Authors : Nisha Ashok Ghosh; Dr. Vaishali Kale

Volume/Issue : Volume 10 - 2025, Issue 9 - September

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DOI : https://doi.org/10.38124/ijisrt/25sep1070

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Abstract : Introduction: Shoulder instability is a common and debilitating condition in competitive swimmers, primarily caused by repetitive overhead motions that lead to muscular imbalances and decreased performance. Proprioceptive Neuromuscular Facilitation (PNF) and Muscle Energy Technique (MET) are established manual therapies for restoring joint function. However, there is a significant gap in research directly comparing their effectiveness within the elite swimming population, creating a need for evidence-based guidance on optimal rehabilitation strategies.  Methods: A comparative study was conducted over four weeks with 50 swimmers (aged 10–25 years). Participants were randomly allocated to two groups: Group A (n=25) received PNF, and Group B (n=25) received MET. Outcomes—shoulder ROM (goniometry), strength (M-AST), stability (OSIS), and swim times (25m, 50m, 450m)—were analysed using t-tests (p < 0.05).  Results: Following the 4-week intervention, both groups demonstrated improvement in shoulder range of motion, muscle strength, functional stability, and swimming performance. However, Group B (Muscle Energy Technique) showed significantly greater improvements across most parameters. In terms of internal rotation, Group B improved by 6.96° (p = 0.0184), while Group A (Proprioceptive Neuromuscular Facilitation) showed a lesser and non-significant gain of 3.48° (p = 0.2192). Similarly, external rotation increased by 6.48° in Group B (p = 0.0379) compared to 3.84° in Group A (p = 0.2331). Muscle strength, assessed via the Modified Athletic Shoulder Test at 90°, 135°, and 180° abduction angles, improved significantly more in Group B, with mean gains of 2.28 kg, 2.20 kg, and 1.92 kg respectively (p < 0.01 for all), whereas Group A showed modest, statistically insignificant changes. Functional stability, measured by the Oxford Shoulder Instability Score, improved by 3.40 points in Group B (p = 0.0126) versus 2.12 points in Group A (p = 0.1323). Regarding swimming performance, both groups achieved statistically significant improvements across 25m, 50m, and 450m trials. Group A demonstrated slightly better gains in the 25m sprint, while Group B showed superior results in the 50m and 450m distances, although the difference between the groups was minimal.  Conclusion: Both PNF and MET are effective in improving shoulder function and swim performance in swimmers with shoulder instability. However, MET showed significantly greater improvements in ROM, strength, and shoulder stability, making it a more effective intervention for long-term rehabilitation. PNF may be more beneficial for enhancing short-distance swim speed due to its functional movement emphasis.

Keywords : Proprioceptive Neuromuscular Facilitation, Muscle Energy Technique, Shoulder Instability, Swimmers, Rehabilitation, Sports Physiotherapy.

References :

1. Ludewig PM, Borstad JD. The shoulder complex. In: Joint Structure and Function: A Comprehensive Analysis. 2005. p. 233-71.
2. Lodha S, Mazloom S, Resler AG, Frank RM. Shoulder instability treatment and rehabilitation. In: Brotzman SB, Manske RC, editors. Clinical Orthopaedic Rehabilitation: An Evidence-Based Approach. 4th ed. Philadelphia: Elsevier; n.d. p. 106-13.
3. Lambert AJ. Rehabilitation for shoulder instability. Br J Sports Med. 2010;44(5):333-40.
4. Contreras Fernández JJ, Liendo Verdugo R. Shoulder pain in swimmers. In: Pain in Perspective. Chile: Intech Open; n.d. doi:10.5772/51013
5. Escamilla RH. Optimal management of shoulder impingement syndrome. Open Access J Sports Med. 2014; 5:13-24. doi:10.2147/OAJSM.S36646
6. Cuéllar R, Ruiz Ibán MA, Cuéllar A. Anatomy and biomechanics of the unstable shoulder. Open Orthop J. 2017; 11:919-33. doi:10.2174/1874325001711010919
7. Davis DD, NM. Swimmer’s shoulder. 2017 Dec 22 [cited 2025 Aug 17].
8. Delbridge AB. An inside look at ‘swimmer’s shoulder’: a cause of swimmer’s shoulder. Aspetar Sports Med J. 2019;8(1). 2019 May 17.
9. Chui TC. Proprioceptive neuromuscular facilitation. In: Martin SKT, editor. Neurologic Interventions for Physical Therapy. 4th ed. Elsevier; n.d.
10. Li BX. Study on the effect of PNF method on the flexibility and strength quality of stretching muscles of shoulder joints of swimmers. 2020 Dec 21.
11. Chaitow L. Muscle Energy Techniques. 3rd ed. Edinburgh: Churchill Livingstone; 2006.
12. Smith AB, Johnson RT. Effects of proprioceptive neuromuscular facilitation on shoulder stability in overhead athletes. J Sport Rehabil. 2015;24(3):211-8.
13. Lee HY, Kim JH, Park SY. Influence of PNF based training on shoulder function in collegiate swimmers. Int J Sports Phys Ther. 2018;13(5):723-30.
14. Adler SS, Beckers D, Buck M. PNF in Practice: An Illustrated Guide. 4th ed. Berlin: Springer; 2014.
15. Sharman MJ, Cresswell AG, Riek S. Proprioceptive neuromuscular facilitation stretching: mechanisms and clinical implications. Sports Med. 2006;36(11):929-39. doi:10.2165/00007256-200636110-00002
16. Moore SD, Laudner KG, McLoda TA, Shaffer MA. The immediate effects of muscle energy technique on posterior shoulder tightness: a randomized controlled trial. J Orthop Sports Phys Ther. 2011;41(6):400-7.
17. Tooth C, Forthomme B, Croisier JL, et al. The Modified Athletic Shoulder Test: reliability and validity of a new on-field assessment tool. Phys Ther Sport. 2022; 58:8-15. doi: 10.1016/j.ptsp.2022.08.003
18. van der Linde J, et al. The Oxford Shoulder Instability Score: validation in Dutch and first-time assessment of its smallest detectable change. J Orthop Surg Res. 2015; 10:146.
19. Reed ML, Begalle RL, Laudner KG. Acute effects of muscle energy technique and joint mobilization on shoulder tightness in youth throwing athletes: a randomized controlled trial. Int J Sports Phys Ther. 2018;13(6):1024-31.
20. Ganesh BR, PP. Effect of muscle energy technique on strength and range of motion in young swimmers with SICK scapula syndrome: a pre–post clinical trial. Indian J Physiother Occup Ther. n.d.:45-9.
21. Rabbani F, Shetty RB. A study to assess the effectiveness of muscle energy technique with sleeper stretch on posterior shoulder tightness in tennis players. Int J Health Clin Res. 2021;4(8):234-9.
22. Usman TG, Hussain A. Comparative study of MET and conventional therapy on shoulder ROM in adhesive capsulitis patients. Bull Fac Phys Ther. 2024;29(4):44. doi:10.1186/s43161-025-00297-9
23. Li J, Wang X, Cheng L. Effects of proprioceptive neuromuscular facilitation stretching on shoulder flexibility and freestyle stroke performance in collegiate swimmers. Med Chem Biol. 2021;18(2):189-98.
24. Tamjeed UG, Ahmad I, Mushtaq M. Comparative effectiveness of proprioceptive neuromuscular facilitation stretch vs Spencer muscle energy technique on pain and disability in patients with adhesive capsulitis. Int J Phys Educ Sports Health. 2023;10(1):234-8.
25. Farquharson J. PNF vs. MET: similarities, differences, techniques, methods. 2010