Background: Shoulder impingement syndrome (SIS) is a frequent overuse condition that affects water polo players because of the repetitive overhead throwing, swimming, and defensive actions they perform. This repeated stress on the shoulder can lead to discomfort, weakening of the rotator cuff muscles, and issues with daily functioning, which can harm their performance in sports. Blackburn exercises are a set of exercises designed to stabilize the shoulder blade and strengthen the rotator cuff muscles, with the aim of improving shoulder mechanics. However, there is not much research on how effective these exercises are for water polo players specifically.

Objective: The goal of this study was to assess how effective Blackburn exercises are in reducing pain, improving the strength of the rotator cuff muscles, and enhancing shoulder function in water polo players who have shoulder impingement syndrome.

Methods: This study used a pre-post experimental design and included 47 water polo players aged between 17 and 35 years who had been diagnosed with shoulder impingement syndrome based on positive results from the Neer and Hawkins-Kennedy tests.Participants took part in a supervised Blackburn exercise program that lasted six weeks.Pain levels were measured using the Visual Analogue Scale (VAS), the strength of the rotator cuff muscles was assessed through Individual Muscle Testing (IMT), and shoulder function was evaluated using the Kerlan-Jobe Orthopaedic Clinic (KJOC) Shoulder and Elbow Score.The data was analyzed using SPSS version 23.To check if the data followed a normal distribution, the Shapiro-Wilk test was used, and paired t-tests were used to compare results before and after the intervention.A p-value less than 0.05 was considered statistically significant.

Results: All 47 participants completed the study.After the six-week intervention, there were significant improvements in all the measured outcomes.The average VAS scores dropped from

5.64 ± 0.90 to 1.70 ± 0.70 (p < 0.0001).There were also notable gains in the strength of the rotator cuff muscles, with the average IMT scores increasing from 2.44 to 4.48 for the infraspinatus, 2.14 to 4.32 for the supraspinatus, 2.56 to 4.52 for the teres minor, and 2.64 to

4.74 for the subscapularis (all p < 0.0001).Functional outcomes also showed significant improvement, with the KJOC scores rising from 71.22 ± 9.00 to 91.01 ± 4.32 (p < 0.0001).