Download PDF
Int J Sports Med 2013; 34(07): 654-660
DOI: 10.1055/s-0032-1312587
Orthopedics & Biomechanics
© Georg Thieme Verlag KG Stuttgart · New York

Shoulder Strength Imbalances as Injury Risk in Handball

P. Edouard
1   Department of Physical Medicine and Rehabilitation, Faculty of Medicine, University Hospital of Saint-Etienne, France
2   Department of Clinical and Exercise Physiology, Sports Medicine Unity, Faculty of Medicine, University Hospital of Saint-Etienne, France
3   Laboratory of Exercise Physiology, University of Lyon, Saint-Etienne, France
,
F. Degache
4   Institute of Sport Sciences, Department of Physiology. Faculty of Biology and Medicine, Bâtiment Vidy, CH-1015, University of Lausanne, Switzerland
,
R. Oullion
2   Department of Clinical and Exercise Physiology, Sports Medicine Unity, Faculty of Medicine, University Hospital of Saint-Etienne, France
3   Laboratory of Exercise Physiology, University of Lyon, Saint-Etienne, France
5   Handball French Federation, Paris, France
,
J.-Y. Plessis
5   Handball French Federation, Paris, France
,
S. Gleizes-Cervera
5   Handball French Federation, Paris, France
,
P. Calmels
1   Department of Physical Medicine and Rehabilitation, Faculty of Medicine, University Hospital of Saint-Etienne, France
3   Laboratory of Exercise Physiology, University of Lyon, Saint-Etienne, France
› Author Affiliations
Further Information

Publication History



accepted after revision 30 March 2012

Publication Date:
26 February 2013 (online)

Also available at
    Permissions and Reprints

Abstract

This study was conducted to analyze whether internal (IR) and external (ER) rotator shoulder muscles weakness and/or imbalance collected through a preseason assessment could be predictors of subsequent shoulder injury during a season in handball players. In preseason, 16 female elite handball players (HPG) and 14 healthy female nonathletes (CG) underwent isokinetic IR and ER strength test with use of a Con-Trex® dynamometer in a seated position with 45° shoulder abduction in scapular plane, at 60, 120 and 240°/s in concentric and at 60°/s in eccentric, for both sides. An imbalanced muscular strength profile was determined using ­statistically selected cut-offs from CG values. For HPG, all newly incurred shoulder injuries were reported during the season. There were significant differences between HPG and CG only for dominant eccentric IR strength, ER/IR ratio at 240°/s and for IRecc/ERcon ratio. In HPG, IR and ER strength was higher, and ER/IR ratios lower for dominant than for nondominant side. The relative risk was 2.57 (95%CI: 1.60–3.54; P<0.05) if handball players had an imbalanced muscular strength profile. In youth female handball players IR and ER muscle strength increases on the dominant side without ER/IR imbalances; and higher injury risk was associated with imbalanced muscular strength profile.

Key words

sports injury prevention - rotator cuff strength - isokinetic - overhead sports - strength imbalance
 

  • References

  • 1 Andrade Mdos S, Fleury AM, de Lira CA, Dubas JP, da Silva AC. Profile of isokinetic eccentric-to-concentric strength ratios of shoulder rotator muscles in elite female team handball players. J Sports Sci 2010; 28: 743-749
    CrossrefPubMedGoogle Scholar
  • 2 Bahr R, Krosshaug T. Understanding injury mechanisms: a key component of preventing injuries in sport. Br J Sports Med 2005; 39: 324-329
    CrossrefPubMedGoogle Scholar
  • 3 Bayios IA, Anastasopoulou EM, Sioudris DS, Boudolos KD. Relationship between isokinetic strength of the internal and external shoulder rotators and ball velocity in team handball. J Sports Med Phys Fitness 2001; 41: 229-235
    PubMedGoogle Scholar
  • 4 Brown LP, Niehues SL, Harrah A, Yavorsky P, Hirshman HP. Upper extremity range of motion and isokinetic strength of the internal and external shoulder rotators in major league baseball players. Am J Sports Med 1988; 16: 577-585
    CrossrefPubMedGoogle Scholar
  • 5 Caine D, Caine C, Maffulli N. Incidence and distribution of pediatric sport-related injuries. Clin J Sport Med 2006; 16: 500-513
    CrossrefPubMedGoogle Scholar
  • 6 Codine P, Bernard PL, Pocholle M, Benaim C, Brun V. Influence of sports discipline on shoulder rotator cuff balance. Med Sci Sports Exerc 1997; 29: 1400-1405
    CrossrefPubMedGoogle Scholar
  • 7 Edouard P, Calmels P, Degache F. The effect of gravitational correction on shoulder internal and external rotation strength. Isokinet Exerc Sci 2009; 17: 35-39
    PubMedGoogle Scholar
  • 8 Edouard P, Degache F, Beguin L, Samozino P, Gresta G, Fayolle-Minon I, Farizon F, Calmels P. Rotator cuff strength in recurrent anterior shoulder instability. J Bone Joint Surg Am 2011; 93: 759-765
    CrossrefPubMedGoogle Scholar
  • 9 Edouard P, Frize N, Calmels P, Samozino P, Garet M, Degache F. Influence of rugby practice on shoulder internal and external rotators strength. Int J Sports Med 2009; 30: 863-867
    Article in Thieme ConnectPubMedGoogle Scholar
  • 10 Edouard P, Samozino P, Julia M, Gleizes Cervera S, Vanbiervliet W, Calmels P, Gremeaux V. Reliability of Isokinetic Assessment of Shoulder-Rotator Strength: A systematic review of the effect of position. J Sport Rehabil 2011; 20: 367-383
    PubMedGoogle Scholar
  • 11 Ellenbecker TS, Davies GJ. The application of isokinetics in testing and rehabilitation of the shoulder complex. J Athl Train 2000; 35: 338-350
    PubMedGoogle Scholar
  • 12 Fleck SJ, Smith SL, Craib MW, Denabam T, Snow RE, Mitchel ML. Upper extremity isokinetic torque and throwing velocity in team handball. J Appl Sport Sci Res 1992; 6: 120-124
    PubMedGoogle Scholar
  • 13 Fuller CW, Ekstrand J, Junge A, Andersen TE, Bahr R, Dvorak J, Hagglund M, McCrory P, Meeuwisse WH. Consensus statement on injury definitions and data collection procedures in studies of football (soccer) injuries. Br J Sports Med 2006; 40: 193-201
    CrossrefPubMedGoogle Scholar
  • 14 Harriss DJ, Atkinson G. Update – ethical standards in sport and exercise science research. Int J Sports Med 2011; 32: 819-821
    Article in Thieme ConnectPubMedGoogle Scholar
  • 15 Hinton RY. Isokinetic evaluation of shoulder rotational strength in high school baseball pitchers. Am J Sports Med 1988; 16: 274-279
    CrossrefPubMedGoogle Scholar
  • 16 Ivey Jr FM, Calhoun JH, Rusche K, Bierschenk J. Isokinetic testing of shoulder strength: normal values. Arch Phys Med Rehabil 1985; 66: 384-386
    PubMedGoogle Scholar
  • 17 Langevoort G, Myklebust G, Dvorak J, Junge A. Handball injuries during major international tournaments. Scand J Med Sci Sports 2007; 17: 400-407
    PubMedGoogle Scholar
  • 18 Meister K. Injuries to the shoulder in the throwing athlete. Part two: evaluation/treatment. Am J Sports Med 2000; 28: 587-601
    PubMedGoogle Scholar
  • 19 Michael JW, Konig DP, Bertram C, Hessling U, Eysel P. Isokinetic testing of the shoulder of handball players. Sportverletz Sportschaden 2005; 19: 151-155
    Article in Thieme ConnectPubMedGoogle Scholar
  • 20 Nielsen AB, Yde J. An epidemiologic and traumatologic study of injuries in handball. Int J Sports Med 1988; 9: 341-344
    Article in Thieme ConnectPubMedGoogle Scholar
  • 21 Noffal GJ. Isokinetic eccentric-to-concentric strength ratios of the shoulder rotator muscles in throwers and nonthrowers. Am J Sports Med 2003; 31: 537-541
    CrossrefPubMedGoogle Scholar
  • 22 Olsen OE, Myklebust G, Engebretsen L, Bahr R. Injury pattern in youth team handball: a comparison of two prospective registration methods. Scand J Med Sci Sports 2006; 16: 426-432
    CrossrefPubMedGoogle Scholar
  • 23 Plotnikoff NA, MacIntyre DL. Test-retest reliability of glenohumeral internal and external rotator strength. Clin J Sport Med 2002; 12: 367-372
    CrossrefPubMedGoogle Scholar
  • 24 Seil R, Rupp S, Tempelhof S, Kohn D. Sports injuries in team handball. A one-year prospective study of sixteen men’s senior teams of a superior nonprofessional level. Am J Sports Med 1998; 26: 681-687
    CrossrefPubMedGoogle Scholar
  • 25 Sirota SC, Malanga GA, Eischen JJ, Laskowski ER. An eccentric- and concentric-strength profile of shoulder external and internal rotator muscles in professional baseball pitchers. Am J Sports Med 1997; 25: 59-64
    CrossrefPubMedGoogle Scholar
  • 26 Stickley CD, Hetzler RK, Freemyer BG, Kimura IF. Isokinetic peak torque ratios and shoulder injury history in adolescent female volleyball athletes. J Athl Train 2008; 43: 571-577
    CrossrefPubMedGoogle Scholar
  • 27 van Mechelen W, Hlobil H, Kemper HC. Incidence, severity, aetiology and prevention of sports injuries. A review of concepts. Sports Med 1992; 14: 82-99
    Google Scholar
  • 28 Vlak T, Pivalica D. Handball: the beauty or the beast. Croat Med J 2004; 45: 526-530
    PubMedGoogle Scholar
  • 29 Wang HK, Cochrane T. Mobility impairment, muscle imbalance, muscle weakness, scapular asymmetry and shoulder injury in elite volleyball athletes. J Sports Med Phys Fitness 2001; 41: 403-410
    PubMedGoogle Scholar
  • 30 Wang HK, Macfarlane A, Cochrane T. Isokinetic performance and shoulder mobility in elite volleyball athletes from the United Kingdom. Br J Sports Med 2000; 34: 39-43
    CrossrefPubMedGoogle Scholar
  • 31 Warner JJ, Micheli LJ, Arslanian LE, Kennedy J, Kennedy R. Patterns of flexibility, laxity, and strength in normal shoulders and shoulders with instability and impingement. Am J Sports Med 1990; 18: 366-375
    CrossrefPubMedGoogle Scholar
  • 32 Wedderkopp N, Kaltoft M, Lundgaard B, Rosendahl M, Froberg K. Injuries in young female players in European team handball. Scand J Med Sci Sports 1997; 7: 342-347
    PubMedGoogle Scholar
  • 33 Zapartidis I, Gouvali M, Bayios I, Boudolos K. Throwing effectiveness and rotational strength of the shoulder in team handball. J Sports Med Phys Fitness 2007; 47: 169-178
    PubMedGoogle Scholar