Effectiveness of Proprioceptive Neuromuscular Facilitation and Muscle Energy Technique for Shoulder Instability in Swimmers

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.