Shoulder pain in Amateur fast bowlers: incidence, associated factors and prevention

Abstract

Fast bowlers commonly suffer from shoulder pain and -injury. There is a dearth of information regarding the incidence of shoulder pain and its associated factors in amateur fast bowlers. Once the incidence of, and the factors associated to shoulder pain in fast bowlers are determined, shoulder pain could be addressed and prevented in this population. The aim of this thesis was to develop, and determine the effectiveness of a shoulderimpairment exercise programme to address the biomechanical factors contributing to shoulder pain in amateur fast bowlers. The Northern Premier Cricket league is the highest form of club cricket (amateur cricket) in South Africa and was the source of the fast bowlers in this study. Three objectives were identified and the corresponding studies were executed chronologically. Firstly, a longitudinal cohort study was employed to determine the incidence of and associated factors to shoulder pain in fast bowlers whereby the amateur fast bowlers were tested for baseline values of shoulder muscle strength, stability, shoulder range of motion (ROM) and endurance. Information was provided by answering a baseline questionnaire regarding their anthropometrics, demographics, past injuries and playing roles. Throughout the 2018/2019 season they then answered a weekly questionnaire regarding their development of shoulder injury/pain. Secondly, a modified e-Delphi technique was employed to develop a shoulder exercise programme aimed at addressing these factors. Ten experts in the field of physiotherapy were sent the exercise programme and their comments and suggestions were applied accordingly. Thirdly, the effectiveness of the exercise program was tested via a quasi-experimental pre-post-test study design. One amateur cricket team was assessed before and after the completion of the exercise programme for a period of six weeks. Nine (23%) of the fast bowlers sustained shoulder pain during the 2018/19 season. The associated factors to shoulder pain were (effect sizes): decreased internal rotation ROM (0.6); increased external rotation ROM (effect size=1.0); poor endurance (effect size= 0.5) and isometric muscle strength of selected muscles (0.3 - 0.5). The developed shoulder exercise programme addressing these factors had been found to: improve muscle strength of the selected muscles (p=0.00-0.02), increase GHJ internal rotation (p=0.02), increase endurance and proprioception of the surrounding shoulder muscles: CKUEST (p=<0.001) and prone-Y and scaption testing positions (p=<0.001). An exercise programme aimed at addressing the factors associated with shoulder pain was proven effective in addressing the biomechanical factors associated to shoulder pain. The ability of this programme to prevent shoulder pain in fast bowlers is recommended to be assessed in future studies.