The goal of this randomized control trial is to evaluate the effect of the Dynamic Neuromuscular Stabilization (DNS) and Gyrotonic training compared to a control group on pain level, functional performance, and shoulder stability in overhead athletes aged 18 to 25 years. The main question is whether these interventions are more effective than usual training in improving clinical and performance related outcomes.

Participants will take part in a supervised rehabilitation program based on these methods three times per week for six weeks.

Assessments were performed at baseline and after 6 weeks of intervention. Outcome measures included pain level, functional performance, and dynamic shoulder stability. Also, core endurance, shoulder mobility, and shoulder muscle strength will be evaluated as a secondary outcomes.

These outcomes will be assessed using Visual Analog Scale (VAS), Kerlan-Jobe Orthopedic Clinic score (KJOC), the Y-Balance Upper Quarter Stability Test (UQYBT), McGill Endurance Test Battery, goniometer and digital dynamometer.

The study was approved by the Ethics Committee of the Sports University of Tirana. All participants involved in this study provided written informed consent.

One of the most challenging aspects of orthopedic sports medicine is the rehabilitation of the overhead athletes. Overhead athletes place a lot of load on the shoulder joint, because of the volume of throws, mechanical stress and repetitive movements above shoulder level. During the game these athletes require high levels of mobility and stability at the same time, and neuromuscular control. Rapid motion, poor biomechanics, and weak links in the kinetic chain put this area in high risk of injury in glenohumeral joint and surrounding soft tissues. As a result, those athletes are exposed of developing shoulder pain, functional impairments, overuse injuries, and deficits in strength and mobility.

Recent rehabilitation programs for shoulder injuries in overhead athletes incorporate exercise-based interventions that integrate core activation, coordinated movement, and sport-specific function.

The purpose of this randomized controlled trial was to investigate the effect of structured neuromuscular rehabilitation program based on the Dynamic Neuromuscular Stabilization (DNS) method and Gyrotonic training on shoulder pain, functional performance, and dynamic stability in overhead athletes with shoulder injuries. The study looked for to determine whether these interventions could lead to significant improvements in the variables at baseline and after the interventions.

Participants meeting the inclusion criteria were recruited and were randomly allocated into one of three study groups. The intervention consisted of a supervised rehabilitation program focused on key components of shoulder function, such as neuromuscular control, strength, mobility, and coordination. The DNS program was focused on exercise based on developmental kinesiology, aimed to improve core stability, breathing patterns, and shoulder stabilization in various functional positions. The Gyrotonic program incorporated three-dimensional, spiral movement patterns aimed to improve mobility, coordination, and integrated upper limb function. The athletes involved in the DNS and Gyrotonic group continued also with their usual sports training. Exercise sessions were performed regularly in both intervention groups for a period of six-weeks. Participants in the control group continued with the usual training regime and did not receive any specific rehabilitation intervention.

Outcome assessments were conducted at baseline and after six weeks of intervention. Pain intensity, functional performance, dynamic stability were the main outcomes that were evaluated before and after the intervention period.

In addition, core endurance, mobility and muscle strength of glenohumeral joint was evaluated as a secondary outcome before and after the rehabilitation program. This study design allows the comparison of changes over time within and between groups in order to identify the most effective approach for improving pain, functional performance and stability in overhead athletes with shoulder injuries.

The findings of this study aim to provide clinically relevant evidence for the rehabilitation of overhead athletes with shoulder injuries.

Inclusion Criteria:

• Male and female participants
• Had a minimum of two years of sports experience
• Presence of shoulder region injury or pain
• Active participation in sports

Exclusion Criteria:

• Shoulder surgery
• Neurological disorders that can affect the upper limb
• Shoulder dislocation
• Orthopedic condition such as upper or lower limb fractures
• Athletes with less than two years of sports experience

The individual participant data (IPD) will not be shared in order to protect participant confidentiality and privacy. In accordance with institutional regulations and informed consent obtained from participants, only overall results will be reported in publications.

Outcome assessors will be blinded to group allocation. The assessors performing questionnaires and functional tests will not be informed about whether participants are assigned to DNS group, Gyrotonic training group, or control group. Participants and therapists will be aware of the assigned interventions due to the nature of the rehabilitation methods.