Effectiveness of overuse injury prevention programs on upper extremity performance in overhead youth athletes: A systematic review

Abstract

Several targeted upper extremity injury prevention programs have been developed to mitigate the risk of upper extremity overuse injuries among youth athletes in overhead sports; however, their effectiveness on performance outcome measures has not been investigated. This systematic review evaluated the effectiveness of existing upper extremity injury prevention programs that focused on modifying intrinsic risk factors, and performance outcome measures in overhead youth athletes. The secondary aim was to identify the training components of these programs. PubMed, Physiotherapy Evidence Database (PEDro), SPORTDiscus (via EBSCOhost), and Web of Science were searched from January 2000 to November 2020 for studies that implemented training programs or exercises for upper extremity injury prevention among youth athletes in overhead throwing or striking sports. An updated search was conducted from December 2020 to October 2022. A program was deemed effective for a performance outcome measure if significant improvements were observed in the intervention group as compared to the control group. Of the 1 394 studies identified, five studies met the inclusion criteria. The effectiveness of the injury prevention programs on the identified performance outcome measures of strength, mobility, and sport-specific measures were 30.4%, 28.6%, and 22.2%, respectively. The training components targeted were strength, mobility, and plyometrics. Strength was the most common training component and was also the most widely investigated performance outcome measure. Overall, current upper extremity injury prevention programs seem effective at improving performance outcome measures of strength, mobility, and sport-specific outcomes with training components of strength, mobility and plyometrics. Standardized protocols are required for the measurement and reporting of performance outcomes measures, and the reporting of training components.

Keywords

Youth sports / Overhead athlete / Overuse injury / Injury prevention / Shoulder / Elbow

References

[[1]] RBJ Kraan, DD Nobel, D Eygendaal, JG Daams, PPFM Kuijer, M Maas. Incidence, prevalence, and risk factors for elbow and shoulder overuse injuries in youth athletes: A systematic review. Transl Sports Med, 2 (4) ( 2019), pp. 186-195. DOI: 10.1002/tsm2.82

[[2]] S Braun, D Kokmeyer, PJ Millett. Shoulder injuries in the throwing athlete. J Bone Joint Surg Am, 91 (4) ( 2009), pp. 966-978, DOI: 10.2106/JBJS.H.01341

[[3]] M Asker, HL Brooke, M Waldén, et al.. Risk factors for, and prevention of, shoulder injuries in overhead sports: a systematic review with best-evidence synthesis. Br J Sports Med, 52 (20) ( 2018), pp. 1312-1319, DOI: 10.1136/bjsports-2017-098254

[[4]] J DiFiori, H Benjamin, J Brenner, et al.. Overuse injuries and burnout in youth sports: a position statement from the American Medical Society for Sports Medicine. Br J Sports Med, 48 (4) ( 2014), pp. 287-288, DOI: 10.1136/bjsports-2013-093299

[[5]] DJ Caine N. Maffulli. Epidemiology of children’s individual sports injuries. An important area of medicine and sport science research. Med Sport Sci, 48 ( 2005), pp. 1-7, DOI: 10.1159/000084274

[[6]] F Johansson, A Cools, T Gabbett, J Fernandez-Fernandez, E Skillgate. Association between spikes in external training load and shoulder injuries in competitive adolescent tennis players: the SMASH cohort study. Sports Health, 14 (1) ( 2021), pp. 103-110, DOI: 10.1177/19417381211051643

[[7]] EG Post, SM Trigsted, JW Riekena, et al.. The association of sport specialization and training volume with injury history in youth athletes. Am J Sports Med, 45 (6) ( 2017), pp. 1405-1412, DOI: 10.1177/0363546517690848

[[8]] KE Frisch, J Clark, C Hanson, C Fagerness, A Conway, L Hoogendoorn. High prevalence of nontraumatic shoulder pain in a regional sample of female high school volleyball athletes. Orthop J Sports Med, 5 (6) ( 2017), Article 2325967117712236, DOI: 10.1177/2325967117712236

[[9]] C Aasheim, H Stavenes, SH Andersson, L Engbretsen, B Clarsen. Prevalence and burden of overuse injuries in elite junior handball. BMJ Open Sport Exerc Med, 4 (1) ( 2018), Article e000391. DOI: 10.1136/bmjsem-2018-000391

[[10]] A Frisch, J-L Croisier, A Urhausen, R Seil, D Theisen. Injuries, risk factors and prevention initiatives in youth sport. Br Med Bull, 92 (1) ( 2009), pp. 95-121. DOI: 10.1093/bmb/ldp034

[[11]] B Clarsen, G Myklebust, R. Bahr. Development and validation of a new method for the registration of overuse injuries in sports injury epidemiology: the Oslo Sports Trauma Research Centre (OSTRC) Overuse Injury Questionnaire. Br J Sports Med, 47 (8) ( 2013), pp. 495-502, DOI: 10.1136/bjsports-2012-091524

[[12]] W van Mechelen, H Hlobil, HC Kemper. Incidence, severity, aetiology and prevention of sports injuries. A review of concepts. Sports Med, 14 (2) ( 1992), pp. 82-99, DOI: 10.2165/00007256-199214020-00002

[[13]] SR Augustsson, J Augustsson, R Thomeé, J Karlsson, B I Eriksson, U Svantesson. Performance enhancement following a strength and injury prevention program: a 26-week individualized and supervised intervention in adolescent female volleyball players. Int J Sports Sci Coach, 6 (3) ( 2011), pp. 399-417. DOI: 10.1260/1747-9541.6.3.399

[[14]] C Hanlon, JJ Krzak, J Prodoehl, KD Hall. Effect of injury prevention programs on lower extremity performance in youth athletes: a systematic review. Sport Health, 12 (1) ( 2020), pp. 12-22, DOI: 10.1177/1941738119861117

[[15]] CA Emery, TO Roy, JL Whittaker, A Nettel-Aguirre, W van Mechelen. Neuromuscular training injury prevention strategies in youth sport: a systematic review and meta-analysis. Br J Sports Med, 49 (13) ( 2015), pp. 865-870. DOI: 10.1136/bjsports-2015-094639

[[16]] R Bahr, T. Krosshaug. Understanding injury mechanisms: a key component of preventing injuries in sport. Br J Sports Med, 39 (6) ( 2005), pp. 324-329, DOI: 10.1136/bjsm.2005.018341

[[17]] MJ Page, JE McKenzie, PM Bossuyt, et al.. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ, 372 ( 2021), p. n71, DOI: 10.1136/bmj.n71

[[18]] A Plummer, H Mugele, K Steffen, J Stoll, F Mayer, J Müller. General versus sports-specific injury prevention programs in athletes: a systematic review on the effects on performance. PLoS One, 14 (8) ( 2019), Article e0221346. DOI: 10.1371/journal.pone.0221346

[[19]] KM Crossley, BE Patterson, AG Culvenor, AM Bruder, AB Mosler, BF Mentiplay. Making football safer for women: a systematic review and meta-analysis of injury prevention programmes in 11 773 female football (soccer) players. Br J Sports Med, 54 (18) ( 2020), pp. 1089-1098. DOI: 10.1136/bjsports-2019-101587

[[20]] NA de Morton. The PEDro scale is a valid measure of the methodological quality of clinical trials: a demographic study. Aust J Physiother, 55 (2) ( 2009), pp. 129-133, DOI: 10.1016/s0004-9514(09)70043-1

[[21]] SA Olivo, LG Macedo, IC Gadotti, J Fuentes, T Stanton, DJ Magee. Scales to assess the quality of randomized controlled trials: a systematic review. Phys Ther, 88 (2) ( 2008), pp. 156-175. DOI: 10.2522/ptj.20070147

[[22]] CG Maher, C Sherrington, RD Herbert, AM Moseley, M Elkins. Reliability of the PEDro scale for rating quality of randomized controlled trials. Phys Ther, 83 (8) ( 2003), pp. 713-721

[[23]] AG Cashin, JH McAuley.Clinimetrics: Physiotherapy evidence database (PEDro) scale. J Physiother, 66 (1) ( 2020), p. 59, DOI: 10.1016/j.jphys.2019.08.005

[[24]] J Sakata, E Nakamura, T Suzuki, et al.. Efficacy of a prevention program for medial elbow injuries in youth baseball players. Am J Sports Med, 46 (2) ( 2018), pp. 460-469, DOI: 10.1177/0363546517738003

[[25]] MRL Forrest, JJ Hebert, BR Scott, AR Dempsey. Exercise-based injury prevention for community-level adolescent cricket pace bowlers: a cluster-randomised controlled trial. J Sci Med Sport, 23 (5) ( 2020), pp. 475-480, DOI: 10.1016/j.jsams.2019.12.009

[[26]] NC Mascarin, CAB de Lira, RL Vancini, AC da Silva, MS Andrade. The effects of preventive rubber band training on shoulder joint imbalance and throwing performance in handball players: a randomized and prospective study. J Bodyw Mov Ther, 21 (4) ( 2017), pp. 1017-1023, DOI: 10.1016/j.jbmt.2017.01.003

[[27]] NC Mascarin, CAB de Lira, RL Vancini, A de Castro Pochini, AC da Silva, M Dos Santos Andrade. Strength training using elastic bands: improvement of muscle power and throwing performance in young female handball players. J Sport Rehabil, 26 (3) ( 2017), pp. 245-252, DOI: 10.1123/jsr.2015-0153

[[28]] J Fernandez-Fernandez, T Ellenbecker, D Sanz-Rivas, A Ulbricht, A Ferrautia. Effects of a 6-week junior tennis conditioning program on service velocity. J Sports Sci Med, 12 (2) ( 2013), pp. 232-239

[[29]] J Sakata, E Nakamura, T Suzuki, et al.. Throwing injuries in youth baseball players: can a prevention program help? A randomized controlled trial. Am J Sports Med, 47 (11) ( 2019), pp. 2709-2716, DOI: 10.1177/0363546519861378

[[30]] GS Fleisig, SW Barrentine, RF Escamilla, JR Andrews. Biomechanics of overhand throwing with implications for injuries. Sports Med, 21 (6) ( 1996), pp. 421-437, DOI: 10.2165/00007256-199621060-00004

[[31]] M Lesinski, O Prieske, U Granacher. Effects and dose-response relationships of resistance training on physical performance in youth athletes: a systematic review and meta-analysis. Br J Sports Med, 50 (13) ( 2016), pp. 781-795, DOI: 10.1136/bjsports-2015-095497

[[32]] AM Cools, FR Johansson, D Borms, A Maenhout. Prevention of shoulder injuries in overhead athletes: a science-based approach. Braz J Phys Ther, 19 (5) ( 2015), pp. 331-339, DOI: 10.1590/bjpt-rbf.2014.0109

[[33]] PA Borsa, KG Laudner, EL Sauers. Mobility and stability adaptations in the shoulder of the overhead athlete: a theoretical and evidence-based perspective. Sports Med, 38 (1) ( 2008), pp. 17-36, DOI: 10.2165/00007256-200838010-00003

[[34]] KE Wilk, LC Macrina, GS Fleisig, et al.. Correlation of glenohumeral internal rotation deficit and total rotational motion to shoulder injuries in professional baseball pitchers. Am J Sports Med, 39 (2) ( 2011), pp. 329-335, DOI: 10.1177/0363546510384223

[[35]] TF Tyler, MJ Mullaney, MR Mirabella, SJ Nicholas, MP McHugh. Risk factors for shoulder and elbow injuries in high school baseball pitchers: the role of preseason strength and range of motion. Am J Sports Med, 42 (8) ( 2014), pp. 1993-1999, DOI: 10.1177/0363546514535070

[[36]] L Achenbach, L Laver, SS Walter, F Zeman, M Kuhr, W Krutsch. Decreased external rotation strength is a risk factor for overuse shoulder injury in youth elite handball athletes. Knee Surg Sports Traumatol Arthrosc, 28 (4) ( 2020), pp. 1202-1211, DOI: 10.1007/s00167-019-05493-4

[[37]] RA Keller, AF De Giacomo, JA Neumann, O Limpisvasti, JE Tibone. Glenohumeral internal rotation deficit and risk of upper extremity injury in overhead athletes: a meta-analysis and systematic review. Sports Health, 10 (2) ( 2018), pp. 125-132. DOI: 10.1177/1941738118756577

[[38]] M Mayes, M Salesky, DA Lansdown. Throwing injury prevention strategies with a whole kinetic chain-focused approach. Curr Rev Musculoskelet Med, 15 (2) ( 2022), pp. 53-64, DOI: 10.1007/s12178-022-09744-9

[[39]] KE Wilk, TR Hooks, LC Macrina. The modified sleeper stretch and modified cross-body stretch to increase shoulder internal rotation range of motion in the overhead throwing athlete. J Orthop Sports Phys Ther, 43 (12) ( 2013), pp. 891-894, DOI: 10.2519/jospt.2013.4990

[[40]] T Yamauchi, S Hasegawa, M Nakamura, et al.. Effects of two stretching methods on shoulder range of motion and muscle stiffness in baseball players with posterior shoulder tightness: a randomized controlled trial. J Shoulder Elbow Surg, 25 (9) ( 2016), pp. 1395-1403, DOI: 10.1016/j.jse.2016.04.025

[[41]] C Tooth, A Gofflot, C Schwartz, et al.. Risk factors of overuse shoulder injuries in overhead athletes: a systematic review. Sport Health, 12 (5) ( 2020), pp. 478-487, DOI: 10.1177/1941738120931764

[[42]] AA Wright, BM Ness, M Donaldson, EJ Hegedus, P Salamh, JA Cleland. Effectiveness of shoulder injury prevention programs in an overhead athletic population: a systematic review. Phys Ther Sport, 52 ( 2021), pp. 189-193. DOI: 10.1016/j.ptsp.2021.09.004

Not applicable.