Association of trunk and lower limb factors with shoulder complaints and sport performance in overhead athletes: A systematic review including GRADE recommendations and meta-analysis

Objective: To identify the association of trunk and lower limb factors with shoulder complaints and sport performance in overhead athletes.Methods: Search performed at PubMed/Medline, Embase, CINAHL, LILACS, Cochrane, Web of Science and SPORTDiscus for observational studies. Methodological quality and strength of the evidence was assessed with the Newcastle-Ottawa Scale and GRADE. Meta-analysis and effects sizes analysis were calculated when possible.Results: Sixty-five studies were included. Low to very-low evidence suggests no association of trunk/ lower limb strength, endurance, power, jump or balance with shoulder complaints and/or throwing performance. Athletes with shoulder complaints performed worse in trunk stability and endurance tests (mean difference:-6.83 (95%CI:-8.78,-4.88)). Athletes with high throwing performance presented better results in CMJ, horizontal jump, power measures and knee extension strength. For swimmers, there was no association of trunk/lower limb endurance with shoulder complaints (moderate evidence) and no association of balance and swimming performance (low evidence). Better trunk/lower limb strength, power and vertical jumps measures were associated with better swimming performance.Conclusions: In methodologically similar studies, some trunk/lower limb outcomes are associated with shoulder complaint or sport/swimming performance. Results should be considered with caution and future studies should use better methodologies.(c) 2023 Elsevier Ltd. All rights reserved.

Automated summary

This study aimed to investigate the association of trunk and lower limb factors with shoulder complaints and sport performance in overhead athletes. Sixty-five studies were included, and the evidence suggests that trunk/lower limb strength, endurance, power, jump, and balance were not associated with shoulder complaints and/or throwing performance. However, athletes with shoulder complaints performed worse in trunk stability and endurance tests, while athletes with high throwing performance had better results in jump measures and knee extension strength.