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Vetter S, Witt M, Hepp P, Schleichardt A, Schleifenbaum S, Roth C, Denecke T, Henkelmann J, Köhler HP. A 6-week randomized-controlled field study: effect of isokinetic eccentric resistance training on strength, flexibility and muscle structure of the shoulder external rotators in male junior handball players. Front Physiol 2024; 15:1368033. [PMID: 38516212 PMCID: PMC10955123 DOI: 10.3389/fphys.2024.1368033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 02/26/2024] [Indexed: 03/23/2024] Open
Abstract
Background: Team handball involves a tremendous amount of shoulder motion with high forces during repeated extended external range of motion. This causes shoulder complaints and overuse injuries. While eccentric training for the lower extremity shows preventive effects by improving strength, range of motion and fascicle length, there is a research gap for the shoulder joint and for advanced tissue characterization using diffusion tensor imaging. Objectives: To investigate the effects of 6-week eccentric isokinetic resistance training on strength, flexibility, and fiber architecture characteristics of the external rotators compared to an active control group in junior male handball players. Methods: 15 subjects were randomly assigned to the eccentric training group and 14 subjects to the active control group (conventional preventive training). Primary outcome measures were eccentric and concentric isokinetic strength of the external rotators, range of motion, and muscle fascicle length and fascicle volume. Results: The intervention group, showed significant changes in eccentric strength (+15%). The supraspinatus and infraspinatus muscles showed significant increases in fascicle length (+13% and +8%), and in fractional anisotropy (+9% and +6%), which were significantly different from the control group. Conclusion: Eccentric isokinetic training has a significant effect on the function and macroscopic structure of the shoulder external rotators in male junior handball players. While strength parameters and muscle structure improved, range of motion did not change. This research helps understanding the physiology of muscle and the role of eccentric training on shoulder function and muscle structure. Furthermore, DTI was found to be a promising tool for advanced tissue characterization, and the in vivo derived data can also serve as model input variables and as a possibility to extend existing ex-vivo muscle models. Future research is needed for functional and structural changes following convenient eccentric field exercises.
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Affiliation(s)
- Sebastian Vetter
- Department of Biomechanics in Sports, Leipzig University, Leipzig, Germany
| | - Maren Witt
- Department of Biomechanics in Sports, Leipzig University, Leipzig, Germany
| | - Pierre Hepp
- Department of Orthopaedics, Trauma and Plastic Surgery, Leipzig University, Leipzig, Germany
| | - Axel Schleichardt
- Department of Biomechanics, Institute for Applied Training Science, Leipzig, Germany
| | - Stefan Schleifenbaum
- Department of Orthopaedics, Trauma and Plastic Surgery, Leipzig University, Leipzig, Germany
| | - Christian Roth
- Department of Pediatric Radiology, Leipzig University, Leipzig, Germany
| | - Timm Denecke
- Department of Diagnostic and Interventional Radiology, Leipzig University, Leipzig, Germany
| | - Jeanette Henkelmann
- Department of Diagnostic and Interventional Radiology, Leipzig University, Leipzig, Germany
| | - Hans-Peter Köhler
- Department of Biomechanics in Sports, Leipzig University, Leipzig, Germany
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Alonso-Muñoz MB, Calvache-Mateo A, Martín-Núñez J, López-López L, Navas-Otero A, Heredia-Ciuró A, Valenza MC. Musculoskeletal, Functional and Performance Impairment in Female Overhead Athletes with a Previous Shoulder Injury. Healthcare (Basel) 2023; 12:21. [PMID: 38200927 PMCID: PMC10779138 DOI: 10.3390/healthcare12010021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 12/18/2023] [Accepted: 12/19/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Shoulder injuries are substantial problems in overhead athletes, and more studies are necessary to deepen the knowledge on this type of injury. The objective of this study was to compare the overall function and performance of female overhead athletes with and without a previous history of shoulder injuries. METHODS In this cross-sectional study, female overhead athletes with and without a previous shoulder injury were included. Muscular impairment, the stability of the shoulder, strength, scapular dyskinesia, functionality and sports performance were evaluated. A total of 50 females were included. RESULTS There were significant differences in strength (p = 0.046) and stability (p = 0.039) between groups, with a poorer score in the group with a history of shoulder injury. Regarding scapular dyskinesia, significant differences were also observed between groups (p = 0.048), with higher levels of dyskinesia in the group with previous shoulder injury. Also, muscular impairment showed significant differences between groups for the three muscles evaluated (p < 0.005). Additionally, the group without a previous shoulder injury presented with a significantly greater score in functionality (p = 0.046) and sports performance (p = 0.004). CONCLUSION In conclusion, previous shoulder injuries are an important factor to take into account in female overhead athletes. Players with a history of shoulder injury present clinical impairments during the game, leading to poorer functional status and performance in sport.
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Affiliation(s)
| | | | | | - Laura López-López
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Av. De la Ilustración, 60, 18071 Granada, Spain; (M.B.A.-M.); (A.C.-M.); (J.M.-N.); (A.N.-O.); (A.H.-C.); (M.C.V.)
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Tooth C, Schwartz C, Gofflot A, Bornheim S, Croisier JL, Forthomme B. Preseason shoulder screening in volleyball players: is there any change during season? JSES Int 2023; 7:662-667. [PMID: 37426908 PMCID: PMC10328776 DOI: 10.1016/j.jseint.2023.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023] Open
Abstract
Background Volleyball players sollicit their shoulder with high velocity and high ranges of motion. Musculoskeletal adaptations have been described after some years of practice but have not been explored after some months of practice. The objective of this study was to analyze the short-term evolution of shoulder clinical measures and functional performance in youth competitive volleyball players. Methods Sixty-one volleyball players were assessed twice, at preseason and at midseason. Shoulder internal and external rotation range of motion as well as forward shoulder posture and scapular upward rotation were measured in all players. Two functional tests were also performed: the upper quarter Y-balance test and the Single-arm medicine ball throw. The results obtained at midseason were compared to those measured at preseason. Results Compared to preseason, an increase in absolute value of shoulder external rotation, total rotation range of motion and forward shoulder posture were observed at midseason (P < .001). An increase in side-to-side difference for shoulder internal rotation range of motion was also observed during the season. As for scapular kinematics, scapular upward rotation was significantly decreased at 45° and increased at 120° of abduction at midseason. Concerning functional tests, an increase in throwing distance in the single-arm medicine ball throw was observed at midseason while no change was noted for the upper quarter Y-balance test. Conclusion Significant changes in clinical measures and functional performance were observed after some months of practice. Since some variables have been suggested to be correlated to a higher risk of shoulder injuries, the current study emphasizes the importance of regular screening in order to highlight injury risk profiles throughout the season.
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Affiliation(s)
- Camille Tooth
- Laboratory of Human Motion Analysis, University of Liège, Liège, Belgium
- Department of Physical Medicine and Rehabilitation, University of Liège, Liège, Belgium
| | - Cédric Schwartz
- Laboratory of Human Motion Analysis, University of Liège, Liège, Belgium
| | - Amandine Gofflot
- Department of Physical Medicine and Rehabilitation, University of Liège, Liège, Belgium
| | - Stephen Bornheim
- Department of Physical Medicine and Rehabilitation, University of Liège, Liège, Belgium
| | - Jean-Louis Croisier
- Laboratory of Human Motion Analysis, University of Liège, Liège, Belgium
- Department of Physical Medicine and Rehabilitation, University of Liège, Liège, Belgium
| | - Bénédicte Forthomme
- Laboratory of Human Motion Analysis, University of Liège, Liège, Belgium
- Department of Physical Medicine and Rehabilitation, University of Liège, Liège, Belgium
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Partner R, Tee J, Darrall-Jones J, Jones B. Development of a rugby shoulder function (RSF) questionnaire: An online Delphi study. Phys Ther Sport 2023; 61:185-191. [PMID: 37116373 DOI: 10.1016/j.ptsp.2023.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 04/05/2023] [Accepted: 04/06/2023] [Indexed: 04/30/2023]
Abstract
OBJECTIVE Develop a questionnaire to monitor symptoms of player perceived shoulder function/dysfunction. DESIGN 3-Stage Online Delphi Study. METHODS Participants: surgeons, sports and exercise medics, academic researchers, strength and conditioning coaches, therapists and athletes split by level of expertise/experience. Stage-1: experts (n = 12) rated constructs/items from the steering group and made changes/proposed additional constructs/items. Stage-2: experts rated/amended new constructs/items from stage-1. Stage-3: experienced professionals (n = 25) rated/ranked constructs/items from stage 2. Consensus thresholds were defined per stage (≥50% agreement/4-5 rating on 1-5 Likert scale (stages 1-2), ≥68% agreement, and items ranked for perceived importance (stage-3)). RESULTS Stage-1, all four constructs (a. Activities of daily living, b. Range of motion, c. Strength and conditioning, d. Sports specific training and competition) and 26/42 original items achieved consensus. Twelve items were combined into five items. Four new items were also proposed. Stage-2, the combined items and three of the four new items achieved consensus. Stage-3 the four constructs and 22 items all achieved consensus. CONCLUSIONS Following a 3-stage online Delphi process, involving expert and experienced clinicians, practitioners and athletes, a new four construct, 22 item RSF questionnaire has been developed which can be used with rugby players, to monitor perceived shoulder performance and symptoms.
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Affiliation(s)
- Richard Partner
- Musculoskeletal Health Research Group, School of Health, Leeds Beckett University, Leeds, United Kingdom; Carnegie Applied Rugby Research (CARR) Centre, Carnegie School of Sport, Leeds Beckett University, Leeds, United Kingdom.
| | - Jason Tee
- Carnegie Applied Rugby Research (CARR) Centre, Carnegie School of Sport, Leeds Beckett University, Leeds, United Kingdom; Department of Physiology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Josh Darrall-Jones
- Carnegie Applied Rugby Research (CARR) Centre, Carnegie School of Sport, Leeds Beckett University, Leeds, United Kingdom
| | - Ben Jones
- Carnegie Applied Rugby Research (CARR) Centre, Carnegie School of Sport, Leeds Beckett University, Leeds, United Kingdom; Leeds Rhinos Rugby League Club, Leeds, United Kingdom; England Performance Unit, Rugby Football League, Leeds, United Kingdom; School of Science and Technology, University of New England, Armidale, NSW, Australia; Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, The University of Cape Town and the Sports Science Institute of South Africa, Cape Town, South Africa
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Rau A, Jungmann PM, Diallo TD, Reisert M, Kellner E, Eisenblaetter M, Bamberg F, Jung M. Application of diffusion microstructure imaging in musculoskeletal radiology - translation from head to shoulders. Eur Radiol 2023; 33:1565-1574. [PMID: 36307552 PMCID: PMC9935724 DOI: 10.1007/s00330-022-09202-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/14/2022] [Accepted: 09/25/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Quantitative MRI techniques, such as diffusion microstructure imaging (DMI), are increasingly applied for advanced tissue characterization. We determined its value in rotator cuff (RC) muscle imaging by studying the association of DMI parameters to isometric strength and fat fraction (FF). METHODS Healthy individuals prospectively underwent 3T-MRI of the shoulder using DMI and chemical shift encoding-based water-fat imaging. RC muscles were segmented and quantitative MRI metrics (V-ISO, free fluid; V-intra, compartment inside of muscle fibers; V-extra, compartment outside of muscle fibers, and FF) were extracted. Isometric shoulder strength was quantified using specific clinical tests. Sex-related differences were assessed with Student's t. Association of DMI-metrics, FF, and strength was tested. A factorial two-way ANOVA was performed to compare the main effects of sex and external/internal strength-ratio and their interaction effects on quantitative imaging parameters ratios of infraspinatus/subscapularis. RESULTS Among 22 participants (mean age: 26.7 ± 3.1 years, 50% female, mean BMI: 22.6 ± 1.9 kg/m2), FF of the individual RC muscles did not correlate with strength or DMI parameters (all p > 0.05). Subjects with higher V-intra (r = 0.57 to 0.87, p < 0.01) and lower V-ISO (r = -0.6 to -0.88, p < 0.01) had higher internal and external rotation strength. Moreover, V-intra was higher and V-ISO was lower in all RC muscles in males compared to female subjects (all p < 0.01). There was a sex-independent association of external/internal strength-ratio with the ratio of V-extra of infraspinatus/subscapularis (p = 0.02). CONCLUSIONS Quantitative DMI parameters may provide incremental information about muscular function and microstructure in young athletes and may serve as a potential biomarker. KEY POINTS • Diffusion microstructure imaging was successfully applied to non-invasively assess the microstructure of rotator cuff muscles in healthy volunteers. • Sex-related differences in the microstructural composition of the rotator cuff were observed. • Muscular microstructural metrics correlated with rotator cuff strength and may serve as an imaging biomarker of muscular integrity and function.
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Affiliation(s)
- Alexander Rau
- Department of Diagnostic and Interventional Radiology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Str. 64, 79106, Freiburg, Germany.
- Department of Neuroradiology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106, Freiburg, Germany.
| | - Pia M Jungmann
- Department of Diagnostic and Interventional Radiology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Str. 64, 79106, Freiburg, Germany
| | - Thierno D Diallo
- Department of Diagnostic and Interventional Radiology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Str. 64, 79106, Freiburg, Germany
| | - Marco Reisert
- Medical Physics, Department of Diagnostic and Interventional Radiology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106, Freiburg, Germany
- Department of Stereotactic and Functional Neurosurgery, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106, Freiburg, Germany
| | - Elias Kellner
- Medical Physics, Department of Diagnostic and Interventional Radiology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106, Freiburg, Germany
| | - Michel Eisenblaetter
- Department of Diagnostic and Interventional Radiology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Str. 64, 79106, Freiburg, Germany
| | - Fabian Bamberg
- Department of Diagnostic and Interventional Radiology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Str. 64, 79106, Freiburg, Germany
| | - Matthias Jung
- Department of Diagnostic and Interventional Radiology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Str. 64, 79106, Freiburg, Germany
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Sports-Related Shoulder Injuries Among Female Athletes. Curr Rev Musculoskelet Med 2022; 15:637-644. [PMID: 36469281 PMCID: PMC9789246 DOI: 10.1007/s12178-022-09802-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/30/2022] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW The objectives of this review are to explore the recent literature evaluating sports-related shoulder injuries among female athletes. RECENT FINDINGS Recent literature has highlighted sex-related differences in injury trends and patterns among athletes. Increased participation of women in both recreational and professional sports has resulted in increased exposure to injury. While men experience greater rates of shoulder injury overall, women tend to experience more overuse-related injuries. Evidence also suggests women are more susceptible to shoulder laxity and rotator cuff tears. In comparison to their male counterparts, women note poorer function, increased pain, and decreased activity level following shoulder injuries. Women may also be more likely to experience worse outcomes following surgical intervention. Sex-related differences in injury patterns and outcomes results from a combination of molecular and environmental influences, including hormone pathways, shoulder morphology, and differing rates of participation in, and athletic regulations among, certain sports. Sex-related differences occur in how athletes sustain, experience, and recover from sports-related injuries. A comprehensive understanding of sex-related injuries enhances clinical decision making, treatment, and recovery. Further research is needed to clarify sex as an independent variable when evaluating sports-related shoulder injuries.
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Asker M, Hägglund M, Waldén M, Källberg H, Skillgate E. The Effect of Shoulder and Knee Exercise Programmes on the Risk of Shoulder and Knee Injuries in Adolescent Elite Handball Players: A Three-Armed Cluster Randomised Controlled Trial. SPORTS MEDICINE - OPEN 2022; 8:91. [PMID: 35834139 PMCID: PMC9283550 DOI: 10.1186/s40798-022-00478-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 06/13/2022] [Indexed: 11/10/2022]
Abstract
Abstract
Background
The risk of injury in adolescent handball is high, and shoulder and knee injuries are among the most frequent and burdensome. The Swedish Knee Control programme reduced the risk of anterior cruciate ligament injuries in female youth football players and traumatic knee injuries in male and female youth floorball players. However, to date, Knee Control has not been evaluated in an elite youth sport setting. The literature on the prevention of shoulder injuries in sport is scarce, and there are to our knowledge no previous studies evaluating the preventative efficacy of injury prevention exercise programmes (IPEPs) on shoulder injuries in adolescent handball players.
Objectives
To study the preventive efficacy of IPEPs on shoulder and knee injuries in adolescent elite handball players.
Methods
Eighteen Swedish handball-profiled secondary schools (clusters) with players aged 15–19 years, 54% males were randomised into either the Shoulder Group or Knee Group (interventions) or a Control Group. Players in the Shoulder Group were instructed to perform the Shoulder Control programme, and players in the Knee Group to perform the Knee Control programme, three times per week during May 2018 to May 2019. Control Group players continued their usual training. Outcomes were shoulder and knee injuries defined by the Oslo Sports Trauma Research Center Overuse Injury Questionnaire. Intention-to-treat analyses were performed using Cox regression models with hazard rate ratios (HRRs) with corresponding 95% confidence intervals (CI).
Results
Six clusters (199 players) in the Shoulder Group, six clusters (216 players) in the Knee Group and six clusters (212 players) in the Control Group were included. There were 100 shoulder injuries and 156 knee injuries. The Shoulder Group had a 56% lower shoulder injury rate, HRR 0.44 (95% CI 0.29 to 0.68), and the Knee Group had a 31% lower knee injury rate, HRR 0.69 (95% CI 0.49 to 0.97) than the Control Group. The absolute risk reduction was 11% and 8%, and the number needed to treat was 9 and 13, respectively.
Conclusions
Adolescent elite handball players who performed the Shoulder Control and the Knee Control programmes had a lower risk of shoulder and knee injuries, respectively, than players who continued their usual training. Further research on how these two programmes can be combined to reduce knee and shoulder injuries in a time effective way is warranted.
Trial registration ISRCTN15946352.
Key points
The burden of knee and shoulder injuries in handball is high.
The Shoulder Control programme reduces the risk and overall burden of shoulder injuries in adolescent elite handball players.
The Knee Control programme reduces the risk and overall burden of knee injuries in adolescent elite handball players.
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McConnell J. CORR Insights®: Altered Cervical Spine Position Results in Decreased Shoulder Rotation Strength. Clin Orthop Relat Res 2022; 480:1728-1730. [PMID: 35583515 PMCID: PMC9384934 DOI: 10.1097/corr.0000000000002249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 04/26/2022] [Indexed: 01/31/2023]
Affiliation(s)
- Jenny McConnell
- Physiotherapist, McConnell and Clements Physiotherapy, Sydney, Australia
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Vila H, Barreiro A, Ayán C, Antúnez A, Ferragut C. The Most Common Handball Injuries: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191710688. [PMID: 36078403 PMCID: PMC9518369 DOI: 10.3390/ijerph191710688] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 08/17/2022] [Accepted: 08/25/2022] [Indexed: 06/01/2023]
Abstract
Handball is a team sport involving a great physical demand from its practitioners in which a high number of injuries occur, affecting individual and collective performance. Knowledge of the injuries is of great importance for their prevention. The objective of the present study was to identify, locate and compare the most frequent injuries and injury mechanisms in handball practice. It was carried out following the Preferred Informed Item for Systematic Reviews and Meta-analysis (PRISMA) guidelines. The source of data collection was direct consultation of the PubMed and Medline databases. Several keywords were used for the documentary retrieval, and the quality of the studies that were selected was evaluated. Of the 707 studies retrieved, only 27 were considered appropriate for the review, and quality scores were obtained that ranged from 10 to 26 points, out of a maximum of 28. The most frequent injuries in handball players are located in the lower limbs (thigh, knee and ankle), and in the shoulder in the upper limbs. Regarding the playing position, the players who play over the 6-m line are the most affected by injuries, while the women players have a higher probability of injury. Most injuries occur during competition.
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Affiliation(s)
- Helena Vila
- Department of Special Didactics, Faculty of Education and Sport Sciences, University of Vigo, 36005 Pontevedra, Spain
| | - Andrea Barreiro
- Faculty of Education and Sport Science, University of Vigo, 36310 Vigo, Spain
| | - Carlos Ayán
- Department of Special Didactics, Faculty of Education and Sport Sciences, University of Vigo, 36005 Pontevedra, Spain
| | - Antonio Antúnez
- Research Group in Optimization of Training and Sports Performance (GOERD), University of Extremadura, 10005 Caceres, Spain
| | - Carmen Ferragut
- Department of Biomedical Sciences, Faculty of Medicine and Science Health, University of Alcala, 28801 Alcalá de Henares, Spain
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Gibson ES, Cairo A, Räisänen AM, Kuntze C, Emery CA, Pasanen K. The Epidemiology of Youth Sport-Related Shoulder Injuries: A Systematic Review. TRANSLATIONAL SPORTS MEDICINE 2022; 2022:8791398. [PMID: 38655170 PMCID: PMC11022765 DOI: 10.1155/2022/8791398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 06/21/2022] [Accepted: 06/23/2022] [Indexed: 04/26/2024]
Abstract
Background Youth around the globe place their shoulders at risk for injury when participating in sports. Shoulder injuries may vary in severity, produce the potential for time-loss from sport, and result in functional disability. We sought to explore sport-related shoulder injuries in youth by identifying injury rates, risk factors, injury mechanisms, and injury prevention strategies. Methods All relevant full-text articles were identified by searching MEDLINE, EMBASE, CINAHL, Sport Discus, and the Cochrane Controlled Trials Registry. No date restrictions were used. All full-text studies reporting original research describing sport-related shoulder injury among female and/or male youth from 5 to 18 years old were included. Results Of 3,889 studies screened, 97 described shoulder injury in youth sports. Shoulder injuries were identified in 24 unique sports. The median seasonal prevalence of shoulder injury was 10.9% (range 1.2-28.2%). The most common injury mechanisms identified were contacted with another player, contact with the playing environment, and falling to the ground. Risk factors for shoulder injury identified were side-to-side strength imbalances, weak external rotator muscles, and scapular dyskinesia. One study evaluated a successful training strategy to prevent shoulder injuries, but two other interventions demonstrated no effect. Conclusions Sport-related shoulder injuries are prevalent among youth athletes. Injury risk factors identified included modifiable intrinsic factors such as strength, range of motion, and training load. The most common injury mechanism was direct contact with either another person or an object in the playing environment. Innovative shoulder-specific strategies are needed to reduce shoulder injuries in this population. Trial Registration: PROSPERO ID: CRD42020189142.
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Affiliation(s)
- Eric S. Gibson
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Canada
| | - Alexis Cairo
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Canada
| | - Anu M. Räisänen
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Canada
- Department of Physical Therapy Education, College of Health Sciences - Northwest, Western University of Health Sciences, Lebanon, Oregon, USA
| | - Colleen Kuntze
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Canada
| | - Carolyn A. Emery
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Canada
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Canada
| | - Kati Pasanen
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Canada
- Tampere Research Center of Sports Medicine, UKK Institute, Tampere, Finland
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Hoppe MW, Brochhagen J, Tischer T, Beitzel K, Seil R, Grim C. Risk factors and prevention strategies for shoulder injuries in overhead sports: an updated systematic review. J Exp Orthop 2022; 9:78. [PMID: 35971013 PMCID: PMC9378805 DOI: 10.1186/s40634-022-00493-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 05/25/2022] [Indexed: 11/10/2022] Open
Abstract
PURPOSE The aim of this systematic review was to update the knowledge on risk factors and prevention strategies for shoulder injuries in overhead sports with special emphasis on methodological quality. METHODS All methodological procedures were performed in line with a previous systematic review by Asker et al. (2018). The literature search was conducted in the PubMed, Google Scholar, Cochrane, and SPORT-Discuss databases. Due to the risk of bias assessment, only studies with at least an acceptable methodological quality were included. A best-evidence synthesis was performed to clarify the evidence and direction of the risk factors and prevention strategies. RESULTS A total of nine studies were included in the data extraction process. One study had a high and eight studies had an acceptable methodological quality. Seven cohort studies investigated risk factors and two randomised controlled trails evaluated prevention strategies. Moderate evidence was found for two non-modifiable (playing position, gender) and three modifiable factors (shoulder rotational strength, scapular dyskinesia, shoulder prevention programme) that were associated with the shoulder injury risk. All further risk factors had moderate and no association with risk (shoulder rotational ROM, joint position sense) or limited (history of shoulder/elbow pain, age, training experience, training volume, school grade, playing level), and conflicting evidence (setting). CONCLUSIONS There is moderate evidence for two non-modifiable (playing position, gender) and three modifiable factors (shoulder rotational strength, scapular dyskinesia, shoulder prevention programme) being associated with the shoulder injury risk in overhead sports.
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Affiliation(s)
- Matthias Wilhelm Hoppe
- Movement and Training Science, Leipzig University, Jahnallee 59, 04109, Leipzig, Germany.
| | - Joana Brochhagen
- Movement and Training Science, Leipzig University, Jahnallee 59, 04109, Leipzig, Germany
| | - Thomas Tischer
- Clinic for Orthopaedics and Trauma Surgery, Malteser Waldkrankenhaus St. Marien, Erlangen, Germany.,Department of Orthopaedics, University Medical Centre Rostock, Rostock, Germany
| | | | - Romain Seil
- Department of Orthopaedic Surgery, Centre Hospitalier Luxembourg and Luxembourg Institute of Health, Luxembourg, Luxembourg
| | - Casper Grim
- Centre for Musculoskeletal Surgery Osnabrück (OZMC), Klinikum Osnabrück, Osnabrück, Germany.,Institute for Health Research and Education (IGB), Osnabrück University, Osnabrück, Germany
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Johansson F, Tranaeus U, Asker M, Skillgate E, Johansson F. Athletic Identity and Shoulder Overuse Injury in Competitive Adolescent Tennis Players: The Smash Cohort Study. Front Sports Act Living 2022; 4:940934. [PMID: 35873205 PMCID: PMC9299246 DOI: 10.3389/fspor.2022.940934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 06/01/2022] [Indexed: 11/29/2022] Open
Abstract
Objectives Our primary aim was to determine if athletic identity is prospectively associated with shoulder overuse injuries. Secondly, we aimed to determine if athletic identity is prospectively associated with playing through pain and to describe how athletic identity relates to sex, age, playing level, weekly training load, and match volume. Methods A cohort of 269 adolescent tennis players were followed over a period of 52 weeks. Cox regression was used to estimate the hazard rate ratio (HRR) of first-time shoulder overuse injury associated with every 10-unit increase on the Athletic Identity Measurement Scale (AIMS). Results The adjusted HRR of shoulder overuse injury was 0.89 (95% CI: 0.36–2.20) and the odds ratio of playing through pain was 2.41 (95% CI: 0.74–8.96) for every 10 unit increase on AIMS. The level of athletic identity was higher among players at the national level than among players at the regional level and was weakly correlated to weekly hours of tennis matches, tennis training, and fitness training. Conclusions Our results indicate that higher levels of athletic identity may be associated with a lower incidence of shoulder overuse injuries, and potentially with playing through pain, although these results are inconclusive due to wide confidence intervals.
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Affiliation(s)
- Fred Johansson
- Department of Health Promotion Science, Musculoskeletal and Sports Injury Epidemiology Center, Sophiahemmet University, Stockholm, Sweden
- Unit of Intervention and Implementation Research for Worker Health, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- *Correspondence: Fred Johansson
| | - Ulrika Tranaeus
- Unit of Intervention and Implementation Research for Worker Health, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- The Swedish School of Sport and Health Sciences, Gymnastikoch Idrottshögskolan (GIH), Stockholm, Sweden
| | - Martin Asker
- Department of Health Promotion Science, Musculoskeletal and Sports Injury Epidemiology Center, Sophiahemmet University, Stockholm, Sweden
- Unit of Intervention and Implementation Research for Worker Health, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Scandinavian College of Naprapathic Manual Medicine, Stockholm, Sweden
| | - Eva Skillgate
- Department of Health Promotion Science, Musculoskeletal and Sports Injury Epidemiology Center, Sophiahemmet University, Stockholm, Sweden
- Unit of Intervention and Implementation Research for Worker Health, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Fredrik Johansson
- Department of Health Promotion Science, Musculoskeletal and Sports Injury Epidemiology Center, Sophiahemmet University, Stockholm, Sweden
- Unit of Intervention and Implementation Research for Worker Health, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Scandinavian College of Naprapathic Manual Medicine, Stockholm, Sweden
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Fernandez-Fernandez J, Granacher U, Martinez-Martin I, Garcia-Tormo V, Herrero-Molleda A, Barbado D, Garcia-Lopez J. Physical fitness and throwing speed in U13 versus U15 male handball players. BMC Sports Sci Med Rehabil 2022; 14:113. [PMID: 35725495 PMCID: PMC9210574 DOI: 10.1186/s13102-022-00507-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 06/14/2022] [Indexed: 11/13/2022]
Abstract
Background The aim of this study was to analyze the shoulder functional profile (rotation range of motion [ROM] and strength), upper and lower body performance, and throwing speed of U13 versus U15 male handball players, and to establish the relationship between these measures of physical fitness and throwing speed. Methods One-hundred and nineteen young male handball players (under (U)-13 (U13) [n = 85]) and U15 [n = 34]) volunteered to participate in this study. The participating athletes had a mean background of sytematic handball training of 5.5 ± 2.8 years and they exercised on average 540 ± 10.1 min per week including sport-specific team handball training and strength and conditioning programs. Players were tested for passive shoulder range-of-motion (ROM) for both internal (IR) and external rotation (ER) and isometric strength (i.e., IR and ER) of the dominant/non-dominant shoulders, overhead medicine ball throw (OMB), hip isometric abductor (ABD) and adductor (ADD) strength, hip ROM, jumps (countermovement jump [CMJ] and triple leg-hop [3H] for distance), linear sprint test, modified 505 change-of-direction (COD) test and handball throwing speed (7 m [HT7] and 9 m [HT9]). Results U15 players outperformed U13 in upper (i.e., HT7 and HT9 speed, OMB, absolute IR and ER strength of the dominant and non-dominant sides; Cohen’s d: 0.76–2.13) and lower body (i.e., CMJ, 3H, 20-m sprint and COD, hip ABD and ADD; d: 0.70–2.33) performance measures. Regarding shoulder ROM outcomes, a lower IR ROM was found of the dominant side in the U15 group compared to the U13 and a higher ER ROM on both sides in U15 (d: 0.76–1.04). It seems that primarily anthropometric characteristics (i.e., body height, body mass) and upper body strength/power (OMB distance) are the most important factors that explain the throw speed variance in male handball players, particularly in U13. Conclusions Findings from this study imply that regular performance monitoring is important for performance development and for minimizing injury risk of the shoulder in both age categories of young male handball players. Besides measures of physical fitness, anthropometric data should be recorded because handball throwing performance is related to these measures.
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Affiliation(s)
- Jaime Fernandez-Fernandez
- Faculty of Physical Activity and Sports Sciences, Universidad de León, León, Spain.,AMRED, Human Movement and Sports Performance Analysis, Universidad de León, León, Spain
| | - Urs Granacher
- Division of Training and Movement Sciences, Research Focus Cognition Sciences, Faculty of Human Sciences, University of Potsdam, Am Neuen Palais 10, 14469, Potsdam, Germany.
| | - Isidoro Martinez-Martin
- Faculty of Physical Activity and Sports Sciences, Universidad de León, León, Spain.,AMRED, Human Movement and Sports Performance Analysis, Universidad de León, León, Spain
| | - Vicente Garcia-Tormo
- Faculty of Physical Activity and Sports Sciences, Universidad de León, León, Spain.,AMRED, Human Movement and Sports Performance Analysis, Universidad de León, León, Spain
| | - Alba Herrero-Molleda
- Faculty of Physical Activity and Sports Sciences, Universidad de León, León, Spain.,AMRED, Human Movement and Sports Performance Analysis, Universidad de León, León, Spain
| | - David Barbado
- Department of Sport Science, Sport Research Centre, Miguel Hernandez University of Elche, Elche, Spain
| | - Juan Garcia-Lopez
- Faculty of Physical Activity and Sports Sciences, Universidad de León, León, Spain.,AMRED, Human Movement and Sports Performance Analysis, Universidad de León, León, Spain
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14
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Ageberg E, Brodin EM, Linnéll J, Moesch K, Donaldson A, Adébo E, Benjaminse A, Ekengren J, Granér S, Johnson U, Lucander K, Myklebust G, Møller M, Tranaeus U, Bunke S. Cocreating injury prevention training for youth team handball: bridging theory and practice. BMJ Open Sport Exerc Med 2022; 8:e001263. [PMID: 35505981 PMCID: PMC8984048 DOI: 10.1136/bmjsem-2021-001263] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2022] [Indexed: 11/12/2022] Open
Abstract
Although it is advocated that end-users are engaged in developing evidence-based injury prevention training to enhance the implementation, this rarely happens. The ‘Implementing injury Prevention training ROutines in TEams and Clubs in youth Team handball (I-PROTECT)’ uses an ecological participatory design incorporating the perspectives of multiple stakeholders throughout the project. Within the I-PROTECT project, the current study aimed to describe the development of holistic injury prevention training specifically for youth handball players through using knowledge from both end-users (coaches and players) and researchers/handball experts. Employing action evaluation within participatory action research, the cyclical development process included three phases: research team preparation, handball expert-based preparation and end-user evaluation to develop injury prevention training incorporating both physical and psychological perspectives. To grow the knowledge of the interdisciplinary research team, rethinking was conducted within and between phases based on participants’ contributions. Researchers and end-users cocreated examples of handball-specific exercises, including injury prevention physical principles (movement technique for upper and lower extremities, respectively, and muscle strength) combined with psychological aspects (increase end-user motivation, task focus and body awareness) to integrate into warm-up and skills training within handball practice. A cyclical development process that engaged researchers/handball experts and end-users to cocreate evidence-based, theory-informed and context-specific injury prevention training specifically for youth handball players generated a first pilot version of exercises including physical principles combined with psychological aspects to be integrated within handball practice.
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Affiliation(s)
- Eva Ageberg
- Department of Health Sciences, Lund University, Lund, Sweden
| | - Eva M Brodin
- Department of Educational Sciences, Lund University, Lund, Sweden.,Centre for Higher and Adult Education (CHAE), Stellenbosch University, Stellenbosch, South Africa
| | - Jennie Linnéll
- Department of Health Sciences, Lund University, Lund, Sweden
| | - Karin Moesch
- Department of Psychology, Lund University, Lund, Sweden
| | - Alex Donaldson
- Centre for Sport and Social Impact (CSSI), La Trobe University, Melbourne, Victoria, Australia
| | - Emme Adébo
- Regional Handball Federation in South Sweden, Lund, Sweden
| | - Anne Benjaminse
- Center for Human Movement Sciences, University of Groningen, Groningen, The Netherlands.,School of Sport Studies, Hanze University Groningen School of Social Studies, Groningen, The Netherlands
| | - Johan Ekengren
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Simon Granér
- Department of Psychology, Lund University, Lund, Sweden
| | - Urban Johnson
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | | | - Grethe Myklebust
- Oslo Sports Trauma Research Center, Norwegian School of Sports Sciences, Oslo, Norway
| | - Merete Møller
- Oslo Sports Trauma Research Center, Norwegian School of Sports Sciences, Oslo, Norway.,Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Ulrika Tranaeus
- Department of physiology, nutrition and biomechanics, The Swedish School of Sport and Health Sciences, Stockholm, Sweden.,Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Sofia Bunke
- Department of Psychology, Lund University, Lund, Sweden
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15
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Achenbach L, Huppertz G, Zeman F, Weber J, Luig P, Rudert M, Krutsch W. Multicomponent stretching and rubber band strengthening exercises do not reduce overuse shoulder injuries: a cluster randomised controlled trial with 579 handball athletes. BMJ Open Sport Exerc Med 2022; 8:e001270. [PMID: 35342642 PMCID: PMC8919472 DOI: 10.1136/bmjsem-2021-001270] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2022] [Indexed: 01/13/2023] Open
Abstract
Objectives Handball is associated with a high risk of overuse shoulder injury. This study investigated if an injury prevention programme effectively reduces overuse injury to the throwing shoulder of handball athletes. Methods 61 men’s and women’s handball teams (u-19 and senior athletes) were cluster-randomised into an intervention and a control group in the 2019–2020 season. Players of the intervention group regularly carried out an injury prevention programme. Both groups documented overuse shoulder injuries via an online questionnaire every second week. The primary endpoint was the prevalence of overuse injury to the throwing shoulder. Secondary endpoints were the influence of compliance on the primary endpoint and intensity of overuse shoulder symptoms measured by a shortened, handball-specific Western Ontario Shoulder Index (WOSI). Results 31 teams (295 players) in the intervention group and 30 teams (284 players) in the control group were included for analyses. The overall questionnaire response rate was 61%. The average prevalence of overuse shoulder injury did not significantly differ between the intervention group (n=109, 38.4% (95% CI 32.9% to 44.2%)) and the control group (n=106, 35.9% (95% CI 30.7% to 41.6%), p=0.542). Compliance with the intervention programme did not significantly affect overuse shoulder injury (p=0.893). Using generalised estimating equations for WOSI, the estimated mean for the intervention group was 44.6 points (95% CI 42.0 to 47.1) and 47.6 points for the control group (95% CI 44.9 to 50.3, p=0.111). Conclusions A multicomponent exercise programme using rubber bands and stretching did not significantly reduce the prevalence or symptoms of overuse throwing shoulder injury in handball athletes of both sexes. Randomised controlled study; level of evidence I. Trial registration number ISRCTN99023492.
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Affiliation(s)
- Leonard Achenbach
- Department of Orthopedics, König-Ludwig-Haus, Julius Maximilians University Würzburg, Würzburg, Germany.,Department of Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Gunnar Huppertz
- Center for Clinical Studies, University Medical Center, Regensburg, Germany
| | - Florian Zeman
- Center for Clinical Studies, University Medical Center, Regensburg, Germany
| | - Johannes Weber
- Department of Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany
| | | | - Maximilian Rudert
- Department of Orthopedics, König-Ludwig-Haus, Julius Maximilians University Würzburg, Würzburg, Germany
| | - Werner Krutsch
- Department of Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany
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16
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Johansson F, Asker M, Malmberg A, Fernandez-Fernandez J, Warnqvist A, Cools A. Eccentric and Isometric Shoulder Rotation Strength and Range of Motion: Normative Values for Adolescent Competitive Tennis Players. Front Sports Act Living 2022; 4:798255. [PMID: 35252855 PMCID: PMC8891455 DOI: 10.3389/fspor.2022.798255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 01/10/2022] [Indexed: 11/13/2022] Open
Abstract
The aim of this cross-sectional study was to investigate isometric internal rotation (IR), external rotation (ER), abduction (ABD), and eccentric external rotation (eccER) shoulder strength and rotational range of motion (ROM) in adolescent male and female competitive tennis players. Additional aims of the study were to provide a tennis-specific normative database based on a large sample of players to deepen the knowledge regarding shoulder strength and ROM for adolescent competitive tennis players, and to discuss differences based on sex, age, and level of play. Shoulder strength and ROM was assessed in 301 adolescent competitive tennis players, 176 boys and 125 girls with a mean age of 14.6 and 14.4 years, respectively. Outcome variables of interest were isometric IR and ER strength, ABD strength, eccER shoulder strength, intermuscular strength ratios ER/IR and eccER/IR, IR ROM, ER ROM, and total range of motion (TROM). A General Linear Model two-way ANOVA was used to analyze differences in sex, age, and level of play. The findings of this study demonstrated age, side, and sex differences in the shoulder isometric strength, the eccER strength and ROM in adolescent competitive tennis players. Furthermore, when strength was expressed as ratios ER/IR and eccER/IR both sexes showed a lower ratio for eccER/IR in national players (0.95 ± 0.22 and 0.95 ± 0.23) compared to regional players (1.01 ± 0.32 and 1.07 ± 0.29) for male and female players, respectively. In conclusion, this paper presents a tennis-specific normative database for shoulder rotation strength and ROM in adolescent male and female competitive players. The key points in this evaluation are strength values normalized to body mass, intermuscular ratios, and TROM.
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Affiliation(s)
- Fredrik Johansson
- Tennis Research and Performance Group, Department of Health Promotion Science, Sophiahemmet University, Stockholm, Sweden
- Scandinavian College of Naprapathic Manual Medicine, Stockholm, Sweden
- *Correspondence: Fredrik Johansson
| | - Martin Asker
- Scandinavian College of Naprapathic Manual Medicine, Stockholm, Sweden
- Handball Research Group, Department of Health Promotion Science, Sophiahemmet University, Stockholm, Sweden
| | - Andreas Malmberg
- Tennis Research and Performance Group, Department of Health Promotion Science, Sophiahemmet University, Stockholm, Sweden
| | | | - Anna Warnqvist
- Division of Biostatistics, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - Ann Cools
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Gent, Belgium
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17
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Flexibility, Position, and Strength of the Shoulder Complex in Pediatric and Adult Amateur Tennis Athletes. J Sport Rehabil 2022; 31:1-9. [PMID: 34167082 DOI: 10.1123/jsr.2020-0331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 04/14/2021] [Accepted: 04/25/2021] [Indexed: 12/16/2022]
Abstract
CONTEXT Understanding the musculoskeletal adaptations in the shoulder complex of varying ages of tennis athletes may suggest preventive protocols and conditioning and rehabilitation programs to this population. This study aimed to generate a bilateral descriptive profile of shoulder flexibility, scapular and clavicular position, and muscle strength in pediatric and adult amateur tennis athletes. The outcome measures were compared between groups and sides. The number and percentage of athletes "at risk" according to cutoff values for shoulder range of motion (ROM) were also analyzed. DESIGN Cross-sectional study. METHODS 36 pediatric and 28 adult amateur tennis athletes were tested. Outcome measures were ROM of shoulder flexion, abduction, internal and external rotation, posterior capsule tightness, pectoralis minor index (PMI), scapular upward rotation, clavicular elevation, and strength of the external rotators, serratus anterior, and lower trapezius of the dominant/nondominant sides. RESULTS Pediatric athletes had greater dominant side external rotation (P = .01) and total ROM (P = .04), increased Low Flexion test (P = .01), and decreased PMI (P = .01) compared with the adults. Bilaterally, the pediatric athletes had greater dominant side external rotation ROM (P < .01) and decreased PMI (P = .002) as compared with their nondominant side, whereas the adults displayed lower values on posterior capsule tightness (P = .01) and decreased PMI (P = .02) on their dominant side compared with their nondominant side. For the remaining outcomes, no interaction effects were observed. The cutoff values for shoulder ROM showed that several athletes were "at risk" of shoulder problems. CONCLUSION Upper extremity adaptations at the shoulder are present in both pediatric and adult tennis athletes. These data can assist clinicians in better understanding the biomechanical adaptations in the shoulder of amateur tennis athletes in different age groups.
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18
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2022 Bern Consensus Statement on Shoulder Injury Prevention, Rehabilitation, and Return to Sport for Athletes at All Participation Levels. J Orthop Sports Phys Ther 2022; 52:11-28. [PMID: 34972489 DOI: 10.2519/jospt.2022.10952] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
There is an absence of high-quality evidence to support rehabilitation and return-to-sport decisions following shoulder injuries in athletes. The Athlete Shoulder Consensus Group was convened to lead a consensus process that aimed to produce best-practice guidance for clinicians, athletes, and coaches for managing shoulder injuries in sport. We developed the consensus via a 2-round Delphi process (involving more than 40 content and methods experts) and an in-person meeting. This consensus statement provides guidance with respect to load and risk management, supporting athlete shoulder rehabilitation, and decision making during the return-to-sport process. This statement is designed to offer clinicians the flexibility to apply principle-based approaches to managing the return-to-sport process within a variety of sporting backgrounds. The principles and consensus of experts working across multiple sports may provide a template for developing additional sport-specific guidance in the future. J Orthop Sports Phys Ther 2022;52(1):11-28. doi:10.2519/jospt.2022.10952.
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19
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Skejø SD, Liaghat B, Jakobsen CC, Møller M, Bencke J, Papi G, Kunwald NP, Sørensen H. Quantifying throwing load in handball: a method for measuring the number of throws. Sports Biomech 2021:1-12. [PMID: 34294020 DOI: 10.1080/14763141.2021.1951345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 06/29/2021] [Indexed: 10/20/2022]
Abstract
Shoulder injuries are a common problem in handball. One likely cause of such injuries is excessive throwing. However, it is difficult to measure the number of player throws in large cohort studies using existing methods accurately. Therefore, the purpose of this study is to develop and validate a method for identifying overhead throws using a low-cost inertial measurement unit (IMU) worn on the wrist. In a two-stage approach, we developed a threshold-based automatic identification method for overhead throws in a laboratory study using the IMU. Subsequently, we validated the suggested thresholds in a field setting by comparing throws identified by the threshold-method to throws identified by video recordings of handball practices. The best set of threshold values resulted in a per-player median sensitivity of 100% (range: 84-100%) and a median positive predictive value (PPV) of 96% (range: 86-100%) in the development study. In the validation study, the per-player median sensitivity dropped to 78% sensitivity (range: 52-91%), while the per-player median PPV dropped to 79% (range: 47-90%). The proposed method is a promising method for automatically identifying handball throws in a cheap and feasible way.
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Affiliation(s)
| | - Behnam Liaghat
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | | | - Merete Møller
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Jesper Bencke
- Human Movement Analysis Laboratory, Department of Orthopaedic Surgery, Copenhagen University Hospital at Amager-Hvidovre, Hvidovre, Denmark
| | - Giovanni Papi
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | | | - Henrik Sørensen
- Department of Public Health, Aarhus University, Aarhus, Denmark
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20
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No Added Benefit of 8 Weeks of Shoulder External Rotation Strength Training for Youth Handball Players Over Usual Handball Training Alone: A Randomized Controlled Trial. J Orthop Sports Phys Ther 2021; 51:174-187. [PMID: 33789429 DOI: 10.2519/jospt.2021.9957] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To assess the effectiveness of a short (5-10 minutes) shoulder external rotation (ER) strength program, using elastic bands, in adolescent handball players. DESIGN Randomized controlled trial. METHODS The sample included 6 adolescent handball teams (3 female, 3 male) with a total of 92 players and a mean age of 16.6 years. Players were randomized within teams to an intervention group, which completed a shoulder ER strengthening program of 2 exercises performed 3 times per week after handball training for 8 weeks, or a control group of no treatment. The primary outcome was the between-group difference in shoulder ER strength change, measured as isometric strength using a handheld dynamometer from preintervention to postintervention (8 weeks). Secondary outcomes were between-group differences in internal rotation (IR) strength and the ER/IR strength ratio from preintervention to postintervention. RESULTS The estimated between-group difference in dominant-shoulder ER strength was 0.06 N/kg (95% confidence interval [CI]: -0.01, 0.14) in favor of the intervention group. The estimated between-group differences in the ER/IR ratio and IR strength were 0.03 (95% CI: -0.02, 0.08) and 0.02 (95% CI: -0.08, 0.13), respectively. CONCLUSION The ER strength program improved neither the ER strength nor the ER:IR ratio. J Orthop Sports Phys Ther 2021;51(4):174-187. doi:10.2519/jospt.2021.9957.
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21
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Shoulder Rotation Strength Changes From Preseason to Midseason: A Cohort Study of 292 Youth Elite Handball Players Without Shoulder Problems. J Orthop Sports Phys Ther 2020; 50:381-387. [PMID: 32605467 DOI: 10.2519/jospt.2020.9183] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To investigate change in shoulder rotation strength from preseason to midseason during a competitive season in youth elite handball players without shoulder problems. DESIGN Prospective cohort study. METHODS Players (n = 292, 45% female, 14-18 years of age) without shoulder problems from Danish youth elite handball clubs were assessed in the preseason and midseason. We measured isometric shoulder strength using handheld dynamometry in internal rotation (IR) and external rotation (ER) in supine, with the shoulder abducted 90° in neutral rotation and in 30° of IR. The primary outcome was the change in corresponding ER/IR ratio. RESULTS The mean ER/IR ratios increased from preseason to midseason in neutral rotation (male player difference, 0.02; 95% confidence interval [CI]: -0.01, 0.06; female player difference, 0.05; 95% CI: 0.01, 0.09) and in 30° of IR (male player difference, 0.15; 95% CI: 0.11, 0.20; female player difference, 0.12; 95% CI: 0.07, 0.17). The change in ER/IR ratio may be explained by an increase in ER strength in female players and a decrease in IR strength in male players. The amount of change in ER/IR ratio over the season was greater than individual measurement error metrics for 45% to 66% of the players. CONCLUSION Shoulder rotation strength ratios changed during a competitive season in Danish youth elite handball players. J Orthop Sports Phys Ther 2020;50(7):381-387. doi:10.2519/jospt.2020.9183.
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