Shoulder injury prevention in overhead athletes
Three established risk factors (GIRD, rotator-cuff/external-rotator strength, scapular dyskinesis) drive a four-step science-based prevention approach
Key Findings
The shoulder is at high risk in overhead sports, particularly throwing or hitting activities (baseball, tennis, handball, volleyball).
Four steps for science-based prevention of recurrent injury: (1) define risk factors for injury and re-injury; (2) use established risk factors as return-to-play criteria with cut-off values from normative databases; (3) measure them with reliable, valid tools and procedures; (4) design and implement preventative training programmes in the athlete's training.
Three risk factors form the basis for prevention and return-to-play recommendations: glenohumeral internal-rotation deficit (GIRD); rotator-cuff strength, in particular the external rotators; and scapular dyskinesis, in particular scapular position and strength.
Full text, checked 2026-09-27: the review expresses cuff balance as an ER:IR strength ratio and describes posterior-shoulder stretching (sleeper/cross-body) for GIRD and scapular-control exercises for dyskinesis.
Practical Application
The review's position: shoulder prevention in overhead athletes rests on screening and correcting three modifiable factors — GIRD, external-rotator (rotator-cuff) strength and scapular dyskinesis — measured with valid tools and fed back as return-to-play cut-offs, then trained prophylactically inside the normal programme.
Off-court prophylaxis: ER + scapular strengthening (side-lying ER, prone Y/T/W, band ER), posterior-capsule stretching if GIRD (exercise selection is the base's own practice, in line with the review's three factors).
Not from this paper; the base's own practice: kinetic-chain strength (legs/hips/trunk) for force transfer, and periodising serve/smash counts — deload overhead volume in fatigue weeks; don't push through shoulder pain.
Applies to tennis serve, badminton smash, padel bandeja/víbora/smash; recreational players ramping overhead volume are the classic overuse case (inference from the review's population).
Not from this paper: elbow overuse ("tennis elbow") management via technique, grip size, string tension and forearm conditioning belongs to Pluim 2006, not this review.
Limitations
Narrative/clinical review, not pooled RCT; derived largely from throwing athletes → partly adjacent to racket sports (esp. badminton/padel); screening thresholds not universally standardized; the review frames prevention of *recurrent* injury and return to play, so primary-prevention transfer is inference.
How this entry was checked and changed
Why this level
regraded 2026-09-27 from C: authoritative narrative review from the leading group on shoulder/scapular rehabilitation in overhead athletes (Cools); narrative, not systematic
Content correction 2026-09-27
"Five prevention pillars" -> the abstract names three risk factors (GIRD, rotator-cuff/external-rotator strength, scapular dyskinesis) and a four-step approach; kinetic-chain integration and load management relabelled as the base's own practice.
Elbow/tennis-elbow advice labelled as not from this paper (Pluim 2006). Level C -> B+ (authoritative narrative review from the leading group); Tier "mixed" -> Tier 2-5.
Lines labelled "full text; not checked" were read against the open-access full text (PMC4647145): 1 confirmed and relabelled.