of Sports Medicine. 2014; 48(8):692-7. [DOI:10.1136/bjsports-2013-092148] [PMID]
Lee JH, Kim TH, Lim KB. Effects of eccentric control exercise for wrist extensor and shoulder stabilization exercise on the pain and functions of tennis elbow. The Journal of Physical Therapy Science. 2018; 30(4):590-4. [DOI:10.1589/jpts.30.590] [PMID] [PMCID]
Kirithika G, Kamalakannan M, Ramana K, Anitha A. Efficacy of scapular strengthening exercise and eccentric forearm exercise on functional recovery in subjects with lateral epicondylitis. Indian Journal of Physiotherapy and Occupational Therapy, An International Journal. 2024; 18(5):44-9. [DOI:10.37506/v1zm1714]
Vidyashree K A. Integrating scapular strengthening exercises into rehabilitation of lateral epicondylitis: A narrative review. The Indian Journal of Physiotherapy & Occupational Therapy. 2026; 19(2025):1. [DOI:10.37506/2bjdrt82]
Alireza Z, Hashem P, Razieh H, Amir Reza S, Amir Reza Ghareh K. Comparison of functional movement screen scores and performance between male and female soccer players. Journal of Modern Rehabilitation. 2025; 20(1):23-35. [Link]
Cools AM, Johansson FR, Borms D, Maenhout A. Prevention of shoulder injuries in overhead athletes: A science-based approach. British Journal of Sports Medicine. 2015; 49(5):327-37. [DOI:10.1590/bjpt-rbf.2014.0109] [PMID] [PMCID]
Hotta GH, de Assis Couto AG, Cools AM, McQuade KJ, de Oliveira AS. Effects of adding scapular stabilization exercises to a periscapular strengthening exercise program in patients with subacromial pain syndrome: A randomized controlled trial. Musculoskeletal Science & Practice. 2020; 49:102171. [DOI:10.1016/j.msksp.2020.102171] [PMID]
Tang L, Chen K, Ma Y, Huang L, Liang J, Ma Y. Scapular stabilization exercise based on the type of scapular dyskinesis versus traditional rehabilitation training in the treatment of periarthritis of the shoulder: study protocol for a randomized controlled trial. Trials. 2021; 22(1):713 [DOI:10.1186/s13063-021-05654-2] [PMID] [PMCID]
Rasool MJ, Akram S, Jamil A, Tauseef M, Ilyas A. Effects of Power Ball exercises in addition to routine physical therapy on pain, grip strength and functional disability in patients with carpal tunnel syndrome. The Healer Journal of Physiotherapy and Rehabilitation Sciences. 2023; 3(4):451-60. [DOI:10.55735/hjprs.v3i4.139]
Babaei Mobarakeh M, Letafatkar A, Barati AH. Effect of eight weeks of Powerball-mediated resistance training on strength, proprioception, and upper extremity performance in volleyball players with tennis elbow. The Scientific Journal of Rehabilitation Medicine. 2018; 7(3):141-56. [DOI:10.22037/jrm.2017.110996.1683]
Mirhassan Zadeh Kuhkamar M, Hadadnezhad M, Khaleghi Tazji M. The effect of 8 weeks’ scapular focused training on pain, proprioception, scapular kinematics and upper extremity performance in male volleyball players with shoulder impingement syndrome. Medical Journal of Tabriz University of Medical Sciences and Health Services. 2020; 42(4):466-75. [DOI:10.34172/mj.2020.069]
Jones IA, Togashi R, Heckmann N, Vangsness Jr CT. Minimal clinically important difference for patient-reported shoulder outcomes. Journal of Shoulder and Elbow Surgery. 2020; 29(7):1484-92. [DOI:10.1016/j.jse.2019.12.033] [PMID]
Gagnier JJ, Mullins M, Huang H. Minimal clinically important difference for patient-reported outcomes in musculoskeletal disorders. Journal of Clinical Epidemiology. 2018; 102:1-12. [DOI:10.1016/j.jclinepi.2018.06.010] [PMID]
MacDermid JC, Silbernagel KG. Outcome evaluation in tendinopathy: Foundations of assessment and a summary of selected measures. Journal of Orthopaedic & Sports Physical Therapy. 2015; 45(11):950-64. [DOI:10.2519/jospt.2015.6054] [PMID]
Mintken PE, Glynn P, Cleland JA. Psychometric properties of the DASH in patients with shoulder pain. Journal of Orthopaedic & Sports Physical Therapy. 2009; 39(8):584-95. [DOI:10.1016/j.jse.2008.12.015] [PMID]
Cacchio A, Necozione S, MacDermid JC, Rompe JD, Maffulli N, Di Orio F, et al. Cross-cultural adaptation and measurement properties of the Italian version of the Patient-Rated Tennis Elbow Evaluation questionnaire. 2012; 92(8):1036-45.doi: [DOI:10.2522/ptj.20110398] [PMID]
Lowdon H, Chong HH, Dhingra M, Gomaa A-R, Teece L, Booth S, et al. Comparison of interventions for lateral elbow tendinopathy: A systematic review and network meta-analysis for patient-rated tennis elbow evaluation pain outcome. Journal of Hand Surgery. 2024; 49(7):639-48. [DOI:10.1016/j.jhsa.2024.03.007] [PMID]
Stasinopoulos D, Stasinopoulos I. Comparison of effects of eccentric training, eccentric-concentric training, and eccentric-concentric training combined with isometric contraction in the treatment of lateral elbow tendinopathy. Journal of Hand Therapy. 2017; 30(1):13-9. [DOI:10.1016/j.jht.2016.09.001] [PMID]
Mostafaee N, Divandari A, Negahban H, Kachooei AR, Moradi A, Ebrahimzadeh MH, et al. Shoulder and scapula muscle training plus conventional physiotherapy versus conventional physiotherapy only: A randomized controlled trial of patients with lateral elbow tendinopathy. Physiotherapy Theory and Practice. 2022; 38(9):1153-64. [DOI:10.1080/09593985.2020.1821417] [PMID]
Lucado AM, Kolber MJ, Cheng MS. Scapular muscle performance in individuals with lateral elbow tendinopathy. Journal of Shoulder and Elbow Surgery. 2019; 28(10):1960-7. [DOI:10.1016/j.jse.2019.03.033] [PMID]
Ludewig PM, Lawrence RL, Braman JP. What is the role of the scapula in shoulder pain? British Journal of Sports Medicine. 2022; 56(15):834-42.
Salamh P, Lewis J. The role of proximal control in elbow and wrist disorders. Physical Therapy in Sport. 2021; 50:45-52. [DOI:10.1016/j.ptsp.2021.04.003] [PMID]
Bohannon RW. Minimal clinically important difference for grip strength: A systematic review. The Journal of Physical Therapy Science. 2019; 31(1):75-8. [DOI:10.1589/jpts.31.75] [PMID] [PMCID]
Mendez-Rebolledo G, Araya-Quintanilla F, Guzmán-Muñoz E, Salazar-Mendez J, Cruz-Montecinos C, Berckmans KR, et al. Comparative electromyographic study of scapular stabilizing muscles during five main rehabilitation exercises. American Journal of Physical Medicine & Rehabilitation. 2024; 103(6):502-9. [DOI:10.1097/PHM.0000000000002394] [PMID]
Horlings CG, Küng U, Van Engelen B, Voermans N, Hengstman G, Van Der Kooi A, et al. Balance control in patients with distal versus proximal muscle weakness. Neuroscience. 2009; 164(4):1876-86. [DOI:10.1016/j.neuroscience.2009.09.063] [PMID]
| Files | ||
| Issue | Vol 20 No 3 (2026) | |
| Section | Research Article(s) | |
| DOI | https://doi.org/10.18502/jmr.v20i3.22530 | |
| Keywords | ||
| Lateral elbow tendinopathy Scapular dyskinesis Scapular stabilization Exercise therapy Athletic performance | ||
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