This narrative review builds a science-based framework for preventing recurrent shoulder injuries in overhead athletes like baseball, tennis, handball, and volleyball players. It organizes prevention into four steps: define risk factors, set return-to-play cut-offs, measure with valid tools, and design targeted training. The focus is on three local shoulder-girdle risk factors.
When you screen an overhead athlete, three modifiable factors drive your assessment: GIRD, external rotator weakness, and scapular dyskinesis. Apply the ROM rule directly: internal rotation loss under 18° and total ROM asymmetry under 5°. Because humeral retrotorsion shifts the rotation arc, isolated GIRD can mislead you, so measure total ROM.
For strength, an isokinetic ER/IR ratio of 66% (or isometric 75%) flags an at-risk cuff, and expect the dominant side to be roughly 10% stronger, not weaker. A key pitfall: do not treat every asymmetric scapula as pathology. In overhead athletes some asymmetry is a normal adaptation, and dyskinesis prevalence is nearly identical in painful and pain-free shoulders.
Remember the evidence gap. Stretching and strengthening relieve symptoms and restore ROM, but no data yet prove these programs actually reduce recurrent injury.
This narrative review builds a science-based framework for preventing recurrent shoulder injuries in overhead athletes like baseball, tennis, handball, and volleyball players. It organizes prevention into four steps: define risk factors, set return-to-play cut-offs, measure with valid tools, and design targeted training. The focus is on three local shoulder-girdle risk factors.
When you screen an overhead athlete, three modifiable factors drive your assessment: GIRD, external rotator weakness, and scapular dyskinesis. Apply the ROM rule directly: internal rotation loss under 18° and total ROM asymmetry under 5°. Because humeral retrotorsion shifts the rotation arc, isolated GIRD can mislead you, so measure total ROM.
For strength, an isokinetic ER/IR ratio of 66% (or isometric 75%) flags an at-risk cuff, and expect the dominant side to be roughly 10% stronger, not weaker. A key pitfall: do not treat every asymmetric scapula as pathology. In overhead athletes some asymmetry is a normal adaptation, and dyskinesis prevalence is nearly identical in painful and pain-free shoulders.
Remember the evidence gap. Stretching and strengthening relieve symptoms and restore ROM, but no data yet prove these programs actually reduce recurrent injury.