Impact of a competition with two consecutive matches in a day on physical performance in young tennis players

The purpose of this study was to analyze the effects of playing 2 tennis matches on the same day on physical performance in young tennis players. Twelve well-trained young tennis players took part in a simulated tennis competition consisting of 2 tennis matches on the same day (morning and afternoon sessions). Before and the day after the competition, physical performance was measured using a battery of countermovement jumps; a 10 m sprint; the 5–0–5 agility test; hip, grip and shoulder maximal isometric strength; shoulder range of motion; and a serve velocity test. Postcompetition results showed reduced performance in 10 m (–3.3%, effect size (ES) = small), dominant and nondominant 5–0–5 agility test (–4.6%, ES = moderate; –4.2%, ES = moderate, respectively), bilateral (–5.2%, ES = small), and unilateral countermovement jumps (dominant leg: –7.2%, ES = small; non-dominant leg: –9.1%, ES = small). Both dominant and nondominant shoulder external rotation range of motion increased (12.2%, ES = moderate; 5.6%, ES = small), whereas internal rotation decreased (–4.2%, ES = small; –3.3%, ES = small) in the postcompetition tests, together with the dominant shoulder external rotation (–10.7%, ES = moderate) and internal rotation (–9.3%, ES = small) strength. Physical impairments occurred in neuromuscular performance variables involving lower (e.g., jumping, sprinting, and change of direction) and upper (e.g., isometric strength and range of motion) limbs the day after playing a competition with 2 consecutive matches on the same day. These alterations in neuromuscular and sport-specific performance need to be taken into consideration when planning tournament schedules for young tennis players, as well as preparing match and recovery strategies.

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Influence of a Pre-throwing Protocol on Range of Motion and Strength in Baseball Athletes

International Journal of Sports Medicine ◽

10.1055/a-1214-6278 ◽

2020 ◽

Author(s):

Jessica Downs ◽

Kyle Wasserberger ◽

Gretchen D. Oliver

Keyword(s):

Range Of Motion ◽

External Rotation ◽

Isometric Strength ◽

Intervention Teams ◽

Shoulder Range Of Motion ◽

Hip Range Of Motion ◽

Control Team ◽

Overhand Throwing ◽

Intervention Team ◽

Shoulder Range

AbstractThough chronic overhand throwing is known to result in range of motion and strength adaptations, there is limited research regarding interventions for maintenance of these characteristics. Therefore, the purposes of this study were to explore the use of a pre-throwing protocol focusing on lumbopelvic-hip complex musculature in high school baseball players and examine its effects on shoulder and hip range of motion and isometric strength over the course of a season. Four exercises were added to the intervention team’s warm-up routine. The control and intervention teams’ passive bilateral hip and shoulder range of motion and isometric strength were assessed pre/post-season. A multivariate analysis of variance revealed significant differences in delta scores between the teams for multiple shoulder and hip range of motion and isometric strength variables. Key results were the intervention team lost significantly more stride hip external rotation but gained more isometric strength than the control team. The intervention team was also able to better maintain shoulder range of motion than the control team. Practitioners should use the results of this study and consider incorporating exercises that target lumbopelvic-hip complex musculature into their current training program.

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The Relationship Between Shoulder Range of Motion and Arm Stress in College Pitchers: A MOTUS Baseball Study

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120s00401 ◽

2020 ◽

Vol 8 (7_suppl6) ◽

pp. 2325967120S0040

Author(s):

Caleb Gulledge ◽

Toufic Jildeh ◽

Joseph Tramer ◽

Fabien Meta ◽

Kevin Taylor ◽

...

Keyword(s):

Range Of Motion ◽

Upper Extremity ◽

Internal Rotation ◽

External Rotation ◽

Outcome Measurement ◽

Overhead Athletes ◽

Shoulder Range Of Motion ◽

Patient Reported ◽

The Relationship ◽

Shoulder Range

Objectives: Overuse injuries in overhead athletes are becoming more prevalent, with an unclear relationship between shoulder biomechanics and medial elbow symptoms and injury. The purpose of this study was to investigate the relationship of shoulder range of motion to torque across the medial elbow in college pitchers using a validated MOTUS sensor baseball sleeve. Methods: Pitchers were recruited from three local university baseball teams. Exclusion criteria included injury or restricted activity due to pain. They were evaluated in the preseason, within two weeks before their first game of the season. Pitchers completed workload questionnaires and patient reported outcome measurement information system (PROMIS) pain interference (PI), physical function (PF), and upper extremity (UE) surveys. Shoulder range of motion and upper extremity lengths were measured bilaterally. After adequate warm-up, pitchers were fitted with a MOTUS sensor baseball sleeve (Motus Global, Massapequa, NY) and instructed to throw 5 fastballs in a standardized manner off the mound at game-speed effort. The sensor placed at the medial elbow reported elbow torque, arm speed, arm slot, and shoulder rotation for each pitch, while a radar gun measured peak ball velocity. The primary outcome was to evaluate the relationship between shoulder range of motion and increased stress across the medial elbow. Additional outcomes evaluated pitcher characteristics, demographics, and outcome scores. Outcomes were assessed via a multivariable model, which controlled for possible covariates. Results: Twenty-eight pitchers were included in the preseason analysis with an average (SD) age of 20.1 (1.3) years and playing experience of 15.3 (1.8) years, 2.5 (1.2) of those years at collegiate level. The dominant shoulder demonstrated decreased internal rotation (54.5+/-10.6 vs 65.8+/-9.1) and increased external rotation (ER, 94.1+/-10.4 vs 88.4+/-9.2) relative to the non-dominant side (p < 0.001), while total rotational range of motion (TRROM) was significantly decreased in the dominant arm (148.6+/-12.4 vs 154.1+/-10.6, p < 0.001). The average glenohumeral internal rotation deficiency (GIRD) was 11.3 (9.87) and average external rotation gain (ERG) was 5.71 (8.8). External rotation was found to be a predictor of arm stress, with an increase in 0.35 Nm of elbow torque for every degree increase in ER (beta = 0.35+/-0.06, p = 0.003); there was moderate correlation between ER and arm stress (r = .45, P<.001). Pitchers demonstrated significantly greater arm stress with the following shoulder ROM measurements: GIRD < 20 as compared to greater than 20 degrees (46.6 +/- 0.5 versus 43.5 +/- 1.1, P=.011), ERG greater than 5 as compared to < 5 degrees (47.4 +/- 0.7 versus 45.1 +/- 0.6, P=.014), and loss of total rotational ROM less than 5 as compared to > 5 degrees (46.6 +/- 0.5 versus 43.6 +/- 1.1, P=.013). Multivariate analysis demonstrated significant predictors of PROMIS PF and UE scores were arm stress, ERG, and GIRD (p<0.05), while increased PROMIS PI scores were predicted by increased ERG and GIRD (p<0.05). Conclusion: We found medial elbow stress, arm speed, arm slot, and shoulder rotation as measured by the MOTUS baseball sensor sleeve were influenced by rotational adaptations of the pitching shoulder in collegiate throwing athletes prior to their season. Likewise, arm stress and shoulder rotational adaptations were reflected as predictors of PROMIS PF, UE, and PI scores.

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Descriptive Profile of Hip Rotation Range of Motion in Elite Tennis Players and Professional Baseball Pitchers

The American Journal of Sports Medicine ◽

10.1177/0363546507300260 ◽

2007 ◽

Vol 35 (8) ◽

pp. 1371-1376 ◽

Cited By ~ 52

Author(s):

Todd S. Ellenbecker ◽

Gail A. Ellenbecker ◽

E. Paul Roetert ◽

Rogerio Teixeira Silva ◽

Greg Keuter ◽

...

Keyword(s):

Range Of Motion ◽

Internal Rotation ◽

Hip Joint ◽

External Rotation ◽

Professional Baseball ◽

Tennis Players ◽

Active Range Of Motion ◽

Baseball Pitchers ◽

Hip Rotation ◽

Bilateral Difference

Background Repetitive loading to the hip joint in athletes has been reported as a factor in the development of degenerative joint disease and intra-articular injury. Little information is available on the bilateral symmetry of hip rotational measures in unilaterally dominant upper extremity athletes. Hypothesis Side-to-side differences in hip joint range of motion may be present because of asymmetrical loading in the lower extremities of elite tennis players and professional baseball pitchers. Study Design Cohort (cross-sectional) study (prevalence); Level of evidence, 1. Methods Descriptive measures of hip internal and external rotation active range of motion were taken in the prone position of 64 male and 83 female elite tennis players and 101 male professional baseball pitchers using digital photos and computerized angle calculation software. Bilateral differences in active range of motion between the dominant and nondominant hip were compared using paired t tests and Bonferroni correction for hip internal, external, and total rotation range of motion. A Pearson correlation test was used to test the relationship between years of competition and hip rotation active range of motion. Results No significant bilateral difference (P > .005) was measured for mean hip internal or external rotation for the elite tennis players or the professional baseball pitchers. An analysis of the number of subjects in each group with a bilateral difference in hip rotation greater than 10° identified 17% of the professional baseball pitchers with internal rotation differences and 42% with external rotation differences. Differences in the elite male tennis players occurred in only 15% of the players for internal rotation and 9% in external rotation. Female subjects had differences in 8% and 12% of the players for internal and external rotation, respectively. Statistical differences were found between the mean total arc of hip range of internal and external rotation in the elite tennis players with the dominant side being greater by a clinically insignificant mean value of 2.5°. Significantly less (P < .005) dominant hip internal rotation and less dominant and nondominant hip total rotation range of motion were found in the professional baseball pitchers compared with the elite male tennis players. Conclusion This study established typical range of motion patterns and identified bilaterally symmetric hip active range of motion rotation values in elite tennis players and professional baseball pitchers. Asymmetric hip joint rotational active range of motion encountered during clinical examination and screening may indicate abnormalities and would indicate the application of flexibility training, rehabilitation, and further evaluation.

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A Comparison of the Immediate Effect of Swedish Massage vs Passive Stretching on Range of Motion in Overhead Athletes

The Asian Journal of Kinesiology ◽

10.15758/ajk.2020.22.3.1 ◽

2020 ◽

Vol 22 (3) ◽

pp. 1-7

Author(s):

Jim Schilling ◽

Sujeiry Guzman ◽

Chad Lewis ◽

Jupil Ko

Keyword(s):

Range Of Motion ◽

Internal Rotation ◽

External Rotation ◽

Intervention Group ◽

Post Treatment ◽

Static Stretching ◽

Post Intervention ◽

Overhead Athletes ◽

Passive Stretching ◽

Shoulder Range Of Motion

OBJECTIVES To compare the clinical outcome and effectiveness of Swedish massage and a traditional passive stretching program, on the shoulder of ROM in overhead athletes.PARTICIPANTS A total of 10 overhead throwing overhead male athletes (age= 23.5 ± 1.5yrs; height= 186.69 ± 6.35 cm; mass= 91.86 ± 12.48 kg).METHODS Participants were randomly assigned to either Swedish massage or a traditional passive static stretching program for 1 session of 5 minutes. Baseline and post-intervention shoulder ROM to end range in the flexed, external rotation, internal rotation, horizontal adduction and abduction positions. The Pearson chi-square test was applied to compare the differences of shoulder ROM of both therapeutic variables. Recorded outcome measures on the participants’ shoulder ROM (flexion with scapula fixed, horizontal adduction, horizontal abduction, internal rotational & external rotation) pre- & post-interventions.RESULTS Results indicate that participants in the Swedish massage therapeutic intervention group had significant improvements in their internal rotation post-treatment (M=5.20, SD= 1.304, p=.038) and the traditional passive stretching protocol group had significant improvements in shoulder external rotation post-treatment (M=11.20, SD=2.68, p=.016).CONCLUSION Swedish massage had better effects in four out of the five shoulder motions measured compared to passive static stretching. Educating overhead athletes on the potential beneficial effects of massage therapy and its role in maintaining shoulder range of motion.

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A comparative study on the effectiveness of Mulligan mobilization versus Positional release therapy technique in patients with Adhesive capsulitis

International Journal of Research in Pharmaceutical Sciences ◽

10.26452/ijrps.v12i1.3904 ◽

2021 ◽

Vol 12 (1) ◽

pp. 1-5

Author(s):

Chandrasekaran K ◽

Sundaram M S ◽

Senthil Selvam P ◽

Viswanath Reddy A ◽

Senthilkumar S ◽

...

Keyword(s):

Range Of Motion ◽

Internal Rotation ◽

Functional Activity ◽

External Rotation ◽

Adhesive Capsulitis ◽

Shoulder Range Of Motion ◽

Release Technique ◽

Group A ◽

Group B ◽

Shoulder Range

Adhesive capsulitis is a painful condition in which the movement of the shoulder becomes limited and functional activity is affected. Adhesive capsulitis occurs when the shoulder joint capsule become thick, stiff and inflamed. The aim of the study is to compare the effectiveness of Mulligan movement with mobilization versus Positional release technique on shoulder range of motion and functional activity in patients with adhesive capsulitis. 30 patients were randomly divided into two groups. Group A (N = 15) received Mulligan mobilization technique and Group B (N = 15) received positional release therapy. The shoulder range of motion (Abduction, External rotation, Internal rotation) was measured by goniometer, the functional activity by SPADI questionnaire. The results showed that significant differences in shoulder ROM Abduction (t = 14.18, p = 0.000), Internal rotation (t = 13.80, p = 0.000), External rotation (t = 15.87, p = 0.000) and SPADI questionnaire (t = 13.94, p = 0.000) were observed in group A patients when compared to group B. In conclusion the Mulligan mobilization technique was effective to improve the shoulder ROM and reduce functional disability in patients with adhesive capsulitis compared to Positional release technique.

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Glenohumeral Rotational Motion and Strength and Baseball Pitching Biomechanics

Journal of Athletic Training ◽

10.4085/1062-6050-47.3.10 ◽

2012 ◽

Vol 47 (3) ◽

pp. 247-256 ◽

Cited By ~ 22

Author(s):

Wendy J. Hurd ◽

Kenton R. Kaufman

Keyword(s):

Range Of Motion ◽

Internal Rotation ◽

Rotational Motion ◽

Positive Relationship ◽

External Rotation ◽

Shoulder Range Of Motion ◽

Arm Injuries ◽

Baseball Pitchers ◽

Clinical Measures ◽

Insight Into

Context: Addressing loss of shoulder range of motion and rotator cuff weakness in injury-prevention programs might be an effective strategy for preventing throwing arm injuries in baseball pitchers. However, the influence of these clinical measures on pitching biomechanics is unclear. Objective: To evaluate the relationships among clinical measures of shoulder rotational motion and strength and 3-dimensional pitching biomechanics and to evaluate the presence of coupling between the shoulder and the elbow during pitching to provide insight into the influence of clinical shoulder characteristics on elbow biomechanics. Design: Cross-sectional study. Setting: Biomechanics laboratory. Patients or Other Participants: A total of 27 uninjured male high school baseball pitchers (age = 16 ± 1.1 years, height = 183 ± 7 cm, mass = 83 ± 12 kg). Main Outcome Measure(s): Clinical measures included shoulder internal- and external-rotation range of motion and peak isometric internal- and external-rotator strength. Three-dimensional upper extremity biomechanics were assessed as participants threw from an indoor pitching mound to a target at regulation distance. Linear regressions were used to assess the influence of clinical measures on the peak shoulder internal and external rotation moments and the peak elbow-adduction moment. Results: We found a positive relationship between clinically measured internal-rotator strength and shoulder external-rotation moment (R2 = 0.181, P = .04) during pitching. We also noted an inverse relationship between clinically measured external-rotation motion and the elbow-adduction moment (R2 = 0.160, P = .04) and shoulder internal-rotation moment (R2 = 0.250, P = .008) during pitching. We found a positive relationship between peak shoulder internal-rotation moment and the peak elbow-adduction moment (R2 = 0.815, P < .001) during pitching. Conclusions: This study provides insight into the effects of shoulder strength and motion on pitching biomechanics and how these clinical measures might contribute to throwing arm injuries in the baseball pitcher. A relationship also was identified between peak shoulder and elbow moments in the throwing arm during pitching, providing biomechanical support for addressing clinical shoulder characteristics as a potential strategy for preventing elbow injury.

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Serratus Anterior Stretch: A Novel Intervention and Its Effect on the Shoulder Range of Motion

Journal of Sport Rehabilitation ◽

10.1123/jsr.2020-0121 ◽

2020 ◽

pp. 1-4

Author(s):

Keramat Ullah Keramat ◽

Mohammad Naveed Babar

Keyword(s):

Range Of Motion ◽

Internal Rotation ◽

External Rotation ◽

Scapular Dyskinesis ◽

Serratus Anterior ◽

Shoulder Dysfunction ◽

Shoulder Range Of Motion ◽

Before And After ◽

Movement Screening ◽

Shoulder Range

Context: Serratus anterior tightness is associated with scapular dyskinesis and overall shoulder dysfunction, which affects the range of motion. The most effective intervention to stretch the serratus anterior is unknown. Objective: To evaluate the effect of a therapist-administered novel serratus anterior stretch (SAS) on shoulder range of motion. Method: This study recruited 30 healthy subjects of age 21.20 (1.69) years, height 1.65 (0.11) m, and weight 60.90 (10.36) kg in equal ratio of males and females who scored 1 or 2 on the shoulder mobility test of functional movement screening. A single intervention of a novel SAS was applied to the shoulder. Outcome variables before and after the SAS included the following: shoulder ROM (flexion, abduction, internal rotation, and external rotation) and functional movements of reaching up behind the back and reaching down behind the neck. Results: A paired t test was used to analyze the data. Following the acute SAS intervention, all shoulder ROM improved significantly (P < .000). The change in internal rotation was 6.00° (7.47°), external rotation was 5.66° (9.35°), abduction was 13.50° (11.82°), flexion was 20° (13.33°), reaching up behind the back was 5.10 (2.21) cm, and reaching down behind the neck was 5.41 (2.89) cm. The most marked improvement was in reaching up behind the back (24.48%) and reaching down behind the neck (22.78%). A very large effect size (>1) was observed across most of the variables. Conclusion: An acute SAS intervention improves shoulder mobility in healthy individuals. It is recommended for the trial on the prevention and rehabilitation of shoulder pathologies with restriction in shoulder mobility.

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Adaptive Alterations in Shoulder Range of Motion and Strength in Young Tennis Players

Journal of Athletic Training ◽

10.4085/1062-6050.52.1.10 ◽

2017 ◽

Vol 52 (2) ◽

pp. 137-144 ◽

Cited By ~ 12

Author(s):

Benoit Gillet ◽

Mickaël Begon ◽

Violaine Sevrez ◽

Christian Berger-Vachon ◽

Isabelle Rogowski

Keyword(s):

Range Of Motion ◽

Glenohumeral Joint ◽

External Rotation ◽

Peak Height ◽

Biological Age ◽

Height Velocity ◽

Peak Height Velocity ◽

Tennis Players ◽

Functional Changes ◽

Shoulder Range Of Motion

Context: Playing tennis requires unilateral and intensive movement of the upper limb, which may lead to functional adaptations of the shoulder and an increased injury risk. Identifying which athletes will be future elite tennis players starts at 5 to 6 years of age. Therefore, highly skilled players practice intensively in their childhood. However, whether these functional changes occur during the prepubertal years has not been established. Objectives: To assess changes in glenohumeral-joint–rotation range of motion and strength of the shoulder-complex muscles in prepubertal elite tennis players. Design: Cross-sectional study. Setting: Tennis training sports facilities. Patients or Other Participants: Sixty-seven male tennis players (age range = 7–13 years) selected by a regional tennis center of excellence were divided into 3 biological age groups relative to their predicted age at peak height velocity: greater than 4 (n = 26; age = 8.7 ± 0.7 years, height = 132.4 ± 12.9 cm, mass = 27.8 ± 3.8 kg), 3 to 4 (n = 21; age = 10.3 ± 0.6 years, height = 144.9 ± 5.7 cm, mass = 34.7 ± 4.0 kg), and 2 (n = 20; age = 12.8 ± 1.4 years, height = 158.5 ± 8.7 cm, mass = 43.0 ± 8.2 kg) years before their age at peak height velocity. Main Outcome Measures(s): We measured the internal- and external-rotation ranges of motion of the glenohumeral joint using a goniometer and calculated the total arc of motion. Maximal isometric strength of 8 shoulder muscles was measured using a handheld dynamometer. Strength values were normalized to body weight and used to calculate 4 agonist-to-antagonist strength ratios. Results: The total arc of motion of the glenohumeral joint decreased gradually with biological age (P ≤ .01) due to the decrease in internal-rotation range of motion (P < .001). Absolute strength increased gradually with biological age (P < .001), but the relative strengths and ratios remained similar. Conclusions: Functional adaptations of the shoulder seen in adolescent and adult tennis players were observed in healthy prepubertal players. This knowledge could help clinicians and coaches more effectively monitor shoulder adaptations to tennis practice during the prepubertal years.

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Relationship Between Range of Motion, Strength, Motor Control, Power, and the Tennis Serve in Competitive-Level Tennis Players: A Pilot Study

Sports Health A Multidisciplinary Approach ◽

10.1177/1941738118785348 ◽

2018 ◽

Vol 10 (5) ◽

pp. 462-467 ◽

Cited By ~ 1

Author(s):

Kenneth Palmer ◽

Debi Jones ◽

Christine Morgan ◽

Giorgio Zeppieri

Keyword(s):

Motor Control ◽

Lower Extremity ◽

Range Of Motion ◽

Internal Rotation ◽

External Rotation ◽

Pearson Correlation ◽

Tennis Players ◽

Control Power ◽

Tennis Serve ◽

Shot Put

Background: The tennis serve is a complex skill requiring appropriate energy transfer to maximize serve speed. As the only independently powered shot in tennis, it is important to understand what characteristics contribute to a player’s serve. Hypothesis: Upper extremity and lower extremity power variables will be predictive of serve speed. Study Design: Cross-sectional study. Level of Evidence: Level 3. Methods: A total of 42 competitive tennis players underwent range of motion, strength, motor control, power, and serve speed testing. Motion assessment was completed for shoulder external and internal rotation, trunk rotation, hip external and internal rotation, and ankle dorsiflexion. Strength was assessed for the rotator cuff, scapula, and hip musculature. Motor control was evaluated through upper and lower extremity Y-balance testing. Power assessments were made using broad jump, single-leg hop, and seated unilateral shot put testing. Pearson correlation was conducted to assess associations of skill, height, and tested variables to serve speed. Significant variables were used in a stepwise linear regression model, with serve speed as the dependent variable. Variables are listed in relation to the participant’s dominant arm. Results: Skill, height, contralateral hip external rotation range of motion, nondominant arm Y-balance anterolateral reach, bilateral single-leg hops, and seated unilateral shot put throws for both arms demonstrated significant positive correlations to serve speed ( P < 0.05). Serve speed was predicted with 84% variance through skill, height, contralateral hip external rotation range of motion, ipsilateral single-leg hop, and the seated unilateral shot put throws. Conclusion: The ability to generate increased serve speed is multifactorial. The combination of skill, height, hip motion, and upper and lower extremity power may determine serve speed. Clinical Relevance: The findings suggest that motion, motor control, and power testing should be evaluated when working with this population to improve serve speed.

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Preseason shoulder range of motion screening and in-season risk of shoulder and elbow injuries in overhead athletes: systematic review and meta-analysis

British Journal of Sports Medicine ◽

10.1136/bjsports-2019-100698 ◽

2020 ◽

Vol 54 (17) ◽

pp. 1019-1027 ◽

Cited By ~ 1

Author(s):

Federico Pozzi ◽

Hillary A Plummer ◽

Ellen Shanley ◽

Charles A Thigpen ◽

Chase Bauer ◽

...

Keyword(s):

Systematic Review ◽

Range Of Motion ◽

External Rotation ◽

Meta Analysis ◽

Professional Baseball ◽

Overhead Athletes ◽

Shoulder Range Of Motion ◽

Elbow Injuries ◽

Shoulder External Rotation ◽

Shoulder Range

ObjectiveTo characterise whether preseason screening of shoulder range of motion (ROM) is associated with the risk of shoulder and elbow injuries in overhead athletes.DesignSystematic review and meta-analysis.Data sourcesSix electronic databases up to 22 September 2018.Eligibility criteriaInclusion criteria were (1) overhead athletes from Olympic or college sports, (2) preseason measures of shoulder ROM, (3) tracked in-season injuries at the shoulder and elbow, and (4) prospective cohort design. Exclusion criteria were (1) included contact injuries, (2) lower extremity, spine and hand injuries, and (3) full report not published in English.ResultsFifteen studies were identified, and they included 3314 overhead athletes (baseball (74.6%), softball (3.1%), handball (16.1%), tennis (2.0%), volleyball (2.0%) and swimming (2.2%)). Female athletes are unrepresented (12% of the overall sample). Study quality ranged from 11 to 18 points on a modified Downs and Black checklist (maximum score 21, better quality). In one study, swimmers with low (<93°) or high (>100°) shoulder external rotation were at higher risk of injuries. Using data pooled from three studies of professional baseball pitchers, we showed in the meta-analysis that shoulder external rotation insufficiency (throwing arm <5° greater than the non-throwing arm) was associated with injury (odds ratio=1.90, 95% confidence interval 1.24 to 2.92, p<0.01).ConclusionPreseason screening of shoulder external rotation ROM may identify professional baseball pitchers and swimmers at risk of injury. Shoulder ROM screening may not be effective to identify handball, softball, volleyball and tennis players at risk of injuries. The results of this systematic review and meta-analysis should be interpreted with caution due to the limited number of studies and their high degree of heterogeneity.PROSPERO registration numberCRD42017072895.

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