Original research
Altered scapula position in elite young cricketers with shoulder problems

https://doi.org/10.1016/j.jsams.2012.05.017Get rights and content

Abstract

Objectives

Shoulder injuries associated with the throwing and fielding demands of the game are common in elite cricketers. This study aimed to identify the factors associated with shoulder injuries in an elite junior squad.

Design

Cross-sectional study.

Methods

Sixty players aged 15–19 years, from the Cricket Victoria elite junior male squads completed questionnaires and 46 completed clinical assessments conducted by a physiotherapist that included shoulder strength, range of movement and scapula position. Participants were classified into two groups; players currently reporting shoulder problems (SP) and those not reporting shoulder problems (NSP) on the basis of their response to the question ‘Have you had any problems with your shoulder in the last 12 months that have affected you training for or playing cricket?’.

Results

Fifteen percent (9 of 60) of participants reported shoulder problems (SP). The level of shoulder disability in participants with SP, classified on standard self-report scales, was mild to moderate. The major difference between groups was that the SP group displayed a significant downward rotation of the scapula in almost all shoulder positions. There were no differences between the two groups for training factors, range of motion, or in clinical test results. However, contrary to expectations the SP group exhibited greater strength than the NSP group on some variables.

Conclusions

A consistently downwardly rotated scapula associated with young cricketers with SP may predispose these cricketers to ongoing injury through impingement and also through increased load on the rotator cuff muscles acting at the glenohumeral joint during throwing.

Introduction

Shoulder injuries have been reported to comprise 5–7% of all injuries amongst elite cricketers in Australia,1, 2 South Africa3 and the United Kingdom.4 However, it has been suggested that the incidence of shoulder pain in elite cricketers is underestimated.5 A recent study of English county cricket players suggested that up to 23% may experience some form of shoulder injury, with the majority affected in their throwing arm.6 While these injuries rarely resulted in players missing games, they impacted on playing performance and activities of daily living.

The majority of shoulder injuries in cricket are described as being related to tendon injury,1, 3, 4 and are thought to be more likely related to fielding, particularly throwing, than bowling.3 One study has reported that up to half of all shoulder injuries were related to fielding.7 Throwing a cricket ball from the outfield is likely to be a provocative activity for shoulder injury. It is common for cricketers with shoulder problems to field in positions that will reduce the distance to be thrown.6 Previous studies of overhead athletes have found that shoulder injuries are associated with high training loads.7, 8 Cricketers with shoulder pain have been shown to have a glenohumeral internal rotation range of motion deficit5 and weak scapula stabilizer musculature.9 It has also been suggested that athletes in other overhead sports with altered scapula kinematics may be more susceptible to shoulder injuries.10, 11 These data suggest that factors associated with training load, team role, fielding position, flexibility, strength and scapula kinematics should be taken into account when investigating factors associated with shoulder problems in cricketers.

Overhead athletes are particularly susceptible to injury and with the greater emphasis on fielding activities in the modern game, shoulder injuries in cricket are likely to increase. The aim of this project was to provide baseline data on shoulder functioning in elite young cricketers and to identify factors associated with shoulder injury.

Section snippets

Methods

Using a cross-sectional design, 81 cricketers selected in the male under 17 and under 19 years Cricket Victoria High Performance Youth squads in 2011 were invited to participate in this study, which was approved by the Faculty Human Ethics Committee. All participants (and parents for those under 18 years) completed written consent prior to participation.

Data collection consisted of an internet-based questionnaire and a clinical assessment conducted by two physiotherapists experienced in

Results

Because questionnaire and clinical assessment data were collected separately, not all participants completed both sets of data but 80% (65 of 81) of potential participants completed either the questionnaire or the clinical assessment. Nine of 60 participants who completed the questionnaire were classified as having shoulder problems (SP). Of the nine players in the SP group, all except one had an injury to their dominant arm. The non-dominant injury was a fractured humerus near the shoulder

Discussion

The relatively low proportion (9/61 = 15%) of players reporting shoulder problems (SP group) is less than previous reports of 23% of English county players6 and 36% for elite, predominantly junior, cricketers reporting gradual onset of non-specific shoulder pain.5 The higher proportion of shoulder problems reported in English county players may have reflected a relatively low response rate (42%) and players with shoulder pain being more likely to respond.6 However, it may also be related to the

Conclusion

The altered scapula position of a downwardly rotated scapula was the factor best able to discriminate between elite young cricketers with and without shoulder problems. Playing cricket at an elite level with a downwardly rotated scapula may be associated with shoulder problems and may predispose players to ongoing injury through impingement and also through increased load on the rotator cuff muscles acting at the glenohumeral joint during throwing.

Practical implications

  • Altered scapula position was the factor best able to discriminate between elite young cricketers with and without shoulder problems.

  • Other factors such as training load, muscle strength and joint range of motion had little ability to discriminate between elite young cricketers with and without shoulder problems.

  • The screening process for scapula control described in the current study may be appropriate to be adopted more widely to identify other athletes with shoulder problems.

Acknowledgements

This study was supported by a Cricket Australia Sports Science and Sports Medicine Research Grant. Tim McCaskill and Shawn Flegler from Cricket Victoria supported the project and provided logistic support for data collection. Simon Balster from Lifecare Prahran assisted in designing the clinical assessment procedures and collected some of the data.

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