Sports Medicine Research: In the Lab & In the Field: Preseason Predictors for Shoulder Pain Among Volleyball Players (Sports Med Res)


Wednesday, October 23, 2013

Preseason Predictors for Shoulder Pain Among Volleyball Players

Shoulder Pain among High-Level Volleyball Players and Preseason Features

Forthomme B, Wieczorek V, Frisch A, Crielaard JM, Croisier JL. Med Sci Sports Exerc. 2013 Oct;45(10):1852-60. doi: 10.1249/MSS.0b013e318296128d.

Take Home Message:  Preseason deficits in eccentric internal and external glenohumeral rotation strength may be risk factors for developing shoulder pain during a volleyball season.  Preventative measures, such as eccentric shoulder rotation strengthening, should be considered during preseason and in-season strength and conditioning programs.

Volleyball players are at high risk for shoulder injuries, which account for the most time lost from training and competition as compared with other injuries.  If we could determine risk factors for shoulder injuries this may help us to develop injury prevention programs. The authors performed this study to identify specific intrinsic risk factors for shoulder pain amongst volleyball players (34 men and 32 women from first and second division teams from Belgium, France, the Netherlands, and Luxembourg). Intrinsic factors were defined as anatomy, biomechanics, core stability, glenohumeral internal rotation deficit (GIRD), previous injury, gender, and scapular dyskinesis.  During the preseason, all players completed questionnaires to report prior shoulder pain or injuries, including time of onset, cause, treatments, diagnoses, and reinjuries.  The players then performed isokinetic strength assessments on both shoulders to assess the internal (IR) and external rotators (ER).  Based on the strength tests, the authors calculated absolute peak torque and body mass relative to peak torque.  The authors also conducted bilateral assessments of total range of glenohumeral rotation, scapular position on the thorax, posterior rotator cuff tightness based on internal rotation in the sleeper stretch position, and the anterior position of the humeral head in relation to the acromion.  Throughout the 6 months of their competitive season, the players also completed weekly questionnaires to report any shoulder pain and time lost from play due to it.  A minor injury was defined as less than one week of playing time missed, moderate if between 1 and 3 weeks were missed, and severe injury if absence was longer than 3 weeks.  At the beginning of the season, 52% of the players had a history of shoulder pain in the dominant shoulder.  With respect to the in-season weekly questionnaires, 23% of players experienced dominant shoulder pain (15 out of 66 players). A player who had a history of prior shoulder pain or injury was nine times more likely of develop recurrent pain in the dominant shoulder.  Furthermore, players who developed shoulder pain during the season had weaker eccentric strength in ER and IR compared with their injured counterparts. The authors found that pre-season passive glenohumeral motion, posterior rotator cuff tightness, forward shoulder position, and scapular position failed to distinguish players that did or did not develop shoulder pain during the season.

This study and others like it are important by raising awareness of risk factors for injury. In particular, the authors reported that eccentric strength deficits and a history of shoulder injury may influence the risk of developing shoulder pain in season. Next steps include studying the effect of a program to correct these ER/IR strength deficits on injury rates.   A preventive program should be considered when developing strength and conditioning programs for volleyball players. While the current study suggests that passive tightness and range of motion may not be risk factors for shoulder pain in volleyball players it will be interesting to see if this holds true in larger studies that include volleyball players of various skill levels. In the meantime, it may be advantageous to pursue eccentric strength training exercises for the rotator cuff.

Questions for Discussion: Do you routinely assess your overhead athletes with these types of measurements during the preseason?  What kind of ROM program/strengthening program do you use with your overhead athletes?
Reviewed by: Jeffrey Driban and Stephen Thomas

Related Posts:
Risk Factors for Posterior Shoulder Instability in Young Athletes

Forthomme B, Wieczorek V, Frisch A, Crielaard JM, & Croisier JL (2013). Shoulder Pain among High-Level Volleyball Players and Preseason Features. Medicine and Science in Sports and Exercise, 45 (10), 1852-60 PMID: 23575514


Erika Spudie said...

As a newly certified athletic trainer working with my first team (collegiate volleyball), I can't say that I have used the mentioned measures during preseason screening. Although this study does not indicate a correlation between scapular position and development of pain, one of the more important factors I have learned to take into account during my evaluations of shoulder pain is scapular motion. Scapular dyskinesis, I've seen, is a pretty common problem overhead athletes, especially those who throw or hit. In those whom I've seen scapular winging, I've seen great results (decrease in rotator cuff pain) from scapular strengthening (for example, Blackburn's exercises) and soft tissue work in the traps, rhomboids, etc. From what I've seen, trigger points in these muscles will often refer to pain in the rotator cuff muscles. This has highlighted to me the importance of identifying the source of pain once it has presented through thorough evaluation, rather than simply assuming the pathology is at the glenohumeral joint. Scapular motion is so vital to proper GH motion, so it is always something I will incorporate into my evaluations.

Because scapular pain can be due to developed muscle imbalances, it may be difficult to predict who will and will not develop pain during a season. However, the results of this study, indicating that eccentric strength may predict pain does make me consider being more deliberate about incorporating eccentric exercises into therapeutic exercise programs.

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