The Association Between Internal and External Shoulder Load, Pre-season Strength and Power, with Shoulder Problems in Female Handball Players.
Kari Arnason, Erla Asgeirsdottir, Unnar Arnarsson and 2 others
PMID 40756799WHAT IT FOUND
Stronger female handball players reported more severe shoulder pain as their perceived weekly shoulder load increased.
Higher pre-season strength, power, and lower external rotator strength were linked to greater symptom severity, contradicting the idea that strength alone protects the shoulder.
Key findings
01Players with high pre-season trunk rotation power, lower body strength, and external rotator strength reported more severe shoulder problems as their perceived shoulder load increased throughout the season.
02Perceived shoulder load was a more consistent predictor of shoulder problem severity than the objective number of shots taken.
03Lower external rotator strength was associated with higher shoulder problem severity as the number of shots increased.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
The sample size was 31, which is smaller than the 46 participants required by the power analysis to detect a moderate correlation with 80% power. The average severity score was low (7.7/100), creating a floor effect that may have underestimated the true strength of associations between variables. Handball exposure in minutes was not documented, so it is unknown whether stronger players simply played more time and thus sustained more load. Pre-season testing was scheduled based on availability, which may have introduced variability in fatigue levels at the time of assessment. External load was defined only as match shots, ignoring passes, training shots, and defensive contact.
Declared interests
The authors declare no conflicts of interest.
The easy way to misread this
Do not interpret the positive correlation between strength and shoulder problems as evidence that strength training causes injury. Stronger players may simply be exposed to more playing time and higher cumulative load, and the study did not control for minutes played.