J. Biomedical Science and Engineering, 2010, 3, 811-815 JBiSE
doi:10.4236/jbise.2010.38108 Published Online August 2010 (http://www.SciRP.org/journal/jbise/).
Published Online August 2010 in SciRes. http://www.scirp.org/journal/jbise
Shoulder joint flexibility in top athletes
Hassan Daneshmandi*, Farhad Rahmaninia, Hossein Shahrokhi, Pegah Rahmani, Saeid Esmaeili
Guilan University, Rasht, Iran.
Received 17 April 2010; revised 17 May 2010; accepted 22 May 2010.
ABSTRACT
Joint range of motion (ROM) is very important in daily
activities, sport and in clinical diagnosis. Many factors
have been reported to influence joint ROM. Muscu-
loskeletal adaptation and some special side effects due
to his or her physical demands and movement patterns
in professional athletes are very important subjects in
sport sciences. The present study is a comparison of
shoulder joint ROM in elite athlete and non-athlete
groups and its relationship to their age, post and years
of their tournament play. The subjects in this study
included 106 men with mean age (23.65 ± 3.45) and
mean years of tournament play (5.60 ± 2.23). The groups
of subjects included 26 handball players, 25 volleyball
players, 25 soccer players and 30 non-athletes. Data
were collected through questionnaires and inspection,
and subjects’ ROM was measured by “Leighton flex-
ometer” (r = 0.90 – 0.99) in external rotation and ab-
duction of shoulder joint in dominant and non-domi-
nant hands. Data were analyzed by correlation coeffi-
cient, t – test, ANOVA and post hock Schaffe test. The
results showed that an increase in age and years of
tournament play reduced the shoulder ROM of sub-
jects (p ≤ 0.05). There were significant differences in
shoulder ROM among athletic groups. Additionally,
there are significant differences between dominant and
non-dominant hands (p ≤ 0.05). It can be concluded
that more specific stretching exercises and warm-up for
shoulder in all athletes and especially in older and ex-
perienced players should be performed by coaches. The
results also emphasized routine screening, corrective
exercise programs and a design of preventing strategies
by athletic trainers and coaches.
Keywords: Range of Motion; Shoulder Joint; Handball;
Volleyball; Soccer; Age; Years of Tournament Play;
Playing Post
1. INTRODUCTION
Joint range of motion (ROM) data is a very important
reference in job and workplace design as well as in
clinical diagnosis. Many factors have been reported to
influence joint ROM. With an increase in age, the de-
generation in these tissues becomes progressively more
apparent, and results in a reduction in joint ROM. Other
factors such as pain, dominant side, and the time of day
may also have effects on joint ROM [1]. The physical
demands of sport performance on the athletes’ body
cause certain musculoskeletal adaptation. Professional
athletes spend most of their sporting life in training and
competition [2]. Load placed on the musculoskeletal
system may be generally classified as tensile or com-
pressive. Repeated demands on a musculotendinous unit
may cause it to shorten, decreasing normal joint range of
motion [3]. Musculoskeletal adaptation and some special
side effects due to his or her physical demands and
movement patterns in professional athletes are very im-
portant subjects in sport sciences. The musculoskeletal
adaptation at this point is called maladaptation, reducing
joint range of motion, changing biomechanical patterns,
decreasing the efficiency of force production, and in-
creasing the chance of injuries to the musculoskeletal
system [4]. Faulty posture could be also the result of that
adaptation [5]. However, faulty posture does not neces-
sarily indicate a disorder but it could cause a loss of op-
timum body mechanics [6].
There is a general agreement that the appropriate
amount of exercise is important for the healthy growth
and optimal development of the body [7]. By contrast,
too much or too little exercise and inappropriate training
may have some adverse effects [8]. Overtraining is an
imbalance between training and recovery. This term is
not new. The symptoms of prolonged fatigue, loss of
motivation, burn out and staleness have been described
in athletes for many decades. They are the maladaptive
responses to the stimulus of training and an extended
period of overload. Maladaptation flexibility due to fre-
quent and old injuries has been recognized for some time
[9]. Each sport has specific patterns of movement which
has an effect on related joint range of motion (ROM)
because skeletal tissue possesses an intrinsic ability to

812 H. Daneshmandi et al. / J. Biomedical Science and Engineering 3 (2010) 811-815
adapt to these physical activities. Adaptations take place
in response to exercise training and those specific pat-
terns of movements. In general, exercise programs usu-
ally include strength, power, endurance and flexibility
training. In shoulder researches, measurements of range
of motion (ROM) have been used as outcome measures
in the vast majority of reported trials [10]. Therefore, the
present study was proposed to compare the range of mo-
tion of shoulder joint (ROM) in elite athlete and
non-athlete groups and its relationship to their age, post
and years of tournament play.
2. METHODOLOGY
The subjects of this study were members of league teams
with more than 2 years of play in league competitions.
These subjects included 106 men with mean age (23.65
± 3.45) and mean of participation in tournament play
(5.60 ± 2.23). The groups of subjects included 26 hand-
ball players (mean age 23.57 ± 2.67, mean playing his-
tory 6.38 ± 2.07), 25 volleyball players (mean age 22.8
±4.31, mean playing history 4.56 ± 2.43), 25 soccer
players (mean age 25.08 ± 2.53, mean playing history
5.84 ± 1.84) and 30 non-athletes (mean age 23.23 ±
3.71).
The players completed questionnaires about age, play-
ing post, past or current shoulder injuries, duration of
dominant and non-dominant glenohumeral joints were
made by Leighton flexometer (r = 0.90 – 0.99) in stan-
dard position. Goniometric measurement of the gle-
nohumeral join is difficult because of the multi-join na-
ture of the shoulder complex. In general, the literature
would appear to indicate that the Leighton flexometer is
a reliable measuring tool, especially when used by a sin-
gle experienced tester.
All ROMs of subjects were measured in the morning
and before play or participating in warm-up drills. No
goniometric measurements were taken in the afternoon
or after participating in play or warm-up drills to mini-
mize the effect of intense activity or play on range of
motion. All testing took place with the subject in a stan-
dard position in special bar and plastic cast and stabi-
lized scapula by three special wide tapes on the hip,
chest and head areas. Shoulder external and internal ro-
tations were measured with the arm positioned in 90° of
glenohumeral abduction and 90° of elbow flexion. Dur-
ing testing, the subjects were asked to actively move the
joint as far as possible through the range of motion
(Graph 1). For each direction, three measurements were
taken and the mean measurements were calculated. We
performed t- test on dominant versus non-dominant
hands of subjects for all measurements. Correlation co-
efficients were computed to determine the strength of the
relationships among variables. We analyzed these groups
Graph 1. Flexion & hyper extension measurements posi-
tion (photo from Ackland et al. [6]).
and the relationship between shoulder ROM and age,
post and history of play were analyzed by ANOVA and
Post hock Scheffe test.
2.1. Reliability of the Measuring Method
The commonly used clinical methods for detecting mus-
cle tightness, described by Kendall [11] are subjective.
When precision and objectivity are needed, estimation of
range of motion by eye (eyeballing) is too inaccurate and
therefore a goniometer was used in this research. Also,
standardized methods of joint motion measurement by
American academy of orthopedic surgeons (AAOS)
1966 and others were advised [12]. The measuring de-
vice is always important. In addition to the accuracy of a
measuring device, an instrument should be easy to be
used by the tester and comfortable for the subjects. Cer-
tain joint movements, especially axial rotations are more
difficult to measure than others and that with a standard
universal goniometer, axial measurements are only ap-
proximates [13].
In this study all ROMs were measured with the
Leighton flexometer, model WA, Spokan because it was
valid, reliable, easy to use and it has been frequently
used by other researchers. There are sufficient studies to
prove the reliability of the Leighton flexometer: Lei-
ghton [14], Bloomfield et al. [6], and Daneshmandi [3].
The reliability and validity of this device were proved by
the researchers. Ekstrand et al. [15] also used the
Leighton flexometer to measure the hip ROM in soccer
players.
3. RESULTS
The results of the present study showed that the volleyball
players were also less flexible than other soccer players
and non-athlete groups for internal rotation (p ≤ 0.05).
The results of this study showed significant differences
of ROM of medial rotation of the shoulder in the four

H. Daneshmandi et al. / J. Biomedical Science and Engineering 3 (2010) 811-815 813
groups of subjects included non-athletes, volleyball players,
handball players and soccer players (p ≤ 0.05) (Table 1
and Figure 1). Additionally, the results of this study
showed that the ranges of motion of medial rotation of
handball players were less than the other groups (p ≤ 0.05).
The findings of this research showed significant dif-
ferences between dominant and non-dominant hands of
players (p ≤ 0.05) (Figures 2 & 3).
The amplitudes of motion of the dominant and non-
dominant shoulder joints in all groups were not similar
and statistically there was a significant relationship be-
tween shoulder’s ROMs of the dominant hand and
shoulder’s ROMs of the non-dominant hand. In other
words, there are significant differences in external rota-
tion between dominant and non-dominant hands of
handball players (p ≤ 0.05).
Table 1. Glenohumeral range of motions for all groups
Flexion Extension Int. rotation Ext rotation Abduction
Handball 185.03 ± 8.84 56.63 ± 10.05 56.5 ± 10.78 117.92 ± 9.12 184.03 ± 7.77
Volleyball 185.48 ± 7.38 58.36 ± 5.67 58.52 ± 7.24 118.44 ± 9.18 178.60 ± 8.44
Soccer 181.72 ± 6.54 57.04 ± 8.86 59.44 ± 4.95 108.20 ± 11.84178.84 ± 8.97
Non ath-
letic 184.70 ± 7.88 57.63 ± 8.28 63.66 ± 10.12 116.26 ± 7.97 183.80 ± 6.84
0
25
50
75
100
125
150
175
200
225
flexextint.r ext.rabd
Handball
Vollyball
Football
Non ath letic
****
*
** **
**
*
*
** **
**
*
Figure 1. Glenohumeral range of movements for all groups.
0
20
40
60
80
100
120
140
1234
Range of movement
degrees
External rot ation
Int e rnal rotation
Handball Volleyball Soccer Non-athletes
Figure 2. Glenohumeral joint rotation of dominant hand.
0
20
40
60
80
100
120
140
1234
Range of movement
degrees
External rotation
Internal rotation
Handball Volleyball Soccer Non-athletes
Figure 3. Glenohumeral joint rotation of non-dominant hand.
The results also showed that by increasing age, the
external rotation of soccer players and non-athletes were
reduced (Figure 4) and also by increasing year of tour-
nament play, shoulder ROM decreased but this deficit
not significant. There are significant differences of
shoulder external and internal rotation between groups
of subject and between different playing post of athletes:
internal rotation in handball players (p ≤ 0.05), internal
and external rotation in volleyball players (p ≤ 0.01) and
external rotation in soccer players (p ≤ 0.05).
4. DISCUSSION
The physiologic adaptations of athletes appear to be
sport specific [16]. This study was designed to measure
glenohumeral range of motion, which has been impli-
cated as a possible etiologic factor in increased geno-
humeral translation. Measurement of glenohumeral fle-
xion, extension and abduction were not reported because
they have not been implicated as factors in increased
glenohumeral translation and because abduction also
involves motion in joints other than the glenohumeral
joint [17].
The results of this study showed that by increasing
age and years of tournament play, internal and external
rotations of shoulder in all groups were reduced. But this
reduction in all groups was not significant, because
range of age and years of tournament play as well as sets
and time of training per week were less in the elite ath-
letes in some countries. Increasing age and years of
tournament play in athletes caused the changes in mus-
culoskeletal structure. This adaptation may be positive or
negative, for example an increase in force and masse of
muscles or a change in range of motion of joints always
obtained by training. Flexibility and tightness of soft
tissues around joints and finally reduce range of motion
23.57
22.8
25.08
23.23
21
22
23
24
25
26
Ageَ
HandballVollyballSoccerNon athletic
Figure 4. ROM and age.
6.38
4.56 5.84
0
2
4
6
8
Ye ars of
tourname nt
pla ying
Handball VolleyballSoccer
Figure 5. Mean years of history playing.

814 H. Daneshmandi et al. / J. Biomedical Science and Engineering 3 (2010) 811-815
of joints as well [18,19]. If the normal flexibility of the
surrounding tissue of a joints is not maintained, over a
period of time a decrease in joint range of motion could
happen leading to a possible decrease in performance or
an increase in chance of injury [4,5].
In this study, the range of external and internal
shoulder rotations was different in sports and in play-
ing posts of athletes, which can be related to their spe-
cific sport demands and emphasizes this point that
flexibility is very specific in any joint, playing post
and sport field. Glenohumeral internal rotation of
handball and volleyball players was less than other
groups in this study. A reduction in shoulder internal
rotation, particularly in the dominant side, can be ex-
plained as an adaptation of the posterior shoulder
musculature and capsular structure to the handball and
volleyball stroke. The increase in external rotation of
shoulder in these athletes is also a likely adaptation to
the overhead movement in these sports. The occur-
rence of an excessive range of external rotation may be
a product of a successful training program to increase
movement and thus the range over which force can be
applied to throwing or stroke [19,20].
The implication of this point is that excessive external
shoulder rotation can create excessive anterior humeral
head displacement [17,21,22]. Current research has con-
vincingly showed that deficits of internal rotation of
shoulder occur as the athlete adapts to the demands of
the sport. It is unclear whether these are normal adapta-
tions that are beneficial, either locally or throughout the
kinetic chain, or whether these are mal-adaptations that
create potentially harmful local or kinetic chain biome-
chanics. Also, the role this adaptation may play in injury
causation or risk is unclear. Several recent papers sug-
gest that decreased internal rotation and total rotation
may adversely affect shoulder performance, and this
effect may increase the risk of injury [22,23].
There are studies which show that inflexibility is a
risk factor for further injury [24,25]. Achievement of full
range of motion is one of the first goals in rehabilitation
programs [20,22]. Most shoulder rehabilitation protocols
now emphasize on a corrective exercise for internal rota-
tion of shoulder of athletes.
The study of water polo players showed that special
repetitive movement in water polo is the same as base-
ball and handball throwing, volleyball service and stroke
and other sports with overhead movements. All these
sports emphasize shoulder adduction and internal rota-
tion that cause force, torque and mass of adductor and
internal rotator muscles can lead to reduction of these
ROMs [2,26].
The study of shoulder movement suggests that de-
creased internal and total rotation may not be optimal
conditions to allow the best athletic performance with
minimal risk of injury. From a performance standpoint,
these conditions create inefficient biomechanics that
interfere with normal coupled motion and may decrease
optimal arm momentum. This paper showed degrees of
asymmetry in dominant and non-dominant hands of
handball and volleyball players. If we do not note it
carefully and do not use correct stretch exercise program,
this imbalance in musculature of shoulder girdle leads
the athletes to decrease their performance or an increase
in the chance of injury. For example, Young et al. [27]
reported a prevalence imbalance in musculature of
shoulder girdle and scoliosis in volleyball players rather
than in non-athletic groups. Improvement of imbalance
musculature due to hard training created scoliosis in
volleyball players. Therefore, if handball and volleyball
players train more and harder bilaterally, this maladapta-
tion will be rapid.
5. CONCLUSIONS
Once again the results of this research showed the limi-
tation of shoulder ROM in athletes. On the basis of this
study and other investigations, it could be suggested that
the specific demands, poor training, particularly lack of
adequate flexibility exercises and inadequate warm-up
exercises for shoulder, may be responsible for such
problems. Exercising muscles without an appropriate
stretching exercise program tends to decrease the motion
in shoulder joints.
Very importantly, the overall (contact or non-contact
sports), hard and stressful competitions, over-training,
exhausting repeated movements, faulty techniques, pre-
vious injuries and probably anthropometric characteris-
tics of players can be also considered as other factors
involved in the limitation of shoulder flexibility. How-
ever, each factor will need more research.
Also, it can be recommended that more stretching ex-
ercises should be considered for older and experienced
players and specific stretching exercises are recom-
mended for different sports and playing posts. Based on
the demands of any sport, coaches and athletes should
apply corrective exercise programs to prevent muscular
imbalance in shoulder girdle.
Much more work is needed to study the exact implica-
tions of our findings. Several directions for future study
are raised by this study. Can these deficits be modified
and, if so, what is the most efficient method of modifica-
tion? If they are modified, what is the relationship be-
tween performance and risk of injury? Do these deficits
continue to decline in a linear direction, or is there a
curvilinear pattern with an absolute maximum? Were
these deficits compounded by variables such as the
amount of weight training exercises and previous child-
hood activities?

H. Daneshmandi et al. / J. Biomedical Science and Engineering 3 (2010) 811-815 815
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