1.    Introduction
Swimming is a sport in which achieving optimal performance is defined by covering a certain distance in the shortest possible time. To reach such performance levels, it is essential to maximize propulsive force while minimizing water resistance (1). Studies have shown that most sports injuries in swimmers occur in the upper limbs, particularly in the shoulder joint (2). Among upper limb injuries, shoulder joint injuries are the most common (3). The shoulder girdle is composed of a complex set of joints and musculo-ligamentous structures that are frequently used in daily activities and during the execution of sports skills (4). This wide range of activities contributes to the high prevalence of shoulder injuries in sports, which can originate from various types of trauma, especially microtrauma (5). Given the importance of combining shoulder and scapular exercises to reduce the complications associated with shoulder impingement syndrome and the beneficial effects of Kinesio Tape, the present study was conducted to determine the impact of a combined shoulder and scapular exercise program with Kinesio Tape on pain, shoulder proprioception, and upper limb function in swimmers with shoulder impingement syndrome.
2.    Methods
This research was applied and semi-experimental in nature. Subjects were selected using a convenience and purposeful random sampling method. The statistical population consisted of male swimmers with shoulder impingement syndrome in Isfahan, totaling 44 individuals. From this group, 30 athletes aged 18 to 25 years with shoulder impingement syndrome were selected as the primary sample and randomly divided into two groups: a control group (15 participants) and a training group (15 participants) based on G*Power software calculations. To select participants, researchers visited swimming pools across Isfahan and distributed questionnaires. Swimmers who were willing to participate in the study were recruited from swimming classes and teams. After assessing the subjects' eligibility and confirming the presence of shoulder impingement syndrome by a physician, ensuring no contraindications to participation, these subjects were enrolled in the study. Inclusion criteria included a minimum of three years of swimming experience, a diagnosis of shoulder impingement syndrome within the last three months as confirmed by the subject and a physician, and voluntary participation in the study. After obtaining informed consent, anthropometric measurements, including height and weight, were recorded. A visual analog scale (VAS) was used to evaluate shoulder pain in this study. Additionally, shoulder proprioception was assessed using a goniometer, and upper limb function was evaluated with the Y Balance Upper Quarter (YBU-UQ) test. A paired t-test was employed to compare the mean values of the research variables before and after the exercise program. Analysis of covariance (ANCOVA) was used to examine the effect of the exercise program on the study variables. The Shapiro-Wilk test was applied to assess the normality of the data. All analyses were conducted using SPSS version 24 software.
3.    Results
Given the normality of the data, as determined by the Shapiro-Wilk test, analysis of covariance (ANCOVA) and paired t-tests were employed to assess the effects of the exercise program and make comparisons between groups. The ANCOVA was specifically used to compare the levels of pain, proprioception, and upper limb function between the groups. The results are presented in Table 1.
The findings indicated that the exercise program had a significant effect on reducing pain (p=0.001), increasing proprioception (p=0.002), and improving upper limb function (p=0.001). Additionally, intergroup comparisons revealed significant differences between the two groups in the variables of pain (p=0.004), proprioception (p=0.001), and upper limb function (p=0.001).

4.    Conclusion
The results of the present study demonstrated that a combined shoulder and scapular exercise program with Kinesio Tape significantly reduces shoulder pain, improves proprioception, and enhances shoulder performance in male swimmers with shoulder impingement syndrome. It appears that interventions targeting both the shoulder and scapula can effectively reduce pain associated with this condition. These exercises include a combination of shoulder stability exercises, rotator cuff strengthening, range of motion activities, proprioceptive neuromuscular facilitation, and stretching exercises. While several individual studies have reported the effectiveness of shoulder stabilization exercises in rehabilitating shoulder impingement syndrome (6, 7), there is limited research on the impact of combined exercise programs. The present study confirms the effectiveness of this combined exercise regimen along with Kinesio Tape. The reduction in pain following the exercise program may also contribute to improved proprioceptive function. In the context of the impact of pain on shoulder function, chronic shoulder pain is often linked to specific adaptations in each sport, resulting in changes in strength, flexibility, and posture, both in the shoulder joint and related movement chains (8). Overall, the findings of this study highlight the importance of using a combined shoulder and scapular exercise program with Kinesio Tape to improve the health and performance of swimmers with shoulder impingement syndrome.
Ethical Considerations
Compliance with ethical guidelines
There were no ethical considerations to be considered in this research.
Funding
This research did not receive any financial support from government, private, or non-profit organizations.
Authors' contributions
All authors were involved in the design, implementation, and writing of all parts of this research.
Conflicts of interest
The authors declare that there are no conflicts of interest associated with this article.