The Relationship Between Shoulder Pain and Disability and Functional Stability Indices in Competitive Male Gymnasts: A Cross-sectional Study

Abstract

Background: Shoulder pain is highly prevalent among male artistic gymnasts because of repetitive, high-load, weight-bearing, and suspension-based demands. Although proximal core stability and distal limb function are considered important components of the kinetic chain, the association between multisegmental functional stability and shoulder pain and disability in this population remains insufficiently understood. Objectives: This study aimed to examine the association between shoulder pain and disability and proximal core stability, upper-limb stability, and lower-limb functional stability among competitive male artistic gymnasts. Methods: This cross-sectional correlational study included 28 competitive male artistic gymnasts aged 22.86 ± 2.25 years who were recruited from regional and national training centers. An a priori power analysis (G*Power 3.1; r = 0.50, α = 0.05, power = 0.80) indicated a minimum required sample of 26 participants. Shoulder pain and disability were assessed using the Shoulder Pain and Disability Index (SPADI). Participants with shoulder symptoms were able to complete all functional assessments without symptom exacerbation. Functional stability was evaluated using the Upper Quarter Y-Balance Test (UQYBT), Lower Quarter Y-Balance Test (LQYBT), and McGill Core Endurance Tests. Pearson correlations with 95% confidence intervals were calculated to examine associations between variables. The Holm-Bonferroni correction was applied to control for multiple comparisons, and multiple linear regression analysis was conducted to determine independent associations. Results: Shoulder pain and disability were moderately to strongly negatively associated with upper-limb stability (r = -0.62, 95% CI -0.81 to -0.32, P = 0.004) and core endurance (r = -0.55, 95% CI -0.76 to -0.22, P = 0.003). Lower-limb stability showed a weaker but significant association (r = -0.41, 95% CI -0.68 to -0.05, P = 0.030). After Holm-Bonferroni correction, the associations with upper-limb stability and core endurance remained significant. Regression analysis indicated that upper-limb stability (β = -0.44, P = 0.01) and trunk flexor endurance (β = -0.36, P = 0.03) independently explained 48% of the variance in SPADI scores (adjusted R2 = 0.48). Conclusions: In competitive male artistic gymnasts, shoulder pain and disability are significantly associated with deficits in proximal core endurance and upper-limb functional stability. However, because of the cross-sectional design, causal relationships cannot be inferred. Prospective longitudinal studies are needed to clarify the temporal sequence and potentially causal relationships.