title: The volleyball athlete's shoulder: biomechanical adaptations and injury associations.
abstract: In volleyball, the dominant shoulder of the athlete undergoes biomechanical and morphological adaptations; however, definitive conclusions about their exact nature, aetiology, purpose and associations with shoulder injury have not been reached. We present a systematic review of the existing literature describing biomechanical adaptations in the dominant shoulders of volleyball players and factors that may predispose to shoulder pain/injury. A thorough literature search via Medline, EMBASE and SCOPUS was conducted for original studies of volleyball players and 15 eligible articles were identified. Assessment of study quality was performed using the STROBE statement. The reviewed literature supports the existence of a glenohumeral internal rotation deficit (GIRD) and a possible (and less pronounced) external rotation gain in the dominant vs. the non-dominant shoulder of volleyball athletes. Unlike other overhead sports, the GIRD in volleyball athletes appears to be anatomical as a response to the repetitive overhead movements and not to be associated with shoulder pain/injury. Additionally, the dominant shoulder exhibits muscular imbalance, which appears to be a significant risk factor for shoulder pain. Strengthening of the external rotators should be used alongside shoulder stretching and joint mobilisations, core strengthening and optimisation of spike technique as part of injury management and prevention programmes.
authors.affiliation: a Department of Trauma & Orthopaedic Surgery , Royal United Hospital , Bath , UK.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Challoumas
authors.affiliation: b School of Medicine , Cardiff University , Cardiff , UK.
authors.forename: Antonio
authors.initials: A
authors.lastname: Stavrou
authors.affiliation: c Department of Cardiothoracic Surgery , University Hospital of Wales , Cardiff , UK.
authors.forename: Georgios
authors.initials: G
authors.lastname: Dimitrakakis
mesh_terms: D000222:Adaptation, Physiological; D001696:Biomechanical Phenomena; D006801:Humans; D053580:Muscle Strength / Q000502:physiology; D018482:Muscle, Skeletal / Q000473:pathology / Q000503:physiopathology; D016059:Range of Motion, Articular; D012307:Risk Factors; D012399:Rotation; D012782:Shoulder / Q000033:anatomy & histology / Q000473:pathology / Q000502:physiology*; D000070599:Shoulder Injuries / Q000473:pathology / Q000503:physiopathology*; D020069:Shoulder Pain / Q000209:etiology; D054798:Volleyball / Q000502:physiology*
keywords: Muscular imbalance; dominant; pain; rotation; strengthening