SEMS-journal
Review
published online on 29.10.2024https://doi.org/10.34045/SEMS/2024/53
[dkpdf-button]

Shoulder Pain among volleyball players: a systematic review

exercise is medicine

Brusini Antonio1, Papotti Benedetta3, Tersigni Simone2, De Marco Francesca3
1 Ausl Modena, Sports Medicine Department
2 ASST Cremona, Emergency Department
3 Independent researcher

Zusammenfassung

In der Literatur finden sich nur wenige Studien zu Schulterschmerzen bei Volleyballspielern im Vergleich mit Verletzungen. Daher ist es wichtig, eine Prävalenz oder Inzidenz von Schulterschmerzen zu ermitteln.
Methoden: Es wurde eine Suche in den wichtigsten inter­nationalen Datenbanken durchgeführt, bei der die Primärstudien berücksichtigt wurden: PubMed, Scopus und Web of Science. Am Ende wurden 7 Studien ausgewählt: 2 experimentelle Studien, 2 Querschnittsstudien, 2 deskriptive Stu­dien und eine prospektive Kohortenstudie.
Ergebnisse: Die Lebenszeitprävalenz von Schulterschmerzen bei Volleyballern, die älter als 18 Jahre sind, liegt zwischen 37,9 % und 52 % (52,5 % unter Berücksichtigung der Schmerzen während der Spiele). Die Prävalenz von Schulterschmerzen bei jüngeren Sportlern liegt zwischen 9,0 % und 40 %.
Schlussfolgerungen: Schulterschmerzen sind bei Volleyballspielern sehr häufig. Es sind jedoch weitere Studien erforderlich, um die Prävalenz von Schulterschmerzen zu bewerten und ihnen vorzubeugen.

Schlüsselwörter: Schulter, Überlastung, Sport

Résumé

La littérature montre peu d’études relatives à la douleur à l’épaule, comparée aux blessures, chez les joueurs de volley-­ball. Il est donc important d’établir une prévalence ou une incidence de la douleur à l’épaule.
Méthodes: Une recherche a été effectuée sur les principales bases de données internationales prenant en compte les études primaires: PubMed, Scopus et Web of Science. En conclusion, 7 études ont été sélectionnées: 2 expérimentales, 2 transversales, 2 descriptives et la dernière est une étude de cohorte prospective.
Résultats: La prévalence de la douleur à l’épaule au cours de la vie chez les joueurs de volley-ball âgés de plus de 18 ans varie entre 37,9 % et 52 % (52,5 % si l’on tient compte de la douleur pendant les matchs). La prévalence de la douleur à l’épaule chez les jeunes athlètes se situe entre 9,0 % et 40 %.
Conclusions: Les douleurs à l’épaule sont très fréquentes chez les joueurs de volley-ball. Cependant, d’autres études sont nécessaires pour évaluer la prévalence des douleurs à l’épaule et pour les prévenir.

Mots clés: épaule, surcharge, sport

Introduction

William J. Morgan invented volleyball in 1895 in Massachusetts, which is currently one of the most popular sports in the world. This sport has more than 800 million athletes worldwide [1]; however, volleyball is one of the sports most influenced by overuse injuries. The biomechanics of the different movements involved in volleyball, in particular the spike and serve, together with the anatomy of volleyball players coincide with the most prevalent overuse injuries, the shoulder region and the spine [2].
Overhead athletes perform movements with high angular velocity and range of motion (ROM), requiring shoulder ­acceleration, eccentric energy absorption, optimal ROM, strength, and dynamic balance [3]. In volleyball, the lower limb was the most affected area (ankle, followed by the knee), followed by the upper limb, trunk, and head [4,5]. Furthermore, elbow and shoulder injuries are more common in overhead sports such as baseball, volleyball, handball, and tennis [6]. Shoulder injuries may result from an instantaneous transfer of large quantities of kinetic energy, from the gradual accumulation of low-energy transfer over time, or a combination of both mechanisms [7]. For example, joint hypermobility in athletes is associated with shoulder pain and injuries in volleyball players [7].
The literature shows few studies relative to shoulder pain, compared to injuries, among volleyball players. The study aims to identify the prevalence of shoulder pain (SP) among volleyball elite players and try to understand solutions for reducing it.

Methods

A search was conducted on the main international databases (PubMed, scopus, and Web of Science) for doing a systematic review. The summary of the search strings is shown in Table 1. The first author searched. The second and the third authors did the quality evaluation.
Inclusion criteria: primary studies that investigate the prevalence of SP among volleyball players around the world. ­Amateur, youth, and professional levels are all considered. Studies cited like references of other studies in this review are considered.
Exclusion criteria: reviews or non-primary studies, non-­English languages, no prevalence or incidence of SP in the study, and studies that recruited only players with pain.
Data Extraction: design of the study, participants (number of subjects, sex, level, competitions, age range or median age if indicated, season / s of study), and the prevalence. Only the prevalence or the incidence of SP is considered for the ­review; SP at different times during the period of the study is considered where it is differentiated.
Figure 1 shows the stages of review; the PIOs framework (Population, Intervention, Outcomes, Study design) is shown in Table 2.
Quality Evaluation: Subsequently, the selected articles were critically analyzed by the second using the JBI Critical Appraisal Tools (https://jbi.global/critical-appraisal-tools), shown in Table 3, Table 4, and Table 5.

Figure 1: Diagram showing the stages of review and item selection [8].

Results

On November 30, 2023, the research produced 327 results, 247 after removing duplicated results. To sum up, 7 studies are selected. Table 6 shows the results. 3 studies are cross-sectional and 1 study is cross-sectional and experimental, 2 are descriptive, and 1 is a prospective cohort study.
Bac et al [9] conducted an experimental study among 61 Polish volleyball players to evaluate joint hypermobility symptoms, using the VAS (Visual Analogue Scale) scale to estimate the average pain intensity in the shoulder joint during and after the play. de Lira et al [10] conducted a prospective cross-sectional study using an experimental procedure to evaluate isokinetic muscle assessment, ball speed test assessment, morphostatic assessment, and pain score (Numerical Rating Scales, NRS-10) for 16 weeks. Included players trained almost five days weekly for 120 minutes daily for at least one year; the exclusion criteria were: reported pain in the past, swelling, orthopedic injuries, or participation in another sport. Forthomme et al [11] conducted a prospective cohort study among 66 players, monitoring shoulder pain at the beginning and during the season. Frisch et al [12] administrated a self-report survey focusing on the prevalence of pain not associated with a traumatic event in female high school youth volleyball players of Iowa, South Dakota, and Minnesota. Khorzoghi et al [13] investigated the prevalence of injury pain and disability among elite youth Iranian players, using the extended version of the Nordic Musculoskeletal Questionnaire (NMQ-E). Mohseni-Bandpei [14] conducted a cross-sectional study among 613 Iranian university athletes (swimming, handball, volleyball, basketball, rowing, and wrestling) without a history of shoulder pathologies. Sekiguchi et al [15] investigated elbow/shoulder pain, back pain, hip pain, knee pain, and foot pain in youth sports with a self-reported questionnaire.
The lifetime shoulder pain prevalence in volleyball players older than 18 (median age) ranges between 37.9 % and 52 % (52.5 % considering the pain during the matches) [9,11,14]. The prevalence of shoulder pain in younger athletes (considering American High Schools) ranges between 9.0 % and 40 % [10,12,15].

Discussion

Studies indicate that almost half of adult volleyball players suffer from shoulder pain. Shoulder pain prevalence seems to be associated with more years of practice. Only de Lira et al [10] studied the incidence of shoulder pain between players without a history of SP during lifetime. The hitter is the ­position with the greatest prevalence of SP: Khourzoghi et al [13] found a 33.1 % of prevalence of pain in the last 12 months among the outside hitter, versus the 23.6 % of opposites, 13.1 % of setters, and 5.4 % of liberos, while Frisch et al [12] found pain prevalence by playing position hitter (43,8 % of the total) setter / defensive specialist (29.8 % of the total), with an estimated incidence of 1.33 per 100 contacts (hitting or service). Also, Forthomme et al [11] found that 87 % [15] of dominant shoulder pain during the season are spikers; all the shoulder pain reported was related to rotator cuff tendinopathy, and 13 athletes out of 15 had experienced shoulder pain previously. The reason for SP can be found in the usual movements made by the shoulder in volleyball: The volleyball attack (‘spike’) is a highly technical, unique overhead movement that is repetitively performed at high frequencies, which may reach up to 40 000 times a year in professional players; the ‘serve’ is another repetitive overhead motion in volleyball and it also places significant loads on the player’s hitting shoulder [16]. De Lira et al [10] found that the feeling of SP is associated with higher values for internal rotator muscle peak torque, and Sekiguchi et al [15] found a higher prevalence of low back, hip, knee, or foot pain in all sport among youth players with shoulder pain. In the last years, in the literature, instruments to evaluate shoulder overuse have started to be presented [17–19]. Soccer has a FIFA (“Fédération internationale de football association”, English: International Association Football Federation) injury prevention program, also for shoulder [20]; a program of FIVB (“Fédération Internationale de Volleyball”, English: International Volleyball Federation) could be a solution to improve the situation about injuries and SP.

Conclusions

In the literature, shoulder pain is very frequent among volleyball players. However, further studies are needed to evaluate the prevalence of shoulder pain and to prevent it.
Limits: This study presents certain limitations. Only two studies analyze pain with an instrument (NRS-10 and VAS), while the majority of studies ask only about the presence of pain. The selected studies are too varied in the level of volleyball and the range age of study; in the future, a major presence of studies, for example among youth or professional players, could give a precise situation about SP. Some studies present notable bias caused by the process of randomization.

Conflicts of Interest

The author declares that he has no conflicts of interest associated with this study.

Funding

This research did not receive any form of funding.

Corresponding author

Antonio Brusini
Ausl Modena
Via Arno 10, 41043 Formigine, Italia
Email: antoniobrusini87@outlook.it

Bibliography

  1. Hopkinson, M., Smolianov, P., Dion, S., & Schoen, C. (2016). Iden­tifying Best Practices for Advancement of Us Volleyball. The 2016 WEI International. Academic Conference Proceedings Boston, USA, 161–164.
  2. Pecos-Martín, D., Patiño-Núñez, S., Quintero-Pérez, J., Cruz-Riesco, G., Quevedo-Socas, C., Gallego-Izquierdo, T., Beltran-Alacreu, H., & Fernández-Carnero, J. (2022). Mechanical Hyperalgesia but Not Forward Shoulder Posture Is Associated with Shoulder Pain in Volleyball Players: A Cross-Sectional Study. Journal of clinical medicine, 11(6), 1472.
  3. Silva Barros, B. R. D., Cavalcanti, I. B. S., Silva Júnior, N. D., & Sousa, C. O. (2022). Correlation between upper limb function and clinical measures of shoulder and trunk mobility and strength in overhead athletes with shoulder pain. Physical therapy in sport: official journal of the Association of Chartered Physiotherapists in Sports Medicine, 55, 12–20.
  4. Migliorini, F., Rath, B., Tingart, M., Niewiera, M., Colarossi, G., Baroncini, A., & Eschweiler, J. (2019). Injuries among volleyball players: a comprehensive survey of the literature. Sport Sciences for Health, 15, 281–293.
  5. Eerkes K. (2012). Volleyball injuries. Current sports medicine reports, 11(5), 251–256.
  6. Liaghat, B., Pedersen, J. R., Husted, R. S., Pedersen, L. L., Thorborg, K., & Juhl, C. B. (2023). Diagnosis, prevention and treatment of common shoulder injuries in sport: grading the evidence – a statement paper commissioned by the Danish Society of Sports Physical Therapy (DSSF). British journal of sports medicine, 57(7), 408–416.
  7. Liaghat, B., Pedersen, J. R., Young, J. J., Thorlund, J. B., Juul-Kristensen, B., & Juhl, C. B. (2021). Joint hypermobility in athletes is associated with shoulder injuries: a systematic review and meta-analysis. BMC musculoskeletal disorders, 22(1), 389.
  8. Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., McGuinness, L. A., … Moher, D. (2021). The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ (Clinical research ed.), 372, n71.
  9. Bac, A., Wojtanek, P., Zalewski, M., Radlińska, N., Ogrodzka, K., Mierzwa, K.F., & Czarnecka, A.Ś. (2020). The influence of joint ­hypermobility syndrome on the incidence of shoulder complex pain in volleyball players. Acta Kinesiologica, 14(1), 35–39.
  10. de Lira, C. A. B., Vargas, V. Z., Vancini, R. L., Hill, L., Nikolaidis, P. T., Knechtle, B., & Andrade, M. D. S. (2023). Shoulder Internal Rotator Strength as Risk Factor for Shoulder Pain in Volleyball Players. International journal of sports medicine, 44(2), 133–137.
  11. Forthomme, B., Wieczorek, V., Frisch, A., Crielaard, J. M., & Croi­sier, J. L. (2013). Shoulder pain among high-level volleyball players and preseason features. Medicine and science in sports and exercise, 45(10), 1852–1860.
  12. Frisch, K. E., Clark, J., Hanson, C., Fagerness, C., Conway, A., & Hoogendoorn, L. (2017). High Prevalence of Nontraumatic Shoulder Pain in a Regional Sample of Female High School Volleyball Athletes. Orthopaedic journal of sports medicine, 5(6), 2325967117712236.
  13. Khorzoghi, M. B., Zarezadeh, F., & Pour, M. R. M. (2021). An Examination of the Prevalence of Injury and the Pain and Disability in Specialized Positions of the Elite Players of Iran’s Youth Premier League Volleyball. Pakistan Journal of Medical and Health Sciences, 15(7), 2136–2143. 10.53350/pjmhs211572136.
  14. Mohseni-Bandpei, M. A., Keshavarz, R., Minoonejhad, H., Mohsenifar, H., & Shakeri, H. (2012). Shoulder pain in Iranian elite athletes: the prevalence and risk factors. Journal of manipulative and physiological therapeutics, 35(7), 541–548.
  15. Sekiguchi, T., Hagiwara, Y., Momma, H., Tsuchiya, M., Kuroki, K., Kanazawa, K., Yabe, Y., Yoshida, S., Koide, M., Itaya, N., Itoi, E., & Nagatomi, R. (2017). Coexistence of Trunk or Lower Extremity Pain with Elbow and/or Shoulder Pain among Young Overhead Athletes: A Cross-Sectional Study. The Tohoku journal of experimental medicine, 243(3), 173–178.
  16. Challoumas, D., Stavrou, A., & Dimitrakakis, G. (2017). The volleyball athlete’s shoulder: biomechanical adaptations and injury associations. Sports biomechanics, 16(2), 220–237.
  17. Lau, R., & Mukherjee, S. (2024). Development and validation of an overuse injury questionnaire for youth athletes: The Youth Overuse Injury Questionnaire. Physical therapy in sport: official journal of the Association of Chartered Physiotherapists in Sports Medicine, 67, 47–53.
  18. Lau, R., & Mukherjee, S. (2024). Developing the Singapore youth shoulder overuse injury prevention program. Physical therapy in sport: official journal of the Association of Chartered Physiotherapists in Sports Medicine, 65, 30–37.
  19. Tooth, C., Schwartz, C., Croisier, J. L., Gofflot, A., Bornheim, S., & Forthomme, B. (2023). Prevention of shoulder injuries in volleyball players: The usefulness and efficiency of a warm-up routine. Physical therapy in sport: official journal of the Association of Chartered Physiotherapists in Sports Medicine, 64, 97–103.
  20. Al Attar, W. S. A., Faude, O., Bizzini, M., Alarifi, S., Alzahrani, H., Almalki, R. S., Banjar, R. G., & Sanders, R. H. (2021). The FIFA 11+ Shoulder Injury Prevention Program Was Effective in Reducing Upper Extremity Injuries Among Soccer Goalkeepers: A Randomized Controlled Trial. The American journal of sports medicine, 49(9), 2293–2300.

Related Posts

Comments are closed.