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