Multicomponent stretching and rubber band strengthening exercises do not reduce overuse shoulder injuries: a cluster randomised controlled trial with 579 handball athletes

Achenbach, Leonard; Huppertz, Gunnar; Zeman, Florian; Weber, J. Robert; Luig, Patrick; Rudert, Maximilian; Krutsch, Werner

doi:10.1136/bmjsem-2021-001270

Cited by 7 publications

(5 citation statements)

References 37 publications

(83 reference statements)

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“…Therefore, a recent meta-analysis [ 16 ] suggests, that future studies should focus on the effects of resistance training modalities on the upper extremity muscle fascicle geometry due to its strong relationship with athletic performance, injury, and force production. However, it seems that the majority of exercise interventions aimed at reducing the risk of shoulder injury and discomfort target functional changes in flexibility and strength without substantially reducing the injury rate [ 17 – 19 ].…”

Section: Introductionmentioning

confidence: 99%

Effect of isokinetic eccentric training on the human shoulder strength, flexibility, and muscle architecture in physically active men: A preliminary study

Vetter,

Hepp,

Schleichardt

et al. 2023

PLoS ONE

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Strengthening the rotator cuff muscles is important for injury prevention and rehabilitation. Since muscle fascicle length improves motor performance and is suggested to reduce the risk of injury for the hamstring, it may be an important variable to promote multidirectional changes in the function and macroscopic structure for the shoulder. Recent literature reviews overwhelmingly suggest that eccentric exercises improve fascicle length and functional measures for the lower limb. However, there is a research gap for the shoulder. Since ultrasound imaging is the most commonly used imaging technique to quantify muscle structure, but has yielded heterogeneous results in different studies, there is another issue and a research gap for the imaging method. Based on the research gaps, the purpose of this study was to evaluate the effects of standardized eccentric strength training on the function and structure of the external rotator cuff muscles using an isokinetic dynamometer and MRI. Therefore, a preliminary pre-post intervention study was conducted and 16 physically active men were recruited in October 2021. For the right shoulder, an eccentric isokinetic training was performed twice a week for almost six weeks. The primary outcome measures (external rotators) were active and passive range of motion, eccentric and concentric torque at 30, 60, and 180°/s isokinetic speed, and fascicle length and fascicle volume for the supraspinatus and infraspinatus muscles. The findings show a training effect for the absolute mean values of eccentric strength (+24%, p = .008). The torque-angle relationship increased, especially in the final phase of range of motion, although a 4% (p = .002) decrease in passive range of motion was found in the stretch test. Positive changes in muscle structure were shown for the supraspinatus muscle fascicle length (+16%, p = .003) and fascicle volume (+19%, p = .002). Based on the study results, we can conclude that eccentric isokinetic training has a significant positive effect on the shoulder. To our knowledge, this is the first eccentric training study using both isokinetic dynamometer and muscle diffusion tensor imaging to access functional and structural changes in the human shoulder rotator cuff muscles. The methods were shown to be applicable for interventional studies. Based on these results, populations such as high-performance handball players with highly trained shoulders should be included in future studies.

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Section: Introductionmentioning

confidence: 99%

Effect of isokinetic eccentric training on the human shoulder strength, flexibility, and muscle architecture in physically active men: A preliminary study

Vetter,

Hepp,

Schleichardt

et al. 2023

PLoS ONE

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“…No systematic reviews were identified. Eight RCTs1 43–49 and one prospective study50 were included (table 2). The highest quality of evidence for a preventative effect was observed for Oslo Sports Trauma Research Center (OSTRC) Shoulder Injury Prevention programme,1 the Shoulder Control programme,47 a throwing injury prevention programme43 and the FIFA 11+ shoulder injury prevention programme (moderate quality of evidence) 44.…”

Section: Resultsmentioning

confidence: 99%

Diagnosis, prevention and treatment of common shoulder injuries in sport: grading the evidence – a statement paper commissioned by the Danish Society of Sports Physical Therapy (DSSF)

et al. 2022

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This statement paper summarises and appraises the evidence on diagnosis, prevention, and treatment of common shoulder injuries in sports. We systematically searched Medline and Embase. The Grading of Recommendations Assessment, Development and Evaluation tool was applied to evaluate the overall quality of evidence.For diagnosis, we included 19 clinical tests from mixed populations. Tests for anterior instability, biceps-labrum complex injuries and full subscapularis rupture had high diagnostic accuracy (low to moderate quality of evidence).For prevention, the Oslo Sports Trauma Research Center, the Shoulder Control, the FIFA 11+ shoulder injury prevention programmes, and a baseball-specific programme (range of motion, stretching, dynamic stability and strengthening exercises) showed moderate to large effect size in reducing the risk of shoulder injury compared with no intervention (very low to moderate quality of evidence).For treatment, a rehabilitation programme including stretching, ice packs, electrotherapy and compression, and strengthening exercises showed a large effect size in reducing pain and disability compared with no intervention in athletes with subacromial impingement syndrome (very low to moderate quality of evidence). For the treatment of supraspinatus tendinopathy, hyperthermia treatment (heating the skin to 38°C–40°C) resulted in large effect size in reducing pain and disability compared with ultrasound or pendular swinging and stretching exercises (moderate quality of evidence). Strengthening exercise alone or in combination with stretching exercises promoted a large effect in reducing shoulder pain (cohort studies, no comparators) (very low quality of evidence). The quality of evidence for most estimates was low to moderate, indicating that future high-quality research may alter our recommendations for clinical practice.

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“…A GIRD above 20° and an isometric strength ratio of 0.78 is typically found for a throwing shoulder with high risk for injury ( Lubiatowski et al, 2018 ; Achenbach et al, 2020 ). In handball, there is a gap in prevention studies for the shoulder ( Achenbach et al, 2020 ), while prevention studies are desperately needed because commonly prescribed exercise strategies for the shoulder do not reduce the risk of overuse injuries in handball ( Achenbach et al, 2022 ). To the best of our knowledge, only Andersson et al (2017) investigated the preventive effects of a strengthening program for the external rotators and found an increase in strength and a 28% decrease in shoulder injuries, providing a little indication of the potential for shoulder prevention exercises.…”

Section: Introductionmentioning

confidence: 99%

A 6-week randomized-controlled field study: effect of isokinetic eccentric resistance training on strength, flexibility and muscle structure of the shoulder external rotators in male junior handball players

Vetter,

Witt,

Hepp

et al. 2024

Front. Physiol.

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Background: Team handball involves a tremendous amount of shoulder motion with high forces during repeated extended external range of motion. This causes shoulder complaints and overuse injuries. While eccentric training for the lower extremity shows preventive effects by improving strength, range of motion and fascicle length, there is a research gap for the shoulder joint and for advanced tissue characterization using diffusion tensor imaging.Objectives: To investigate the effects of 6-week eccentric isokinetic resistance training on strength, flexibility, and fiber architecture characteristics of the external rotators compared to an active control group in junior male handball players.Methods: 15 subjects were randomly assigned to the eccentric training group and 14 subjects to the active control group (conventional preventive training). Primary outcome measures were eccentric and concentric isokinetic strength of the external rotators, range of motion, and muscle fascicle length and fascicle volume.Results: The intervention group, showed significant changes in eccentric strength (+15%). The supraspinatus and infraspinatus muscles showed significant increases in fascicle length (+13% and +8%), and in fractional anisotropy (+9% and +6%), which were significantly different from the control group.Conclusion: Eccentric isokinetic training has a significant effect on the function and macroscopic structure of the shoulder external rotators in male junior handball players. While strength parameters and muscle structure improved, range of motion did not change. This research helps understanding the physiology of muscle and the role of eccentric training on shoulder function and muscle structure. Furthermore, DTI was found to be a promising tool for advanced tissue characterization, and the in vivo derived data can also serve as model input variables and as a possibility to extend existing ex-vivo muscle models. Future research is needed for functional and structural changes following convenient eccentric field exercises.

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Multicomponent stretching and rubber band strengthening exercises do not reduce overuse shoulder injuries: a cluster randomised controlled trial with 579 handball athletes

Cited by 7 publications

References 37 publications

Effect of isokinetic eccentric training on the human shoulder strength, flexibility, and muscle architecture in physically active men: A preliminary study

Effect of isokinetic eccentric training on the human shoulder strength, flexibility, and muscle architecture in physically active men: A preliminary study

Diagnosis, prevention and treatment of common shoulder injuries in sport: grading the evidence – a statement paper commissioned by the Danish Society of Sports Physical Therapy (DSSF)

A 6-week randomized-controlled field study: effect of isokinetic eccentric resistance training on strength, flexibility and muscle structure of the shoulder external rotators in male junior handball players

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