Type of Article:  Original Research

Volume 5; Issue 3 (June 2017)

Page No.: 2133-2143

DOI: https://dx.doi.org/10.16965/ijpr.2017.161


Samah Attia El Shemy *1, Kadrya Hosny Battecha 2.


Background: Many exercise protocols intended to enhance kinesthetic awareness and muscular performance, however more investigations need to be directed to the restoration of muscular imbalances.

Objective: To compare the impacts of isokinetic training and plyometric training of the rotator cuff muscles on shoulder proprioception and isokinetic strength ratios.

Materials and Methods: Seventy five swimmer boys randomly assigned to three equal-sized groups: control group (A) had no strength training, study group (B) received isokinetic training and study group (C) received plyometric training for the rotator cuff muscles. Pre-post testing measurements included: kinesthetic measurements at 45° of internal rotation, 45° external rotation and 75° external rotation; and concentric external/ internal rotation strength ratios at angular velocities of 60°/s and 180°/s using a Biodex System 3 isokinetic dynamometer. The test procedure performed before and after the training period of eight weeks.

Results: Both training groups showed pre-posttest significant differences in all measured variables with non-significant changes in the control group. When comparing the post-treatment results in both training groups, the isokinetic group showed the most significant improvement in the strength ratio. However, no significant differences in kinesthetic awareness found between both training groups.

Conclusion: Isokinetic strengthening is the most effective strategy of adjusting strength ratios of the rotator cuff muscles. Moreover, both isokinetic and plyometric training enhanced kinesthetic awareness, neither technique was superior.

Key words: Isokinetic Training, Plyometric Training, Rotator Cuff, Proprioception, Strength Ratio, Swimmers.


  1. Heinlein SA, Cosgarea AJ. Biomechanical considerations in the competitive swimmer’s shoulder. Sports Health 2010; 2(6): 519-525.
  2. Hibberd EE, Myers JB. Practice habits and attitudes and behaviors concerning shoulder pain in high school competitive club swimmers. Clin J Sport Med 2013; 23(6):450-455.
  3. Fyhr C, Gustavsson L, Wassinger C, Sole G. The effects of shoulder injury on kinaesthesia: A systematic review and meta-analysis. Manual Ther 2015; 20: 28–37.
  4. Dover G, Powers ME. Reliability of joint position sense and force production measures during internal and external rotation of the shoulder. J Athl Train 2003; 38(4):304–310.
  5. Batalha NM, Raimundo AM, Carus P, Barbosa TM, Silva AJ. Shoulder rotator cuff balance, strength, and endurance in young swimmers during a competitive season. J Strength Cond Res 2013; 27(9): 2562-68.
  6. Bea JS, Benson J. The Effects of a 6-Week Dry Land Exercise Program for High School Swimmers. J Phys Edu Sports Manage 2015; 2(1):1-17.
  7. Ellenbecker TS, Davies GJ. The application of isokinetics in testing and rehabilitation of shoulder complex. J Athl Train 2000; 35(3):338-350.
  8. Myers JB, Laudner KG, Pasquale MR, Bradley JP, Lephart SM. Scapular Position and Orientation in throwing athletes. Am J Sports Med 2005; 33:263-271.
  9. Astrab J, Small E, Kerner MS. Muscle strength and flexibility in young elite swimmers. J Med Sci Sports Exerc 2001; 33(5):534.
  10. Hibberd EE, Oyama S, Spang JT, Prentice W, Myers JB. Effect of a 6- week strengthening program on shoulder and scapular-stabilizer strength and scapular kinematics in division I collegiate swimmers. J Sport Rehabil 2012; 21(3):253.
  11. Edouarda P, Codinec P, Samozinob P, Bernarde PL, Hérissond C, Gremeaux V. Reliability of shoulder rotators isokinetic strength imbalance measured using the Biodex dynamometer. J Sci Med Sport 2013; 16(1):162-165.
  12. Richardson SM, Miller LE, Wootten DF, Ramp WK, Herbert WG. Concentric and eccentric isokinetic resistance training similarly increases muscular strength, fat-free soft tissue mass, and specific bone mineral measurements in young women, Osteoporos Int 2007; 18:789-96
  13. Chimera NJ, Swanik KA, Swanik CB, Straub SJ. Effects of plyometric training on muscle activation strategies and performance in female atheletes. J Athl Train 2004; 39(1):24-31
  14. Swanik KA, Lephart SM, Swanik CB, Lephart SP, Stone DA, Fu FH. The effects of shoulder plyometric training on proprioception and selected muscle performance characteristics. J Shoulder Elbow Surg 2002; 11(6):579–86.
  15. Drouin J, Mcleod T, Shultz S, Gansneder B and Perrin D. Reliability and validity of the Biodex system 3 pro isokinetic dynamometer velocity, torque and position measurements. Eur J Appl Physiol 2004; 91(l):22-29.
  16. Baltzopoulos V D, Brodie DA Isokinetic dynamometry. Applications and limitations. Sports Med 1989 Aug; 8(2):101-16.
  17. Batalha NM, Raimundo AM, Carus PT, Fernandes OJ, Marinho DA, Martins AJ. Shoulder rotator isokinetic strength profile in young swimmers. Rev Bras Cineantropom Desempenho Hum 2012; 14(5):545-553.
  18. Wilk K. Isokinetic testing – Setup and positioning. In Biodex System II Manual, Applications/Operations, Biodex System, Inc. New York, USA; 1991.
  19. Blasier RB, Carpenter JE, Huston LJ. Shoulder proprioception effect on joint laxity, joint position, and direction of motion. Orthop Rev 1994; 1:45–50.
  20. Lephart SM, Pincivero DM, Giraldo JL, Fu FH. The role of proprioception in the management and rehabilitation of athletic injuries. Am J Sports Med 1997; 25:130-7.
  21. Ellenbecker TS, Mattalino AJ. Concentric isokinetic shoulder internal and external rotation strength in professional baseball pitchers. J Orthop Sports Phys Ther 1997; 25(5):323-328.
  22. Davies GJ. A compendium of isokinetics in clinical usage. 4th Onalaska, Wisc: S & S; 1992.
  23. Malliou PC, Giannakopoulos K, Beneka AG, Gioftsidou A, Godolias G. Effective ways of restoring muscular imbalances of the rotator cuff muscle group: a comparative study of various training methods. Br J Sports Med 2004; 38:766-72.
  24. Pretz R. ‘‘Ballistic Six’’ Plyometric training for the overhead- throwing athlete. Strength Cond J 2004; 26(6):62–66.
  25. Carter AB, Kaminski TW, Douex JR, Knight CA, Richards JG. Effects of high volume upper extremity plyometric training on throwing velocity and functional strength ratios of the shoulder rotators in collegiate baseball players. J Strength Cond Res 2007; 21(1): 208-15.
  26. Fortun CM, Davies GJ, Kernozck TW. The effects of plyometric training on the shoulder internal rotators. Phys Ther 1998; 78 (5):587.
  27. Davies G, Riemann BL, Manske R. Current concepts of plyometric exercise. Int J Sports Phys Ther 2015; 10(6): 760–786
  28. Potdevin FJ, Alberty ME, Chevutschi A, Pelayo P, Sidney MC. Effects of a 6-week plyometric training program on performances in pubescent swimmers. J Strength Cond Res 2011 Jan; 25(1):80-6.
  29. Reinold MM, Escamilla RF, Wilk KE. Current concepts in the scientific and clinical rationale behind exercises for glenohumeral and scapulothoracic musculature. J Orthop Sports Phys Ther 2009; 39:105-117.
  30. Lin YL, Karduna A. Exercises focusing on rotator cuff and scapular muscles do not improve shoulder joint position sense in healthy subjects. Hum Mov Sci 2016; 49:248–257.
  31. West D, Sole G, Sullivan SJ. Shoulder external and internal rotation isokinetic strength in master’s swimmers. J Sport Rehabil 2005; 14:12-19.
  32. Hurd WJ, Kaplan KM, El Attrache NS, Jobe FW, Morrey BF, Kaufman KR. A profile of glenohumeral internal and external rotation motion in the uninjured high school baseball pitcher, part II: strength. J Athl Train 2011; 46:289–295.
  33. Wernbom M, Augustsson J and Thomee R. The influence of frequency, intensity, volume and mode of strength training on whole muscle cross-sectional area in humans. Sports Med 2007; 37 (3): 225-264
  34. Baltzopoulos V D, Brodie DA. The effect of isokinetic training on maximum torque output of swimmers, using the Akron Isokinetic Dynamometer. 5th International Symposium of Biomechanics in Sports, Athens, July 13-18, 1987.
  35. Beneka A, Malliou P, Giannakopoulos K, et al. Different training modes for the rotator cuff muscle group. A comparative study. Isokinet Exerc Sci 2002; 10:73–9.
  36. Ingebrigtsen J, Holtermann A, Roeleveld K. Effects of load and contraction velocity during three-week biceps curls training on isometric and isokinetic performance. J Strength Cond Res 2009; 23(6): 1670–1676.
  37. Hinton RY. Isokinetic evaluation of shoulder rotational strength in high school baseball pitchers. Am J Sports Med 1988; 16:274-9.
  38. Ivey FM, Calhoun JH, Rusche K, et al. Isokinetic testing of shoulder strength: normal values. Arch Phys Med Rehabil 1985; 66:384-6.
  39. Röijezon U, Clark NC, Treleaven J. Proprioception in musculoskeletal rehabilitation. Part 1: Basic science and principles of assessment and clinical interventions. Manual Ther 2015; 20:368-377.
  40. Rogol IM, Ernst G, Perrin DH. Open and closed kinetic chain exercises improve shoulder joint reposition sense equally in healthy subjects. J Athl Train 1998; 33: 315-20.
  41. Salles JI, Velasques B, Cossich V, Nicoliche E, Ribeiro P, Amaral MV, et al. Strength training and shoulder proprioception. J Athl Train 2015; 50: 277–280.
  42. Voight ML. Stretch-strengthening: an introduction to plyometrics. Orthop Phys Ther Clin North Am 1992; 1:243-52.
  43. Allegrucci M, Whitney SL, Lephart SM, Irrgang JJ, Fu FH. Shoulder kinesthesia in healthy unilateral athletes participating in upper extremity sports. J Orthop Sports Phys Ther 1995; 21:220-6.
  44. Beach ML, Whitney SL, Dickoff-Hoffman SA. Relationship of shoulder flexibility, strength and endurance to shoulder pain in competitive swimmers. J Orthop Sports Phys Ther 1992; 16: 362-8.
  45. Sáez-Sáez de Villarreal E, Requena B, Newton RU. Does plyometric training improve strength performance? A meta-analysis. J Sci Med Sport 2010; 13: 513-522.
  46. Heiderscheit BC, Mclean KP, Davies JG. The effects of isokinetic vs. plyometric training on the shoulder internal rotators. J Orthop Sports Phys Ther 1996; 23 (2):125-133.